BACKGROUND:
With impaired renal function, decreased glomerular filtration rate and accumulation and retention of various products of renal failure the oral cavity may shows a variety of changes as the body progresses through an azotemic to uremic state. In 90% of hemodialysis patient oral manifestation are evident which may be due to disease process or as a result of treatment. Studies have been conducted regarding colonization of yeast in hemodialysis patients. However there is a gap in the knowledge regarding assessment of Candida subspecies and its correlation with oral lesions in hemodialysis patient which aid in prophylactic treatment. Prevalence of Candidiasis, Uremic Stomatitis, Uremic frost and colonization of Candida Subspecies will open eyes in this new research.
AIM OF THE STUDY:
1. To assess the presence of candidiasis, uremic stomatitis, and uremic frost in patients undergoing hemodialysis.
2. To assess the presence of various subspecies of Candida in patients with chronic renal disease undergoing hemodialysis
MATERIALS & METHODS:
A comparative cross-sectional study to determine the presence of Candidiasis, Uremic Stomatitis, and Uremic frost and various subspecies of Candida in patients undergoing hemodialysis was carried out in the outpatient department and the study sample consisted of 50 chronic renal failure patients. The oral health status was assessed clinically for each patient and recorded. The data was analysed by Statistical Package for Social Sciences (SPSS 16.0). Chi square test was applied to find the statistical significance between the groups.
RESULTS:
The analysis demonstrated significant association between colonization by yeasts and patient’s age (P = 0.04), chief complaint (P = 0.004), duration of the diseases (P = 0.03), duration of dialysis treatment (P = 0.03) and oral hygiene status (P = 0.03). However, no significant association was observed with gender.
The percentage of patients affected by the disease was found to be higher between the age group of 40 -60 years of age and the analysis demonstrated that the results in relation to the presence of oral lesion and age changed and were no longer significant for the presence of yeasts. Common dental problems associated with these patients are periodontitis and dental caries. Despite optimal dialysis, oral disease may be increased in these patients treated due to their lower uptake of public dental services, as well as increased malnutrition and inflammation.
Nevertheless, chronic kidney disease patients undergoing hemodialysis treatment were more likely to carry yeasts and its prevalence is higher when lesions were present in the oral cavity. But our results demonstrated only 18 (36%) patients with CKD undergoing HT were colonized by yeasts, from which a total of 2 subspecies were only isolated and identified, all belonging to the genus Candida with the predominance of C. albicans (22%).
Clinical assessment detected more than one type of lesion in one of the 18 patients with CKD undergoing HT with oral lesions. Candidiasis (acute pseudomembranous candidiasis, chronic atrophic candidiasis or angular cheilitis) was confirmed in 17 (34%) of the 18 lesions suggestive of the disease. Among the remaining lesion found, the diagnosis suggested uremic stomatits. Uremic frost was not reported in any patients.
The only type of lesion to show positive association with the presence of yeasts was chronic erythematosus candidiasis, which is the kind of lesion typically resulting from the use of dental prosthesis.
CONCLUSION:
It is concluded that the oral cavity can reveal signs of undiagnosed renal failure, hence oral health care providers must be well aware of signs and symptoms to refer such patients to a physician for further investigation as well as manage and treat the oral health complications
