Al-Nowaiser, Abeer; (2001) The oral health and oral microflora of children with chronic renal failure and children undergoing renal transplantation. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Objectives: To investigate the oral health and oral microflora of children with chronic renal failure (CRF) and children undergoing renal transplantation (RT). Patients and Method: Seventy children with CRF (study 1), 25 with CRF (study 2), and 24 children undergoing renal transplantation (study 3), were recruited from The Great Ormond Street Hospital For Children. They were matched for age, gender, ethnicity and socio-economic class with healthy children recruited from the Paediatric Dental Trauma Clinic at The Eastman Dental Hospital and from Camden and Islington Community Health Services NHS Trust. Indices were recorded for dental caries, dental plaque, gingival inflammation, gingival enlargement and developmental enamel defects from all subjects and controls at the beginning of the study (baseline). These were repeated for the RT children 2 days and 90 days post transplantation. Whole stimulated saliva was collected from the 25 children with CRF for estimation of calcium and urea levels and buffering capacity. The oral flora was sampled for streptococci, enterococci. Enterobacteriaceae, Lactobacilli and Candida species using alginate swabs from the 25 children with CRF and the 24 RT children at baseline. This was repeated for children with RT 2 days and 90 days post - transplantation. Main Results: A significantly greater proportion of the children with CRF were caries-free (Chi-square 18.8, df 1,p = 0.0001). In the CRF group there was a significantly lower dmfs (p = 0.0001) and DMFS (p = 0.004) and a significantly greater plaque score for both the primary teeth (p = 0.04) and permanent teeth (p = 0.05). There were a significantly greater number of children with CRF who had gingival enlargement (p = 0.02) associated with the permanent teeth. There was a significantly greater enamel defect score in the permanent teeth of the CRF group compared to the controls (p = 0.002). There was a significantly greater proportion of S. parasanguis as a percentage of both the total anaerobic count (p = 0.04) and the total streptococcal count (p = 0.02) in the children with CRF. There was a significantly greater total streptococcal count as a percentage of the total anaerobic count in the CRF group (p = 0.05). The S. mitis and S. parasanguis counts were significantly greater in the CRF group (p = 0.02 and p = 0.02, respectively). There were a significantly lower Candida species and S. mutans counts in the children with CRF (p = 0.0001 and p = 0.03, respectively). The children with CRF had significantly greater buffering capacity (p = 0.001) and salivary urea levels (p = 0.0001). In the RT group the proportion of S. salivarius as a percentage of the total streptococcal count increased significantly 90 days post transplantation when compared with baseline (p = 0.005). The number of S. mutans was significantly lower in the RT group compared with the controls at baseline and 90 days later (p = 0.0001 and p = 0.02, respectively). The number of lactobacilli was significantly lower in the RT group compared with the controls at baseline and 90 days later (p = 0.004 and p - 0.05, respectively). The number of Candida species was significantly less in the RT children compared with the controls at baseline (p = 0.004). At the final visit, the RT children had a significantly lower proportion of S. parasanguis as a percentage of both the total streptococcal count and the total anaerobic count (p = 0.02 and p = 0.05, respectively) compared with the controls. Conclusion: The children with CRF and RT children had relatively stable oral health and significantly less caries experience and S. mutans counts than the matched controls. The oral streptococcal flora of the RT children was relatively stable over the transplant period except for S. salivarius.

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