Intraoral Periapical Radiographic Changes of Teeth and Jaw Bones in Chronic Renal Failure Patients - an Observational Case-control Study

Background: Chronic renal failure is an important health care problem throughout the world, with a prevalence of 7852 cases per million population (p.m.p) in India. Patients afflicted by this medical condition can visit a general dentist's office with number of clinical as well radiological manifestations. This study is undertaken to observe the soft radiologic changes occurring in teeth and jaw bones through Intraoral Periapical Radiographs (IOPA) which could be warning signs for undiagnosed kidney disease in these patients.

Methods: IOPA radiographs of 30 patients present in the initial stage of chronic renal failure (CRF) and have not undergone dialysis and 30 control group were taken in to the study. Maxillofacial radiologists measured the changes in the morphological features of the lamina dura, trabecular pattern, pulp size and radiographic density presenting in the teeth and jaw bones.

Results: In patients with CRF the significant changes were observed in lamina dura in the maxilla (93.3% of cases and 43.3% in controls; p=<0.0001) as well as mandible (83.3% of case and 33.3% of controls; p=<0.0001) when compared with controls. Changes in the trabecular pattern of both maxilla (86.6% of cases and 43.3% of controls; p=<0.001) and mandible (86.6% in cases and 10% in controls; p=<0.0001) were very evident in the case group when compared with controls. The radiographic density in case group showed significant change in maxilla (93.3% in cases&20% in controls; p=<0.0001) when compared to controls but interestingly negligible change was seen in mandible of both case and control groups (40% in cases and 23.3% of controls; p=0.1647).No significant change was observed in size of pulp chamber in both maxilla (86.6% in patients and 70% in controls; p=0.117)and mandible (63.3% in patients and 30% in controls; p=0.0096) in both case and control groups.

Conclusions: The results suggest that changes IOPA radiographic changes in Lamina dura, trabecular pattern and overall radiographic density can be a good prognostic tool for assessment and management CRF patients.