PREVALENCE OF RADIOLOGICAL CHANGES OF TEETH & JAW BONES IN ENDSTAGE RENAL DISEASE/prosthodontic courses

PREVALENCE OF RADIOLOGICALPREVALENCE OF RADIOLOGICAL
CHANGES OF TEETH & JAW BONESCHANGES OF TEETH & JAW BONES
IN ENDSTAGE RENAL DISEASEIN ENDSTAGE RENAL DISEASE
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INDIAN DENTAL ACADEMY
Leader in continuing Dental Education

INTRODUCTIONINTRODUCTION
• DrugsDrugs
• Removes toxic substancesRemoves toxic substances
• pH, Blood pressurepH, Blood pressure
• Regulates erythropoiesisRegulates erythropoiesis
• Metabolises vitamin DMetabolises vitamin D

End StageEnd Stage
Renal DiseaseRenal Disease

RENAL OSTEODYSTROPHYRENAL OSTEODYSTROPHY
DefinitionDefinition
A bone disease that occurs when theA bone disease that occurs when the
kidneys fail to maintain the proper levelskidneys fail to maintain the proper levels
of calcium and phosphorus in the blood.of calcium and phosphorus in the blood.
Jr of Med. No. 10, 781-785,Jr of Med. No. 10, 781-785,
19871987

VITAMIN D, Ca+, PHOSPHATE &VITAMIN D, Ca+, PHOSPHATE &
HYPERPARATHYROIDISMHYPERPARATHYROIDISM
Kidney diseaseKidney disease
Active formActive form Vitamin DVitamin D
Ca+ absorptionCa+ absorption
HypocalcemiaHypocalcemia
Excretion of phosphatesExcretion of phosphates
CompensatoryCompensatory hyperparathyroidismhyperparathyroidism
Skeletal changesSkeletal changes
Renal osteodystrophy-Renal osteodystrophy- osteomalacia, osteoporosis,osteomalacia, osteoporosis,
osteosclerosisosteosclerosis ,, osteitis fibrosa cysticaosteitis fibrosa cystica

ORAL MANIFESTATIONSORAL MANIFESTATIONS
SOFT TISSUESOFT TISSUE
Uremic stomatitisUremic stomatitis
Dry mouthDry mouth
Metallic tasteMetallic taste
Urea breathUrea breath
PetechiaePetechiae
EcchymosisEcchymosis
Erosive glossitisErosive glossitis
BleedingBleeding
Reduced salivary flowReduced salivary flow

HARD TISSUE CHANGESHARD TISSUE CHANGES
 Enamel hypoplasiaEnamel hypoplasia
 Low caries rateLow caries rate
 Dark brown stainsDark brown stains
 Tooth erosionTooth erosion
 MalocclusionMalocclusion
 Tooth mobilityTooth mobility

RADIOGRAPHIC CHANGESRADIOGRAPHIC CHANGES
 Bone demineralizationBone demineralization
 Loss of trabaeculationLoss of trabaeculation
 Loss of lamina duraLoss of lamina dura
 Ground glass appearanceGround glass appearance
 Pulpal calcificationPulpal calcification
 Brown tumorsBrown tumors

AIMS & OBJECTIVESAIMS & OBJECTIVES
 Prevalence of radiographic changesPrevalence of radiographic changes
 Correlating the serum calcium level withCorrelating the serum calcium level with
radiologic alterations.radiologic alterations.
 Oral manifestation can compliment the diagnosisOral manifestation can compliment the diagnosis
 Dental managementDental management

MATERIALS & METHODSMATERIALS & METHODS
Study groupStudy group
35 pts35 pts
Control groupControl group
20 pts20 pts

 Intra oral periapical radiographIntra oral periapical radiograph
 OPGOPG
 Biochemical investigationsBiochemical investigations
 Complete HaemogramComplete Haemogram

METHODOLOGYMETHODOLOGY
 Subjects examined under artificialSubjects examined under artificial
illumination.illumination.
 IOPAIOPA
11 12 21 22, 15 16 17, 25 26 2711 12 21 22, 15 16 17, 25 26 27
31 32 41 42, 35 36 37, 45 46 4731 32 41 42, 35 36 37, 45 46 47
(Bisecting angle technique)(Bisecting angle technique)

 Grading of radiographsGrading of radiographs
Pulpal calcificationPulpal calcification
0 – no calcification0 – no calcification
1 – calcification up to 1/3 – 2/3 of pulp chamber/1 – calcification up to 1/3 – 2/3 of pulp chamber/
radicular portionradicular portion
2 – more than 2/3 pulp chamber2 – more than 2/3 pulp chamber
3 – complete pulp calcification3 – complete pulp calcification

 Lamina duraLamina dura
0 – normal0 – normal
1 – localized loss about 1/3 of tooth1 – localized loss about 1/3 of tooth
2 – loss of laminadura from 1/3 to 2/3 of tooth2 – loss of laminadura from 1/3 to 2/3 of tooth
3 – portions of laminadura thickened, milder degree3 – portions of laminadura thickened, milder degree
4 – entire laminadura thickened4 – entire laminadura thickened
 Trabecular patternTrabecular pattern
1 – delicate finely meshed trabeculations1 – delicate finely meshed trabeculations
2 – granular, nearly homogenous patterns, individual2 – granular, nearly homogenous patterns, individual
trabeculations absenttrabeculations absent
3 – some coarser trabeculae, milder degree3 – some coarser trabeculae, milder degree
4 – all trabecular are coarser4 – all trabecular are coarser

 Overall densityOverall density
1 – mild to moderate decrease in radiographic density1 – mild to moderate decrease in radiographic density
2 – severe decrease in density2 – severe decrease in density
3 – mild to moderate increase in radiographic density3 – mild to moderate increase in radiographic density
4 – severe increase in density4 – severe increase in density
The data obtained was entered in the PerformaThe data obtained was entered in the Performa
 OPG – radiolucent / radiopaque lesions not associated withOPG – radiolucent / radiopaque lesions not associated with
apices of teeth as well as pathologic fractures,apices of teeth as well as pathologic fractures,
thinning & loss of cortical borders of max. sinus, mand. canalthinning & loss of cortical borders of max. sinus, mand. canal
& angle of mandible& angle of mandible
 Rest other laboratory investigations were done.Rest other laboratory investigations were done.

RESULTSRESULTS
&&
OBSERVATIONSOBSERVATIONS

BIOCHEMICAL INVESTIGATION
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HAEMATOLOGICAL INVESTIGATIONSHAEMATOLOGICAL INVESTIGATIONS
InvestigationInvestigation Mean valuesMean values
Experimental GroupExperimental Group
Hb% (gm%)Hb% (gm%) 10.8210.82
ESR (mm/hr)ESR (mm/hr) 70.670.6
RBC count (mill cell/mm3)RBC count (mill cell/mm3) 4.84.8
Total count (cells/mm3)Total count (cells/mm3) 76547654
N,L,E,M,B (%)N,L,E,M,B (%) 65, 34, 2, 1, 065, 34, 2, 1, 0
Platelet count (lakhPlatelet count (lakh
cells/mm3)cells/mm3)
1, 99, 4851, 99, 485
BT (min sec)BT (min sec) 3 min 08 sec3 min 08 sec
CT (min sec)CT (min sec) 4 min 28 sec4 min 28 secwww.indiandentalacademy.comwww.indiandentalacademy.com

Pulpal Calcification

Pulpal calcification

THINNING ORLOSS OF LAMINA DURA

OPG FINDINGS

SERUM CALCIUM LEVELS INSERUM CALCIUM LEVELS IN
RELATION WITH RADIOGRAPHICRELATION WITH RADIOGRAPHIC
FINDINGSFINDINGS
RadiographicRadiographic
findingsfindings
No. ofNo. of
subjectssubjects
SerumSerum
calciumcalcium
(mean +(mean +
sd)sd)
‘‘t’ valuet’ value SignificanceSignificance
PulpalPulpal
calcificationcalcification PresentPresent
AbsentAbsent
2020
1515
9.07 + 0.809.07 + 0.80
9.63 + 0.869.63 + 0.86
1.631.63 NSNS
Partial loss ofPartial loss of
lamina duralamina dura PresentPresent
AbsentAbsent
2626
99
9.25 + 0.839.25 + 0.83
9.07 + 0.859.07 + 0.85
0.560.56 NSNS
Delicate finelyDelicate finely
meshedmeshed
trabeculartrabecular
patternpattern
PresentPresent
AbsentAbsent
1515
2020
8.89 + 0.758.89 + 0.75
9.40 + 0.839.40 + 0.83
1.871.87 NSNS

DISCUSSIONDISCUSSION

STUDIES FAVOURINGSTUDIES FAVOURING
 HUTTON C.E (1985)HUTTON C.E (1985)
 KELLY W.H (1980)KELLY W.H (1980)
 CLARK B.D (1987)CLARK B.D (1987)
localized
bone changes
facial bones &
Mandible

 BUNBUN ElevatedElevated (Maxwell 1985)(Maxwell 1985)
 Serum CreatinineSerum Creatinine ElevatedElevated (Katz and Maxwell(Katz and Maxwell
1985)1985)
 Serum ALPSerum ALP ElevatedElevated (Katz 1969 & kelly 1980 )(Katz 1969 & kelly 1980 )

 Serum CalciumSerum Calcium (Katz et al 1969 & Kelly 1980)(Katz et al 1969 & Kelly 1980)
 Serum ProteinSerum Protein (Maxwell 1985)(Maxwell 1985)
 Hb%, ESR, RBC count & TLCHb%, ESR, RBC count & TLC (Levison & Fernandez(Levison & Fernandez
1990)1990)
 Platelet count, BT & CTPlatelet count, BT & CT (Sarah 1986)(Sarah 1986)

VARIATIONVARIATION
 Pulpal calcification, Lamina dura (Kelly):Pulpal calcification, Lamina dura (Kelly): Only dialysis subjectsOnly dialysis subjects
& of longer duration 60 months& of longer duration 60 months
 Our study-Our study- dialysis & transplantation subjects- duration 26dialysis & transplantation subjects- duration 26
monthsmonths

CONCLUSIONCONCLUSION

PREVALENCE OF RADIOLOGICAL CHANGES OF TEETH & JAW BONES IN ENDSTAGE RENAL DISEASE/prosthodontic courses

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PREVALENCE OF RADIOLOGICAL CHANGES OF TEETH & JAW BONES IN ENDSTAGE RENAL DISEASE/prosthodontic courses