The goal of this multidisciplinary pilot and feasibility proposal is to study the impact of systematic control and prevention of chronic periodontitis, a forgotten comorbidity in End Stage Renal Disease (ESRD). This proposal is significant because it offers a novel approach on the management of the inflammatory burden by targeting oral infections and improving quality of life. Periodontitis, a polymicrobial oral infection, is highly prevalent in ESRD and linked to malnutrition, inflammation and cardiovascular (CVD) mortality. Our preliminary data and other reports have revealed that the magnitude of the inflammatory response to periodontal treatment is similar to the one observed after converting catheter vascular access to fistula in ESRD patients on dialysis. This innovative proposal of repeated and systematic oral health interventions aims to change the paradigm of care by reducing oral and systemic inflammatory burden and improving the well being of this population. Unlike the previously reported episodic interventions, we propose to control periodontal infections in a continuous pattern with frequent maintenance and oral health behavior modifications in a long-term observation period. We have the expertise to implement this model in the outpatient dialysis units in order to improve access to oral care and promise better management of this population characterized by fatigue and physical limitations. We hypothesize that this strategy will improve: a) systemic inflammation and oxidative stress, b) oral health and c) quality of life within the 6-month observation period.
We aim to measure true and surrogate outcomes.
The first aim will assess the changes in Oral Health Quality of Life (a 14-item survey) and clinical oral parameters at baseline, 2-, 4- and 6-months.
The second aim will evaluate the changes in markers of systemic inflammation and oxidative stress in the same time points. Our long-term goal is to identify appropriate and well-perceived oral health guidelines to improve health outcomes in this population and to reduce all cause and CVD mortality (Healthy People 2020 objective).
This pilot study proposes to examine, for the first time in dialysis patients, the short and long-term effect of systematic and repeated oral health interventions on inflammation and clinical oral parameters. The ultimategoalofthisproposalistoimproveaccesstooralcareandqualityoflifebyimplementingcontinuousand repeatedin-?centeroralhealthprogramsindialysispopulations.
