Effect of good dental care on oral inflammation, cytokines and chemokines levels in renal transplant patients: A randomized controlled study
Sonia Mehrotra1, Lokesh Sharma2, Raj Kumar Sharma1, Devina Pradhan3, Vamsi K Reddy2.
1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences , Lucknow, India; 2Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental & Medical Sciences, Lucknow, India; 3Department of Public Health Dentistry, Rama Dental College Hospital and Research Centre, Kanpur, India
Poor oral health results in inflammation and cytokine production in CKD and transplant patients. There is need to evaluate the benefit of good oral hygiene on renal transplant outcome. Pro-inflammation cytokines (TNF-A, ILB1, IL2, IL4), anti-inflammatory cytokines( IL6, IL10), chemokines (MCP1,2,3,4) , Adiponectin and CRP are markers of status of inflammation. A randomized controlled trial was carried out amongst CKD patients going for renal transplantation. The randomization was done in 100 CKD patients going for transplantation. All patients had dental and oral examination (Type III clinical examination as per American Dental Association specifications and WHO oral health proforma, 2013)
Group I (Interventional group) 50 CKD patients and Group II (Non-intervention group) - 50 patients of chronic kidney disease (CKD), going for transplantation were studied before and 3 months after transplantation. Group III (Control group) comprised of 50 healthy age, sex matched subjects. Intervention group did regular tooth brushing, use of dental floss along with use of mouth wash twice every day for 3 months after transplantation. They were given counselling sessions for good oral and dental care for a period of 3 months after transplant. Non-intervention group continued usual oral and dental care. Both groups had base line oral examination just before transplantation and at 3 months after transplant. The oral and dental findings specially the periodontitis score was compared between groups I and II and with the healthy controls. TNF-A, ILB1,IL2, IL4 IL6, IL10, MCP1,2,3,4, Adiponectin levels were measured on luminex platform (Bio-Plex Multiplex Immunoassay)and CRP (C- reactive protein) values were assayed(Latex Particle Immuno-turbidimetric mehtod) . These markers were assayed at baseline (before transplantation) and after 3 months.
Comparison between Interventional and non-interventional groups at baseline and at 3months showed that periodontitis score and CRP levels significantly came down at 3 months in intervention group, Adiponectin levels were significantly reduced in non-interventional group while there was no significantly change in adenopectin levels in interventional group. CRP is regulated by interleukin-6 (IL- 6), and tumor necrosis factor-α (TNF-α). IL6, IL10 MCP1,2 values increased significantly by intervention. Rise in levels of IL1B was less in intervention group as compared to non intervention group. TNF-α increased significantly in Non-intervention group after 3 months. There was no effect on IL2,IL4 values remain in both groups,
This is a report of results of a randomized control study in transplant recipients showing the benefits of good oral and dental care in relation to inflammation, Good oral and dental care in transplant recipients improved inflammation score and also reduced markers of inflammation which could have beneficial effect on post-transplant outcomes. There is need to include good oral and dental care and evaluation in CKD patients going for kidney transplantation.
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