الفهرس 
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Abstract
Summary
Changes in the oral cavity and other manifestations of poor oral health are common in patients with CKD and may contribute to increased morbidity and mortality because of systemic consequences such as inflammation, infections, protein-energy wasting, and atherosclerotic complications. Poor oral health in CKD patients may thus represent an important but often overlooked problem.
The consequences of poor oral health may be more severe in CKD patients because of advanced age, common related problems such as hypertension, diabetes, medications, and a state of immune dysfunction that may increase the risk for systemic consequences of oral and dental pathologic conditions. Poor dentition and other signs of poor oral health should be an alarm clock also at the early stages of CKD.
ESRD patients require special attention to dental treatment, not only due to the conditions inherent to the disease and its multiple oral manifestations but also because of the side-effects and characteristics of the treatments they receive.
Xerostomia is one of the most typical symptoms of geriatric patients with ESRD, which can result in a cascade of serious symptoms.
Even though there are many different pharmaceutical formulations for treating xerostomia, there isn’t yet a truly effective cure that works both safely and permanently. Using thyme honey as an oral rinse proved to be very efficient in reducing symptoms and severity of xerostomia in geriatric patients with ESRD without known negative side effects. Thus, it would be a promising alternative to the currently used medications for treating xerostomia.
Taking into consideration the value of the oral health condition in geriatric people with ESRD associated with xerostomia and believing that salivary stimulants or substitutes could potentially be used to manage this condition. This study aimed to evaluate the clinical effectiveness of thyme honey as oral rinse in geriatric patients with ESRD using the subjective dry mouth score as a primary objective and to assess the effect of thyme honey on the salivary nitric oxide level, salivary flow rate, and salivary pH in addition to objective dry mouth score as secondary objectives.
The current study was designed as a randomized controlled trial with two equal arms, the interventional arm (thyme honey oral rinse) and the control arm (saline). Total of twenty-eight geriatric patients with ESRD undergoing hemodialysis complained of xerostomia were recruited from the renal dialysis center at Benha university. Patients in both arms followed the same administration protocol for one month either with thyme honey oral rinse or saline.
The treatment assessment of subjective dry mouth score, objective dry mouth score, salivary pH, and salivary flow rate were carried out at baseline, 2 weeks, and one month after starting the treatment protocol, while the NO levels were measured at baseline and after one month of treatment. After the treatment protocol period ends, all patients were followed up for 4 weeks of the treatment-free observation period.
In the current study it was found that both the subjective and objective dry mouth scores were significantly lower after one month of using thyme honey oral rinse (1.86±0.66B) and (2.21±0.43B) respectively, than the control group (3.07±0.73B) and (3.07±0.83B), respectively with a (p<0.001). Also, the salivary flow rate was significantly higher after one month of using thyme honey oral rinse (1.56±0.51A), than the control group (0.78±0.27A) with a (p<0.001). For the NO levels, there was a significant increase in measured value after 1 month in the intervention group (p<0.001), while for the control group the change was not statistically significant (p=0.166).