How oral infections can influence chronic kidney disease – a review of the literature

A healthy mouth is necessary for optimal health and quality of life. However, oral health is often compromised in adults with chronic kidney disease (CKD). The aim of this review was to present the scientific foundations behind the connection between oral diseases and chronic kidney disease (CKD) in adults, discuss common oral conditions and their systemic effects, investigate biological pathways through which oral infections affect the body and provide guidelines for physicians/nephrologists. Prevalence of oral disease is increased in CKD, including periodontal disease, oral mucosal lesions, edentulousness, xerostomia, gingival overgrowth in immunosuppressed patients and potentially caries. There is moderate to strong evidence to support a negative impact of oral infections in CKD, particularly periodontal disease, with systemic inflammation, bacteraemia of oral origin, endothelial function and gut dysbiosis being potential pathways for this interaction. Poor oral health can be a hidden source of infection and has been associated with increased mortality in CKD patients. Elimination of potential foci for oral infections is crucial before renal transplantation. Frequent dental monitoring is crucial for these patients and should be part of a multidisciplinary approach to manage CKD, with special attention to end-stage kidney disease

An Overview of Systematic Reviews Related to Aspects of the Shortened Dental Arch and Its Variants in Adults.

N/AAim To conduct an overview of systematic reviews (SRs) related to aspects of the shortened dental arch (SDA) and its variants, and critically appraise the methodological quality of the included SRs using the AMSTAR checklist. Methods A comprehensive computerized search and hand-searching of reference lists were conducted for SRs related SDAs to identify publications from 2000-2016. All authors and a research assistant independently screened the results of the electronic searches using an eligibility form and extracted information using a specially designed pre-piloted data extraction form. An 11-question AMSTAR checklist was completed for each included SR. Disputes were resolved by discussion between all researchers and results collated and interpreted. Results For the period 2007-2016, the search yielded 9 SRs incorporating 228 related articles. The research questions for each SR differed but were related to SDAs, thus the included articles were similar across SRs. Characteristics such as aims/objectives, study outcomes and conclusions of the 9 included SRs were compared. The AMSTAR evaluation indicated that 5 out of 9 studies were of a high quality (used a rigorous methodology) and the remaining 4 were of medium quality. All 9 SRs provided designs and characteristics of included studies. None of the SRs assessed publication bias. Conclusion Seven out of the nine SRs drew positive conclusions regarding the SDA concept, finding it functionally sound although some suggested that more high quality primary studies are still needed. The AMSTAR calculation indicated that most included SRs had an acceptable methodological quality, emphasizing the reliability of their results.N/