الفهرس 
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Abstract
The present study investigated oral, salivary and bacteriological status of a sample of children with ESRD undergoing regular HD therapy. In addition, the effects of regular oral hygiene instructions and non surgical periodontal therapy on the periodontal health status and the counts of subgingival A.a were also investigated.
A total of 45 subjects were enrolled in the present study and they were divided into two groups. group I consisted of 25 patients receiving hemodialysis therapy which was compared to group II that consisted of 20 apparently systemically healthy children matched as close as possible to the patients in age and gender. Intra-oral examination was carried out, then stimulated whole saliva was collected to asses stimulated salivary flow rate, salivary pH, and S.mutans counts. The decayed, missing, filled, tooth index (for primary and permanent teeth), simplified oral hygiene index, and gingival index were used to assess caries prevalence, oral hygiene, and gingival health status, respectively.
Subgingival plaque samples were collected to detect A.a. Then, probing depths were assessed for every fully erupted tooth. At the end of clinical examination, all patients were instructed in self performed oral hygiene, non surgical periodontal therapy was performed and patients were followed up.
After the two months follow up period, ten patients were selected to evaluate oral hygiene, gingival health status and counts of A.a in subgingival plaque samples taken from the same sites.
Poor oral hygiene was found in the present study presented as increased plaque and calculus deposits in the HD patients. Few patients reported tooth brushing, only two (8%), while 23 patients did not brush their teeth at all. Results showed that dental visits were seeked, on emergency basis, by only 2 patients (8%), whereas the rest of the patients have never had past dental visits. The OHI-S and its components (DI and CI) were significantly higher in patients than in controls. This finding suggests an increased need for oral care instructions by these patients.
The stimulated salivary flow rate was significantly lower in the HD patients than controls while salivary pH was significantly more alkaline in patients than in controls, probably as a result of high salivary urea concentration that was previously found in these patients.
The present study provides further evidence that caries prevalence is low in HD patients as both the mean dmft and DMFT scores were significantly higher in controls.
Statistical analysis showed that 24 (96%) patients had uremic odor, 9 patients (36%) suffered from dry mouth, 10 patients (40%) had enamel hypoplasia, 5 patients (20%) complained of taste changes. 3 patients (12%) had periodontal pockets, 5 loose teeth were found in 3 patients, one patient (4%) had gingival recession, and 18 patients (72%) were caries free.
Based on the present study periodontal health status of HD children was found to be worse than healthy children since the mean GI scores were significantly higher than controls, however a positive correlation was found between GI scores; and DI, CI, and OHI-S scores. Furthermore, when non surgical periodontal therapy was performed, there was a significant decrease in the mean DI, CI, OHI-S, and GI scores. No correlation could be established between serum creatinine and parathyroid hormone and GI.
The prevalence of A.a in subgingival plaque was significantly higher in the patients than controls however there was no significant difference in the mean counts of A.a between both groups. The counts of A.a in subgingival plaque decreased significantly after non surgical periodontal therapy; however, A.a was not completely eliminated from periodontal pockets. A.a counts showed no significant correlation with GI, serum creatinine or urea level.
The PCR assays showed that S.mutans counts were significantly higher in the control group. This may offer an additional explanation to the decreased caries prevalence in such patients. No significant correlation could be found between S.mutans counts and caries experience, salivary pH or serum urea levels.