Kreher Deborah, Ernst Bero Luke Vincent, Ziebolz Dirk, Haak Rainer, de Fallois Jonathan, Ebert Thomas, Schmalz Gerhard
Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany.
Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig, 04109 Leipzig, Germany.
J Clin Med. 2023 Feb 14;12(4):1507. doi: 10.3390/jcm12041507.
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.
接受肾脏替代治疗（RRT）的患者常出现口腔问题，包括口干、牙周病和牙病。本系统评价旨在评估接受RRT治疗患者的龋齿负担。因此，2022年8月由两名独立人员基于PubMed、科学网和Scopus数据库进行了系统的文献检索。检索词为：“龋齿”和“透析”、“龋齿”和“肾脏替代治疗”、“龋齿”和“肾脏”。通过手动检索对系统检索过程进行补充。对采用任何形式RRT治疗且明确报告龋齿患病率或发病率的成年患者（年龄≥18岁）的研究进行纳入资格检查，随后进行定性分析。对所有纳入研究进行质量评估。通过系统检索，共识别出653项研究，其中33项临床研究纳入定性分析。所有纳入患者中的大多数（31项研究）接受了血液透析（HD），样本量在28至512名参与者之间。11项研究调查了健康对照组。各研究的口腔检查方法不一；龋齿负担主要通过龋失补牙指数（DMF-T）进行评估。各研究中龋牙数量在0.7至3.87之间。在这11项研究中，只有6项发现RRT组与对照组在龋齿患病率/发病率方面存在显著差异，其中只有4项研究证实接受RRT治疗的个体龋齿负担更重。各研究均未提供关于龋病阶段（初期龋、进展性龋、侵入性治疗需求）、龋病活性或部位（如根龋）的信息。大多数纳入研究被评估为中等质量。总之，接受RRT治疗的患者龋齿患病率较高。除了该领域需要进一步研究外，还需要改进的、多学科的、以患者为中心的牙科护理理念，以支持接受RRT治疗个体的牙齿和整体口腔健康。
