2. DR HAIDAR KHADEMI ASSISTANT PROFESSOR AND HEAD OF ORAL MEDICINE DEPARTMENT OF DENTAL SCHOOL OF ISFAHAN MEDICAL SCIENCES UNIVERSITY.IRAN

3. 9/15/20153 Determination of DMFT index in patients with ESRD being treated by hemodialysis in Ali Asghar medical center of

4. There are 8 million people in the UNITED STATES today with some form of kidney disease.Of these,some 60000 die annually as a result of chronic,progressive,irreversible kidney failure(ESRD). Each year approximately 1.3 in 10000 develop ESRD,and this is increasing by about 10% per year,most rapidly in patients over 65.ESRD is a bilateral,progressive,and chronic deterioration of nephrons that results in uremia and ultimately leads to death.

5. 9/15/20155 ACUTE CHRONIC

6.  Diabetes mellitus 44.4%  Hypertension26.6%  Glomerlunephritis 12.2%  Interstitial nephritis7.2 %  Other diseases 9.6%  Diabetes  Diabetes mellitus 44.4%  Hypertension26.6%  Glomerlunephritis  Glomerlunephritis 12.2%  Interstitial  Interstitial nephritis7.2 %  Other  Other diseases 9.6%

7. 9/15/20157  Gastrointestinal  Neuromuscular  Hematologic,immunologic  Endocrine metabolic  Cardiovascular  Dermatologic

9. 9/15/20159 1.Enlarged(asymptomatic salivary glands) 2.Decreased salivary flow 3.Dry mouth 4.Odor of urea on breath 5.Metalic taste 6.Increased calcium formation 7.Low caries rate 8.Enamel hypoplasia 9.Dark brown stains on crowns 10.Dental malocclusion

10. 11.Pale mucosa 12.Low grade gingival inflammation 13.Petechea and echymosis 14.Bleeding from gingiva 15.Prolonged bleeding 16.Candida infections 17.Burninig and tenderness of mucosa 18.Erosive glossitis 19.Tooth erosion (secondray to regugitation) 20.Dehiscence of wounds

11. 9/15/201511 o Deminralization of bone o Loss of bony trabeculation o Ground glass appearance o Loss of lamina dura o Giant cell lesions(brown tumors) o Sockets sclerosis o Pulpal narrowing and calcification o Tooth mobility o Arterial and oral calcification

12. REVIEW OF LITRATURES 1981 BUBLITEZ ENAMEL HYPOPLASIA IN2 GROUPS OF NEPHROTIC SYN {73} AND CRF (49). 1982 DEFFEZ FRENCH. 1984 ORBY FRENCH LOWER DECAY IN ESRD HYPOPLASIA 2 TEETH. 1985 WOLF & PETERSON ENAMEL EFFECTS IN CHILDREN(60%) ESRD,CRF. 1989 GERMANY SCHEULTZEL 52% ENAMEL HYPOPLASIA. 1991 ROJAS FRENCH 1998 U.S.A

13. 9/15/201513 OBJECTIVES Despites these unfavorable factors,the recent researches indicated relatively lower DMFT index in these patients.Regarding these results,this study was trying to identify the DMFT index. The study attempted to find out whether there was statistically meaningful difference between patients with ESRD being treated by hemodialysis,and healthy people.In addition,the effect of factors,sex,the age of the beginning of hemodialysis treatment and duration of hemodialysis.Despites these unfavorable factors,the recent researches indicated relatively lower DMFT index in these patients.Regarding these results,this study was trying to identify the DMFT index. The study attempted to find out whether there was statistically meaningful difference between patients with ESRD being treated by hemodialysis,and healthy people.In addition,the effect of factors,sex,the age of the beginning of hemodialysis treatment and duration of hemodialysis.

14. 9/15/201514 METHODS In this descriptive-analytic research,22 patients with ESRD being treated by hemodialysis were examined.This was the total number of the patients ranging from 17 to 33 years old who had reffered to ALI ASGHAR MEDICAL CENTER IN ISFAHAN during 2 months.After examining and indicating the DMFT index in these patients,they were compared with a healthy control group which were identical to the study group regarding their sex,age and number.In this descriptive-analytic research,22 patients with ESRD being treated by hemodialysis were examined.This was the total number of the patients ranging from 17 to 33 years old who had reffered to ALI ASGHAR MEDICAL CENTER IN ISFAHAN during 2 months.After examining and indicating the DMFT index in these patients,they were compared with a healthy control group which were identical to the study group regarding their sex,age and number.

15. Sampling was easy with no systemic disease except ESRD. 22 patients 16 were man and 6 women and divided in 4 groups. Patients <25 years old (6), between 20 to 25 (7), between 26 to 30 (7) and over 30 were 3 patients.

18. 9/15/201518

19. P=0.493 P>0.05 t-test DMFT INDEX DMFT INDEXPERCENTNUMBERSEX 7.772.716M 9.127.36F TABLE 1: COMPARISON OF MEAN DMFT INDEX BETWEEN MAELS AND FEMAELS.

20. SEX

21. P=0.8 P>0.05 Tukey – HSD test (Analysis of variance) DMFTPERCENTNUMBERGROUP 7.527.361 7.231.872 927.363 9.613.634 TABLE 2: RELATION BETWEEN THE AGE OF DIALYSIS BEGINNING AND DMFT INDEX.

22. AGE OF DIALYSIS BEGINING

23. P= 0.73 P> 0.05 Tukey – HSD test (Analysis of variance) DMFTPERCENTNUMBERGROUP 7.645.4101 7.827.262 9.327.263 TABLE 3: RELATION BETWEEN THE DURATION OF DIALYSIS AND DMFT.

24. THE DURATION OF DIALYSIS

27. P=0.027 P<0.05 t-test ANTERIOR TOOTH (DMFT)NUMBERGROUPS 0.045322CASE 0.954522CONTROL TABLE 4: COMPRISON OF DMFT INDEX IN ANTERIOR TOOTH IN 2 GROUPS(CASE-CONTROL).

29. P=0.007 P<0.05 t-test DMFT IN POSTERIOR DMFT IN POSTERIORTOOTHNUMBERGROUPS 8.090922CASE 11.454522CONTROL TABLE 5: COMPRAISON OF DMFT INDEX IN POSTRIOR TOOTH IN 2 GROUPS (CASE-CONTROL).

31. P=0.001 P<0.05 t-test P=0.001 P<0.05 t-test TOTAL DMFT TOTAL DMFTNUMBERGROUPS 8.136422CAES 12.863622CONTROL TABLE 6: COMPARISON TOTAL DMFT INDEX IN 2 GROUPS (CASE-CONTROL).

37. It was diagnosed that the patients with ESRD BEING TREATED BY HEMODIALYSIS HAD A NOTICEABLE,LOWER DMFT INDEX COMPARED TO THE NORMAL PEOPLE AND THIS DIFFERENCE IS MORE DISTINCT IN POSTERIOR TEETH.Further,despite the fact that no statitically meaningful relation was found between the age of beginning of hemodialysis treatment,the duration of hemodialysis treatment and the DMFT index of patients with ESRD,but it is probable that a direct relation exist between the 2 above mentioned alternatives and the DMFT index in these patients in greater samples.