Effect of Non-Surgical Periodontal Therapy on Serum Albumin Levels of Patients on Maintenance Hemodialysis Therapy, A Randomized Control Trial

Periodontitis is a destructive chronic infection of the gums, ligaments, and bone, predominantly caused by Gram-negative bacteria residing in biofilm surrounding the teeth. Biofilm is an aggregate of microbes with a distinct architecture. This biofilm contains clusters of bacterial species that are found commonly below the gingiva and are associated reproducibly with periodontal disease. These bacteria involved in periodontitis causes destruction of tissues which leads to formation of a periodontal pocket. This space becomes a site for further bacterial colonization and possible entry route of bacteria in blood stream.

It is evident from the data that periodontal health of the Pakistani nation is very poor with only 28% of the 12 year old having healthy gums and more than 93% of the 65 year old have some gum or periodontal disease . These results indicate that periodontal disease including inflammation of gums and calculus is endemic in Pakistan . Like caries, the level of gingival and periodontal disease is higher in the rural population of the Pakistan.

There is an increasing evidence that individuals with periodontal disease are at increased risk of cardiovascular disease, preterm delivery of low birth weight infants, pulmonary diseases, diabetes, osteoporosis, rheumatoid arthritis, alzheimer's disease & kidney diseases. The factors predisposing to periodontal disease and accelerating its progression are clearly evident in chronic renal failure. They encompass hyposalivation and xerostomia, impaired immunity and wound healing, alveolar bone destruction due to renal osteodystrophy, bleeding diathesis, diabetes mellitus, malnutrition and a state of general disability impairing oral hygiene. There is evidence for increased prevalence of periodontal disease in patients with renal disease, especially in dialysis patients.

Chronic kidney disease (CKD) is the progressive loss of kidney function over time. Normal renal functions are normally evaluated by glomerular filtration rate (GFR). Normal results range from 90 - 120 mL/min/1.73 m2.

The loss of kidney function usually takes months or years to occur. The final stage of chronic kidney disease is called end-stage renal disease (ESRD) after which kidneys no longer function and the patient needs dialysis or a kidney transplant .