Prevalence of Dental Caries in Patients on Renal Replacement Therapy—A Systematic Review

Abstract

Patients under renal replacement therapy (RRT) often show oral problems, including dry mouth, periodontal and dental diseases. This systematic review aimed to evaluate the caries burden in patients on RRT. Therefore, a systematic literature search based on the databases PubMed, Web of Science and Scopus was performed by two independent individuals in August 2022. Search terms were: “caries” AND “dialysis”, “caries” AND “renal replacement therapy”, “caries” AND “kidney”. The systematic process was complemented by manual search. Studies on adult patients (age ≥ 18 years), treated by any form of RRT and explicitly reporting caries prevalence or incidence were checked for their eligibility and subsequently analyzed qualitatively. For all included studies, a quality appraisal was applied. From the systematic search, 653 studies were identified, of which 33 clinical investigations were included in the qualitative analysis. The majority (31 studies) of all included patients underwent hemodialysis (HD), with a sample size between 28 and 512 participants. Eleven studies investigated a healthy control group. Oral examinations were heterogeneous across studies; the caries burden was primarily assessed by decayed-(D-T), missing- and filled-teeth index (DMF-T). The number of decayed teeth ranged between 0.7 and 3.87 across studies. Only six out of these 11 studies found significant differences in caries prevalence/incidence between RRT and controls, whereby only four studies confirmed worse caries burden in RRT individuals. No information was provided on caries stadium (initial caries, advanced caries, invasive treatment need), caries activity or location (e.g., root caries) across studies. Most of the included studies were assessed to be of moderate quality. In conclusion, patients on RRT suffer from a high prevalence of dental caries. Alongside a need for further research in the field, improved, multidisciplinary, patient-centered dental care concepts are required to support dental and overall oral health in individuals on RRT.

Dental Caries in Adult Patients with Rheumatoid Arthritis—A Systematic Review

“…While for a definitive confirmation of the hypothesis of this review, a control group would be needed, it was decided to include studies without a control group to increase the number of included studies and, thus, the ability to draw conclusions. This was performed similarly to previous studies [ 40 , 47 ]. Most studies showed a moderate quality ( Table 4 ).…”

“…However, this index does not include any information on the caries localization (crown or root) or the caries stadium (initial lesion, large lesion affecting the pulp chamber, etc.). As described previously in a systematic review on dental caries in patients with renal replacement therapy, improved caries diagnostics should be applied in such cohorts of at-risk patients, for example, by using extended clinical or adjunctive diagnostics [ 40 ]. Additionally, the heterogeneity and quality of the studies, which was moderate in most cases, underline the need for improvements in the research on dental caries in RA patients.…”

Oral manifestations in different stages of chronic kidney disease

“…In the recent literature, missing teeth and dental caries have a high incidence in CKD in dialysis treatment, patients under HD were found to have a high prevalence of dental caries, like we found in our study the mean values on HD group (0.56 ± 0.83) when compared with PD (0.37 ± 0.98) and P-D (0.26 ± 0.60) groups. This may be a consequence of poor oral hygiene, carbohydrate intake, alteration on the composition of the saliva and is pH, the higher risk of infection in CKH patients, the alteration of the oral micro ora (73,74).…”