La enfermedad periodontal se asocia con aumento de PCR en pacientes en hemodiálisis crónica
Resumen
Introducción: La enfermedad periodontal (EP), primera causa de pérdida dentaria en el adulto, comprende un conjunto de lesiones de etiología infecciosa que pueden causar inflamación crónica. Objetivo: Establecer el estado de salud oral, particularmente periodontal, en una población en hemodiálisis crónica (HDC). Material y métodos: Se trata de un estudio descriptivo de corte transversal en pacientes en HDC. El examen oral fue realizado por un profesional odontólogo en la unidad de diálisis, simultáneamente con la determinación de Proteína C Reactiva (PCR). Se tabularon datos demográficos, etiología diabética y no diabética, tabaquismo, índice de masa corporal, uso de eritropoyetina, cobertura de salud. Los pacientes se dividieron en con EP y sin EP. Resultados: Participaron 65 pacientes, 67,6% hombres, 13,8 % diabéticos, edad media 60,6+16.5, tiempo medio en HDC (en meses) 60,8+53.5. En 41 pacientes (63,1%) se diagnosticó EP, sólo 5 tuvieron un examen dental normal; presentaron caries 8 pacientes (12%), prótesis 12 (18,5%) (completa superior e inferior 5, completa superior o inferior 3, parciales 4), restos radiculares 19 (29,2%), ausencia de piezas o movilidad dentarias 9 (14%). El grupo con EP vs sin EP presentó PCR 13,6+12,8 vs 7,81+6,5 (valor normal <6mgr/dl), edad media 58,7+18 vs 63,9+13; tiempo en HDC 60,8+59 vs 57,3+47 respectivamente. Las diferencias fueron estadísticamente significativas sólo con respecto a la PCR (p=0,037). Conclusiones: La prevalencia de patología odontológica fue alta, con franco predominio de la EP. El grupo con EP tuvo significativamente mayor PCR, como marcador de inflamación. La EP es una causa prevenible y tratable de inflamación crónica que debería incluirse en la evaluación al ingreso a HDC.
Citas
Tonetti MS, Mombelli A. Early-onset periodontitis. Ann Periodontol. 1999;4(1):39-53.
Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol. 2001;72(9):1221-7.
Tonetti MS, Van Dyke TE. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol. 2013;40(Suppl. 14):S24–9.
Reyes L, Herrera D, Kozarov E, Roldán S, Progulske-Fox A. Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology. J Clin Periodontol. 2013;40 Suppl 14:S30-50.
Chen LP, Chiang CK, Chan CP, Hung KY, Huang CS. Does periodontitis reflect inflammation and malnutrition status in hemodialysis patients? Am J Kidney Dis. 2006;47(5):815-22.
Kadiroglu AK, Kadiroglu ET, Sit D, Dag A, Yilmaz ME. Periodontitis is an important and occult source of inflammation in hemodialysis patients. Blood Purif. 2006;24(4):400-4.
Oliver RC, Brown LJ, Löe H. Periodontal diseases in the United States population. J Periodontol. 1998;69(2):269-78.
Page RC. The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm. Ann Periodontol. 1998;3(1):108-20.
Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000;13(4):547-58.
Hujoel PP, White BA, García RI, Listgarten MA. The dentogingival epithelial surface area revisited. J Periodontal Res. 2001;36(1):48-55.
Haffajee AD, Socransky SS, Lindhe J, Kent RL, Okamoto H, Yoneyama T. Clinical risk indicators for periodontal attachment loss. J Clin Periodontol. 1991;18(2):117-25.
Craig RG, Boylan R, Yip J, Mijares D, Imam M, Socransky SS, et al. Serum IgG antibody response to periodontal pathogens in minority populations: relationship to periodontal disease status and progression. J Periodontal Res. 2002;37(2):132-46.
D’Aiuto F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflam matory markers. J Dent Res. 2004;83(2):156-60.
Mealey BL, Ocampo GL. Diabetes mellitus and periodontal disease. Periodontol. 2007;44:127-53.
Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16(1):329-34.
Teeuw WJ, Slot DE, Susanto H, Gerdes VE, Abbas F, D'Aiuto F, et al. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol. 2014;41(1):70-9.
Bastos JA, Diniz CG, Bastos MG, Vilela EM, Silva VL, Chaoubah A, et al. Identification of periodontal pathogens and severity of periodontitis in patients with and without chronic kidney disease. Arch Oral Biol. 2011;56(8):804-11.
Chen LP, Chiang CK, Peng YS, Hsu SP, Lin CY, Lai CF, et al. Relationship between periodontal disease and mortality in patients treated with maintenance hemodialysis. Am J Kidney Dis. 2011;57(2):276-82.
Kshirsagar AV, Craig RG, Moss KL, Beck JD, Offenbacher S, Kotanko P, ET AL. Periodontal disease adversely affects the survival of patients with end-stage renal disease. Kidney Int. 2009;75(7):746-51.
Akar H, Akar GC, Carrero JJ, Stenvinkel P, Lindholm B. Systemic consequences of poor oral health in chronic kidney disease patients.
Clin J Am Soc Nephrol. 2011;6(1):218-26.
Davidovich E, Davidovits M, Eidelman E, Schwarz Z, Bimstein E. Pathophysilogy, therapy, and oral implications of renal failure in children and adolescents: an update . Pediatr Dent. 2005;27(2):98-106.
Proctor R, Kumar N, Stein A, Moles D, Porter S. Oral and dental aspects of chronic renal failure. J Dent Res. 2005;84(3):199-208.
Craig RG. Interactions between chronic renal disease and periodontal disease. Oral Dis. 2008;14(1):1-7.
Borawski J, Wilczynska-Borawska M, Stokowska W, Mysliwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant. 2007;22(2):457-64.
Buhlin K, Bárány P, Heimbürger O, Stenvinkel P, Gustafsson A. Oral health and pro-inflammatory status in end-stage renal disease patients. Oral Health Prev Dent. 2007;5(3):235-44.
Grubbs V, Plantinga LC, Crews DC, Bibbins-Domingo K, Saran R, Heung M, et al. Vulnerable populations and the association between periodontal and chronic kidney disease. Clin J Am Soc Nephrol. 2011;6(4):711-7.
Ruospo M, Palmer SC, Craig JC, Gentile G, Johnson DW, Ford PJ, et al. Prevalence and severity of oral disease in adults with chronic kidney disease: a systematic review of observational studies. Nephrol Dial Transplant. 2014;29(2):364-75.
Siribamrungwong M, Yothasamutr K, Puangpanngam K. Periodontal treatment reduces chronic systemic inflammation in peritoneal dialysis patients. Ther Apher Dial. 2014;18(3):305-8.
D'Aiuto F, Nibali L, Parkar M, Suvan J, Tonetti MS. Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol. J Dent Res. 2005;84(3):269-73.
Yazdi FK, Karimi N, Rasouli M, Roozbeh J. Effect of nonsurgical periodontal treatment on C-reactive protein levels in maintenance hemodialysis patients. Ren Fail. 2013;35(5):711-7.
Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007;356(9):911-20.
Strippoli GFM, Palmer SC, Ruospo M, Natale P, Saglimbene V, Craig JC, et al. Oral disease in adults treated with hemodialysis: prevalence, predictors, and association with mortality and adverse cardiovascular events: the rationale and design of the ORAL Diseases in hemodialysis (ORAL-D) study, a prospective, multinational, longitudinal, observational, cohort study. BMC Nephrol. 2013;14:90.
Chen LP, Chiang CK, Peng YS, Hsu SP, Lin CY, Lai CF, et al. Relationship between periodontal disease and mortality in patients treated with maintenance hemodialysis. Am J Kidney Dis. 2011;57(2):276-82.
Siribamrungwong M, Puangpanngam K. Treatment of periodontal diseases reduces chronic systemic inflammation in maintenance hemodialysis patients. Ren Fail. 2012;34(2):171-5.
Vilela EM, Bastos JA, Fernandes N, Ferreira AP, Chaoubah A, Bastos MG. Treatment of chronic periodontitis decreases serum prohepcidin levels in patients with chronic kidney disease. Clinics (Sao Paulo). 2011;66(4):657-62.