Gingivitis Control in Children, Adolescents and Young Adults With Chronic Kidney Disease by a Need-Related Programme: A Randomised Clinical Trial

Abstract

Objectives: Children and young patients with chronic kidney disease (CKD) are at persistent risk of gingivitis despite usual preventive measures. This clinical study aimed to determine the efficacy of an intensive oral preventive programme (OPP) for young patients with CKD in treating plaque-induced gingivitis modified by systemic factors.

Methods: Young patients with CKD (N = 30) were recruited/randomised to a need-related OPP (n = 15) or treatment as usual (TAU) including mainly motivation and instructions (controls, n = 15) followed by a single intensive prophylactic appointment after 3 months. For the OPP group, depending on the baseline degree of inflammation (PBI) professional mechanical plaque removal, local chlorhexidine gel application and mouth rinse were applied at need-related appointments focussing on local plaque control and reduction in inflammation.

Results: After 3 months OPP, lower plaque indices were found (2.62-0.66, p < 0.05) in contrast to TAU (2.32-2.05, p > 0.05) with differences between study groups (p < 0.05). Regarding gingivitis, lower PBI values than baseline were observed in OPP (1.03-0.05, p < 0.05) than TAU (1.15-1.00; p > 0.05); OPP reductions (effect size) were higher than after a single intensive appointment (1.00-0.36; p < 0.05). Degree of immunosuppressive therapy did not differ between groups throughout the study.

Conclusions: Young patients with CKD suffer from generalised gingivitis with increased bleeding sites. This moderate degree of inflammation shows a normal distribution of high and low plaque responders, with no pattern of impact for the degree of immunosuppression. Effectiveness and duration of preventive measures follow a dose-response principle. Therefore, need-related preventive measures should be implemented and maintained in future regular care for CKD patients.

Trial registration: German Clinical Trials Register, registration number: DRKS00010580.

Keywords: adolescent; child; chronic; dental prophylaxis; gingivitis; renal insufficiency; young adults.

FIGURE 1

Overview of the study design (CONSORT diagram) and assessment of the dental care of the need‐related oral prophylaxis programme (OPP) and the statutory health insurance services of the treatment as usual (TAU) group.

FIGURE 2

Scatterplot showing the correlation of plaque amount and inflammation scores (p = 0.002) for all included study patients (both the test and control group). Therefore, the amount of gingival inflammation can be near‐completely explained with local plaque amounts not only in systemically healthy patients but also in chronic kidney disease (CKD) patients. OPP, oral preventive programme; PBI, papilla bleeding index; QHI, Quigley–Hein plaque index; TAU, treatment as usual.

FIGURE 3

Degree of gingival inflammation (papilla bleeding index [PBI], means) decreases due to dental prophylaxis in the oral preventive programme (OPP) and the treatment as usual (TAU) groups. The effectiveness depends on the intensity of the OPP. Baseline local inflammation differs slightly in both groups (p > 0.05). In the test group (OPP), a steeper reduction to a lower value is observed in comparison with smaller improvements in the TAU group patients after a single appointment (p < 0.05). The dotted line demonstrates the higher effectiveness of an intensive versus a standard preventive programme in the TAU group. Without preventive measures, higher plaque values lead to a recurrence of gingivitis after another 3 months in the OPP group patients.