# Oral Health Assessment in Adolescents with End-Stage Chronic Kidney Disease

## TL;DR

This study compares oral health in adolescents with and without end-stage kidney disease, finding worse oral hygiene and inflammation in those with kidney disease.

## Contribution

The study identifies specific oral health markers and dysbiosis in adolescents with end-stage chronic kidney disease using biomarker and microbiota analysis.

## Key findings

- Periodontal indices were significantly higher in adolescents with ESKD compared to healthy controls.
- Oral dysbiosis and periodontopathogenic bacteria were detected in ESKD adolescents.
- Biomarkers like IL-1β, TNF-α, and VEGF were elevated in saliva and GCF of ESKD adolescents.

## Abstract

Background/Objectives: End-stage chronic kidney disease (ESKD) represents a complex condition that also impacts oral health. This pilot study evaluates and compares some approaches to oral health assessment and aims to define the specific oral features common in adolescents with ESKD. Methods: A total of 50 children aged 12 to 17 years were examined, including 30 adolescents with ESKD (Group 1) and 20 adolescents without urinary pathology (Group 2). The decayed, missing, filled teeth (DMFT) index, oral hygiene index-simplified, papillary marginal attached index, and periodontal index were used for dental and periodontal assessment. The Milwaukee PH56 device was used to determine salivary pH. Oral microbiota was analyzed by chromatography–mass spectrometry and polymerase chain reaction detection of periodontopathogenic bacteria. Salivary and gingival crevicular fluid (GCF) biomarkers (IL-1β, TNF-α, IL-8, VEGF, sIgA) and total antioxidant capacity (TAC) were determined using an enzyme-linked immunosorbent assay. Results: DMFT did not differ between the groups. Periodontal indices in Group 1 were increased compared to Group 2 (p < 0.0001). Salivary pH in Group 1 was slightly alkaline; in Group 2, it was slightly acidic (p < 0.0001). Oral dysbiosis and periodontopathogenic bacteria were found in ESKD adolescents. Salivary IL-1β, TNF-α, VEGF, and IL-1β in GCF were elevated in Group 1 compared to Group 2 (p < 0.05). TNF-α, IL-8, and VEGF in GCF and TAC in both fluids were lower in Group 1 compared to Group 2 (p < 0.0001). Salivary IL-8 and sIgA in both saliva and GCF did not differ between the groups. Conclusions: ESKD adolescents had poor oral hygiene and significant oral dysbiosis including periodontopathogenic bacteria. Evaluation of biomarkers in saliva and GCF allowed us to vindicate inflammation, dysbiosis severity, and periodontal diseases.