Relation between severity and distribution of periodontal inflammatory diseases and chronic urinary tract infections at child s age

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1 Relation between severity and distribution of periodontal inflammatory diseases and chronic urinary tract infections at child s age Targova-Dimitrova T. Department of Periodontology and Dental Implantology Faculty of Dental Medicine d_r_targova.t@abv.bg S. Angelova Department of Pediatric Dentistry Faculty of Dental Medicine dsirma_angelova@abv.bg D. Bliznakova Department of Clinical Medical Sciences Educational-Scientific Sector of Pediatrics and Infectious Diseases bliznakova.varna@gmail.com S. Peev Department of Periodontology and Dental Implantology; Faculty of Dental Medicine stefan.peev@mail.bg Abstract: Periodontal inflammatory diseases at child s age are often registered and diagnosed. A large number of predisposing factors such as poor oral hygiene, social-economic status, educational patterns are related with these clinical findings. According to literature co-relations between inflammatory diseases of periodontium and recurring urinary tract infections have already been established. In this study are involved totally 72 children, 30 of them with no systemic diseases and 42 children suffering from recurring urinary tract infections. During the investigation was emphasized on relation between distribution and severity by these groups of disorders. A predisposition for early initiation of inflammatory periodontal processes concerning children with recurring urinary tract infections has been ascertained. Key words: periodontal; urinary; infections; childhood; I. INTRODUCTION Nowadays periodontal inflammatory diseases are widely spread at child s age. Poor oral hygiene, social-economic and educational status of family members are playing essential role of predisposing factors according to plenty of studies [1]. A significant part of systemic diseases afflicting the organism have their onset characterized by explicit clinical manifestation at early child s age [2], [3]. Co-relation between periodontal and recurring urinary tract infections at childhood has already received scientifically-based confirmation [4], [5]. In our research strong emphasis is put on severity and distribution of these inflammatory processes. II. AIM AND TASKS The purpose of this screening study is registration of deviations of indexes representing oral-hygiene and gingival status, clinical attachment level, level of gingival margin, pocket probing depth by dentitions of children of age below 18, healthy and suffering from recurrent infections of urinary tract. Also, we are investigating the criteria of severity and distribution of periodontal inflammatory diseases by the means of proceeding examinations. 22

2 As main tasks of this paper are outlined: Investigation of deviations in the Hygiene Index /HI/ by children of the determined groups. Registration of obtained data into a periodontal chart and table. Records of degree of severity and extent of distribution of gingival inflammation. Records and description of periodontal status into the periodontal chart, followed by comparison of results concerning both of the examined groups of children. Recommendations and instructions addressed to doctors providing treatment and also to parents in conditions of deviations from the definite norm, as well as advices for taking regular optimal prophylactic cares. III. MATERIALS AND METHODS The object of this study are children below the age of 18, 30 of them without systemic diseases and 42- suffering from recurring urinary tract infections [6], [7]. We have defined the criteria of investigation as: gender, age, type of dentition-primary, mixed and permanent, oral hygiene level, recorded by the plaque index- PI by O`Leary, gingival status by the means of BoP /bleeding on probing/ and PBI /papilla bleeding index/, number of intact teeth, number of treated teeth, number of teeth liable to treatment; registration of severity and distribution of inflammation processes, clinical attachment level, pocket probing depth, level of gingival margin, others [8], [9]. Validation of results: Assessment of the child s periodontal health status based on several methods: 1. Affirmation of recurrent infections of urinary tract by hospitalized children, following the protocol of appropriate diagnostic procedures [10]. 2. Inspection of oral mucosa aim to establish or disprove the presence of lesions and orthodontic abnormalities; records of position of attachment of frenulum of upper and lower lips and gingival-buccal junctions [11]. 3. Registration of the index of PI by O`Leary without coloration, by scraping away the accumulated plaque using a periodontal probe of UNC 15 and recording data into the periodontal chart; calculation of the per-cent of distribution of dental plaque [12]. 4. By the means of a periodontal probe of UNC 15, applied during the whole examination, is marked out also presence or absence of bleeding by probing. Again results are recorded into the periodontal chart. Afterwards we calculate the per-cent of distribution of gingival pockets activity. 5. The index of PBI is registered making sweeping-out movements with the periodontal probe on representative teeth surfaces, then marking the obtained values into a table. Determination of degree of severity and extent of distribution of inflammation according to calculation of per-cent expression of the ratio of sites with positive bleeding and mean value of recorded indexes. 6. Measurement of pocket probing depth with a periodontal probe and registration in the periodontal chart of six greatest values from all the tooth surfaces of each present tooth observing the rules of index registration. Calculation of a mean value for the whole dentition [13]. 7. Measurement of the level of gingival margin with a periodontal probe, followed by registration of attained values into the periodontal chart in mm, taking into consideration presence or absence of zones of recessions and hyperplasia. Calculation of mean values of records of the whole dentition. 8. Registration of clinical attachment level according to pocket probing depth and level of gingival margin; records of mean value for the whole dentition [14]. 23

3 The investigation is conducted by specialists at Periodontology, Pediatric Dentistry and dental assistant. Children without systemic diseases involved in the study are examined separated in classes, groups and individually. In conditions of proper illumination of oral cavity are performed as subsequent procedures inspection, registration of deviations and recording of obtained data. There have been examined 42 children suffering from recurring infections of urinary tract, hospitalized at First Clinics of Pediatrics, University Hospital St. Marina - Varna. Investigations have been conducted by the bed of patients. Established deviations are registered in the periodontal chart, and into history of illness paper are marked determined diagnosis and recommendations of adequate treatment [15]. After examination of dentition, oral cavity of each child is rinsed with mouth-rinsing solution, followed by instructions concerning improvement and optimization of personal oral hygiene. There are recommendations addressed to parents for proper prophylactic cares and dental treatment to be provided for their children [16]. Characteristics of examined groups: In the study are involved 72 children, separated into groups, respectively: Children without systemic diseases: 30 children Children suffering from recurring urinary tract infections: 42 children. Separation of examined children of pointed groups regarding type of dentition: with primary dentition: 18 with mixed dentition: 26 with permanent dentition: 28 IV. RESULTS AND DISCUSSION In the process of performed examinations in all the investigated groups have been established clinical signs of a slight degree of gingival inflammation. Concerning children of the first group, with primary dentition, these results have been marked out: PI /plaque index/: 69,63%; BoP: 0,34%; PBI: 3,04%. At children suffering from recurring urinary tract infections of the second group, with mixed dentition, have been recorded these indexes values: PI: 85,17%; BoP: 3,39%; PBI: 24,58%. At children of the third group, with mixed dentition, these figures have been affirmed, namely- PI: 69,44%; BoP: 3,50% and PBI: 22,64%. At children without systemic diseases, group 3, have been ascertained these values: PI: 86,69%; BoP: 16,36%; PBI: 45,79. And at children into group 2, respectively: PI: 96,13%; BoP: 35,57% and PBI: 61,22%. No positions of loss of clinical attachment and recessions have been registered. But, into the group of healthy children /without systemic diseases/ has been recorded the state of hyperplasia of gingival margin at the rate of 0,09. At 9 of the children with recurring urinary tract infection has been diagnosed generalized gingival inflammation. Moderate and severe forms of gingival inflammation have not been diagnosed into any of the examined groups. No data of periodontitis have been obtained during the investigation. Into all the inspected groups have been found no representatives with intact dentition /without decay lesions and/or filling/. Comparative investigation based on specific definite criteria-graphics (1), (2): Graph.1 Co-relation between the criteria of type of dentition /according to the age/ and periodontal and dental status by healthy children: % Healthy BoP PD PBIs Zb GM Gr. 3 Gr. 2 At children without common health problems, because of prevalence of groups 2 and 3 and greater number of teeth that are examined, the values of indexes PI and BoP are higher, related with ascertainment of symptoms of chronic persistent gingival inflammation. Another reason for established pathological findings is the significant 24

4 portion of untreated teeth Zb, serving as plaqueretentive factor and reservoir of infection into oral cavity. Graph.2 Co-relation between the criteria of type of dentition /according to the age/ and periodontal and dental status by children suffering from recurring urinary tract infections: % Children suffering from recurring UTI BoP PD PBIs Zb GM Gr. 3 Gr. 2 Gr. 1 UTI urinary tract infections; Gr.1 -primary dentition; Gr.2 - mixed dentition; Gr.3 -permanent dentition; HI -hygiene index; BoP -bleeding on probing; PBI% -papilla bleeding indexdistribution; PD -probing depth; /AL/CAL clinical attachment level; PBIs-papilla bleeding index-burden; GM -gingival margin; Zz -healthy teeth; Zb teeth with complicated or noncomplicated caries; Zl treated teeth Although there have been registered significant levels of dental plaque by examined children suffering from recurring urinary tract infections, indexes of gingival status do not emphasize on explicit reaction of bleeding from gingival tissues. At the same time, among examined patients were diagnosed such with generalized gingival inflammation. This regularity is based on anamnesis data for oftener, compared with healthy children, provided antibiotics treatment, which suppresses the inflammatory answer by gums. Among patients with recurring urinary tract infections, subject of procedures of assessment and diagnosis, has been prevailing the portion of these with primary dentition, which explains the smaller number of untreated teeth in the context of predominant group of children with mixed dentition. On the grounds of conducted examinations, including comparison, we take into consideration differences between values expression of investigated criteria by these groups of patients, seeking if received results are related with impact upon commented diseases and their severity of clinical manifestation by children with recurring urinary tract infections. V. CONCLUSION At the three of the investigated age groups distribution and severity of gingival inflammation is established to be of slight degree and localized. But, in the group of examined children with recurring urinary tract infections, in the context of lower values of the hygiene index, have been diagnosed 9 patients with generalized gingival inflammation, which figures out at 20.45% of all of them [17]. Taking into account the performed study and its results, we can conclude that by children with recurring urinary tract infections there is predisposition to early initiation of inflammatory periodontal disease. There is a necessity of a more profound and detailed investigation, directed to clarification of reasons. As main priorities have to be outlined in-time performed prophylactic cares and adequate, throughout treatment aiming protection of dentition healthy at later age, avoiding risks of recurrence [18]. REFERENCES [1] Frank A, Oski, MD, Principles and Practice of Pediatrics, USA, 1990 [2] Klegman, Stanton, St. Geme, Nelson Textbook of Pediatrics, 2011 [3] Hrair-George, O. Mesrobian, MD, MSc, Cynthia G. Pan, MD, Pediatric Clinics of North America. Recent Advances in Pediatric Urology and Nephrology, 2006 [4] Foster H., Fitzgerald J., Dental disease in children with chronic illness, Arch Dis Child 2005; 90: ; [5] Fisher A. M., Borgnakke S. W., Taylor W. G., Periodontal disease as a risk marker in coronary heart disease and chronic kidney disease, Curr Opin Nephrol Hypertens, November 2010; 19(6): ; [6] Alar H., Alar C. G., Carrero J. J., Stenvinkel P., Systemic consequences of poor oral health in chronic kidney disease patients, Clin J Am Soc Nephrol 6, 2011, ; [7] Wahid A, Chaudhry S, Ehsan A, Butt S, Khan AA, Bidirectional relationship between chronic kidney disease and periodontal disease, Pak J Med Sci 2013; 29(1): ; [8] Sobrado-Marinho J. S., Tomas-Carmona I., Loureiro A., Limeres-Posse J., Garcia-Caballero L., Diz-Dios P., Oral health status in patients with moderate-severe and terminal renal failure, Med Oral Patol Oral Cir Bucal 2007; 12:E ; [9] Seraj B., Ahmadi R., Ramezani N., Mashayekhi A., Ahmadi M., Oro-dental health status and salivary characteristics in children with chronic renal failure, Journal of Dentistry, Tehran University of Medical Sciences, Tehran, Iran (2011, Vol. 8, 3); [10] Bastos J. do A., Vilela E. M., Henrique M., Daibert P. de C., Fernandes F. M. C., Assessment of knowledge toward 25

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