Uremia affects all parts of the immune system. Since hemodialysis patients travel to the dialysis center three times per week and are surrounded by many other patients and staffs, these could predispose them to a greater risk of coronavirus disease of 2019 (COVID-19) infection. Mortality associated with COVID-19 infection is high in patients receiving dialysis. Currently, the World Health Organization has approved six types of vaccines (ChAdOx1-S, Ad26.COV2.S, BNT162b2, mRNA-1273, BBIBP-CorV and CoronaVac) for COVID-19. Literature data regarding the response rate towards COVID-19 vaccination in dialysis patients is inconclusive. The published response rates varied from 29.6 to 96.0%. The variable response rates across these clinical trials may be explained by different vaccine types, vaccine doses, criteria for positive immune response, timings of antibody detection, races and ethnicities. Side effects of COVID-19 vaccination comprise of pain at injection site, fatigue, myalgia, headache, low fever, syncope, pericarditis, etc. Clinical predictors of positive response towards COVID-19 vaccination include age, previous infection, immunosuppressive therapy, body mass index and serum albumin level. No one is safe until everyone is safe. Therefore, vaccination against COVID-19 infection in dialysis patients is an urgent issue of worldwide concern.

Background. Previous studies have shown that environmental cadmium exposure could disrupt salivary gland function and is associated with dental caries and reduced bone density. Therefore, this cross-sectional study attempted to determine whether tooth decay with tooth loss following cadmium exposure is associated with some dental or skeletal traits such as malocclusions, sagittal skeletal pattern, and tooth decay. Methods. Between August 2019 and June 2020, 60 orthodontic patients with no history of previous orthodontics, functional appliances, or surgical treatment were examined. The patients were stratified into two groups according to their urine cadmium concentrations: high (>1.06 µg/g creatinine, n = 28) or low (<1.06 µg/g creatinine, n = 32). Results. The patients were 25.07 ± 4.33 years old, and most were female (female/male: 51/9 or 85%). The skeletal relationship was mainly Class I (48.3%), followed by Class II (35.0%) and Class III (16.7%). Class I molar relationships were found in 46.7% of these patients, Class II molar relationships were found in 15%, and Class III molar relationships were found in 38.3%. The mean decayed, missing, and filled surface (DMFS) score was 8.05 ± 5.54, including 2.03 ± 3.11 for the decayed index, 0.58 ± 1.17 for the missing index, and 5.52 ± 3.92 for the filled index. The mean index of complexity outcome and need (ICON) score was 53.35 ± 9.01. The facial patterns of these patients were within the average low margin (26.65 ± 5.53 for Frankfort–mandibular plane angle (FMA)). There were no significant differences in the above-mentioned dental indices between patients with high urine cadmium concentrations and those with low urine cadmium concentrations. Patients were further stratified into low (<27, n = 34), average (27–34, n = 23), and high (>34, n = 3) FMA groups. There were no statistically significant differences in the urine cadmium concentration among the three groups. Nevertheless, a marginally significant p-value of 0.05 for urine cadmium concentration was noted between patients with low FMA and patients with high FMA. Conclusion. This analysis found no association between environmental cadmium exposure and dental indices in our orthodontic patients.

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