Oral and dental health in children with chronic liver disease

SUMMARYAim: To evaluate the effects of chronic liver disease on oral and dental health in children that may require liver transplantation which is commonly accepted as treatment modality in recent years and provide better pre-transplant oral hygiene.Material and Method: Thirty-one patients (aged 3 to 18 years) who were followed with the diagnosis of chronic liver disease at Karadeniz Technical University, Deparment of Pediatric Gastroenterology, were enrolled to the study (Group 1). Seventeen patient who were followed with the diagnosis of chronic renal failure whom no-need dialaysis at Karadeniz Technical University, Deparment of Pediatric Nephrology (Group 2) and thirty-five healthy children (Group 3) were taken as control group. To all patiens and control groups questioned about tooth brushing and snacking habit, bottle feeding history and frequency of consuming milk and milk products. Patients demographic datas, age, sex, weights and heights; whether physical inspection findings as ascites, encepholopathy and icterus; laboratuary datas as complete blood count, calcium, phosphorus, alkaline phosphatase, 25 OH D vitamin, INR examinations; Child Pugh, pediatric end stage liver disease scores (PELD) and presence of cirrhosis was recorded. Dental caries, enamel hypoplasias, soft tissue lesions, malocclusions, colourations and absent teeth determined by oral examination. Periodontal structures was evaluted by scoring plaque index and gingival bleeding index. Patient salivary buffer capacity and salivary flow rate was calculated. In saliva SM and LB colonisation was evaluated. DMTF index was calculated. For evaluation of mandibular bone mass by using panoramic radiographs antegonial index was calculated. For statistical analysis we used ?student-t test?, ?Mann Whitney U test?, ?Chi-square ?, ?Pearson?, ?Spearman? tests and ?covaryans analysis?.Results: There was no statistically significant difference among chronic liver disease patients and control group comprising patients with chronic renal failure and control group comprising healthy individuals according to age and gender (p>0.05). The cumulative scores of the answers given by the patients and control group individuals to the questions addressed related with habits such as tooth-brushing, snacking, baby bottle feeding, consumption of dairy products were .5 ± 1.4, 7.5 ± 1.1 ve 7.4 ± 1 for Group 1, 2 and 3, respectively and there was no statistically significant difference among groups (p>0.05). Oral inspection revealed caries in 93.5%, 64.7%, 91.4%, enamel hypoplasia in 54.8%, 41.1%, 31.4%, missing tooth in 22.5%, 5.8%, 11.4% of group 1, 2, and 3, respectively. Malocclusion was observed in 3.2%, 11.7% of group 1 and 2 respectively, however not observed in group 3. Discoloration was observed in 9.6%, 5.8% of group 1 and 2, however it wasn?t observed in group 3. Number of patients with caries was statistically significantly greater in group 1 than in group 2 (p<0.05). Enamel hypoplasia was statistically significantly more frequent in group 1 than group 3 (p<0.05). There was no difference regarding plaque index and gingival index (p>0.05). Salivary buffer capacity of chronic renal failure patients was better than both the patients with chronic liver disease and healthy children (p<0.05). Salivary flow rate of the patients were 0.39 ± 0.1, 0.4 ± 0.11, 0.38 ± 0.09 in group 1, 2 and 3 respectively, without any statistically significant difference. There was no difference among groups regarding salivary flora (p>0.05). No difference could be found among groups regarding DMFT and dmft indexes (p>0.05). There were no difference among factors affecting DMFT index regarding chronic liver disease. Statistically significant difference could not be found both among groups and D vitamin lacking cases regarding antegonial index (p>0.05).Conclusion: Oral hygiene should be provided in children with chronic liver disease which is treated satisfactorily by liver transplantation in current medical practise, also pre-transplant patients should be evaluated in terms of oral and dental healthKey Words: Chronic liver disease, liver transplantation, oral and dental health.