The Effect Of Nonsurgical Periodontal Therapy With Adjunctive Use of Chlorhexidine On The Progression Of Patients With Chronic Kidney Disease Stage 3-5 Nondialysed

Bucco Dental Medicine, University of Yaounde 1
June, 2018


Background: Recent studies have shown a high prevalence of periodontitis in chronic kidney disease (CKD) patients. A bidirectional relationship between the two has been established. Inflammatory burden and periodontal pathogens were identified as the main periodontal factors affecting CKD. Factors predisposing to periodontal disease and accelerating its progression are widespread in chronic renal failure. They include: hyposalivation and xerostomia, impaired immunity and wound healing, alveolar bone destruction, malnutrition and a state of general disability impairing oral hygiene. It has been proven by many studies that treating the periodontal disease through nonsurgical therapy with adjunct antimicrobials like chlorhexidine because of its great spectrum of activity will improve the outcome of the CKD.
To evaluate the effect of nonsurgical periodontal therapy with adjunctive use of chlorhexidine on the progression of CKD stage 3-5 non-dialysed patients after three months as well as changes in the biological and periodontal parameters.

Material and Methods:
An opened label single arm non randomized clinical trial was carried out at the nephrology service of the Yaoundé General Hospital and dentql service qnd biochemistry laboratory of the Yaoundé University Teaching Hospital from January 2018 to May 2018. We included consenting subjects > 18years with stage 3-5 non-dialysed CKD having moderate to severe chronic periodontitis. Subjects needing antibiotherapy, having rheumatoid arthritis, pregnant and having < 14 teeth were excluded. They were treated by non-surgical therapy which consisted of deep cleaning of teeth surfaces, polishing and irrigation of pockets. Each subject was provided with 0.2% Chlorhexidine (CHX) as mouthrinse to be used twice daily for seven days. Appointments were given 6 weeks after treatment for assessment of disease recurrence and retreatment if need be. Periodontal parameters (Gingival bleeding index, plaque index, probing depth and Clinical attachment loss) and biological parameters (Creatinemia, C-reactive protein, spot Proteinuria) were assessed at baseline and at 3 months of therapy.

A total of 15 subjects were enrolled for the study. The studies had 11(73%) men and 4(27%)women, mean(SD) age was 63.33±9.Three months after therapy there was a significant reduction in all periodontal parameters with mean percentage drop of Plaque index(PI) from 49.11% to 37.57% with a mean change of11.53%(p=<0.001), probing dept(PI) reduced from 4.4mm to 2.6mm with a mean change after three months of 1.8mm(p=<0.001), clinical attachment loss(CAL) decreased from 3.63mm to 2.14mm with a mean change of 1.5mm(p=<0.001), gingival bleeding index(GBI) decreased from 54.16% to 3.28% with a mean change of 50.88%. C-reactive protein (CRP) levels dropped from 9.27mg/l to 5.70mg/l with a mean change of 3.56mg/l (p=0.004).There was a significant improvement in the eGFR from 21.02ml/min/1.72/m2 to 22.81 ml/min/1.72/m2 with a mean change of 1.78 ml/min/1.72/m2 (p=0.03). However, there was worsening of proteinuria from 1.3±1,25g/g to 2.72±1.86g/g with a mean change of 1.40±2.21g/g (p=0.02).

The nonsurgical periodontal therapy with adjunctive use of chlorhexidine resulted in significant benefits in the treatment of chronic periodontitis and biological parameters. This suggests that nonsurgical treatment with adjunctive use of CHX will be useful in the management of patients with stage 3-5 non-dialysed chronic kidney disease.