|Year : 2016 | Volume
| Issue : 1 | Page : 1
Points to be considered during restoring uremic patient's teeth
Salah Hasab Mahmoud
Professor and Chairman of Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
|Date of Web Publication||12-Apr-2016|
Salah Hasab Mahmoud
Professor and Chairman of Operative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mahmoud SH. Points to be considered during restoring uremic patient's teeth. J Dent Res Rev 2016;3:1
I am pleased to be invited to write the guest editorial article for this issue of Journal of Dental Research and Review.
Chronic renal failure (CRF) is defined as a progressive decline in renal function associated with a reduced glomerular filtration rate as measured clinically by the creatinine clearance rate. The incidence of CRF has been reported to be 337, 90, 107, and 200 per million populations in the USA, Australia, New Zealand, and Egypt, respectively. Dental changes including enamel hypoplasia of the primary and permanent teeth with or without brown discoloration and narrowing or calcification of the pulp chamber of teeth of adults with CRF5 have been reported. In addition, characteristic changes analogous to those seen in bone were detected in the dentin of erupted teeth in patients with CRF. Mansoura University (Egypt) is famous by its International Nephrology Center, which is one of the most prestigious educational and training medical centers in the world. This allows us in the Faculty of Dentistry to treat a huge number of uremic patients in the dental clinics of Operative Dentistry Department.
The question now is the tooth substrate in uremic patient's similar to normal person tooth structure? Or there are some changes associated with this systemic disorder. This short communication was written to highlight the considerations, which should be taken during restoring of uremic patient's teeth. In 2008, my first "original" study was conducted to investigate the influence of uremia on the shear bond strength of composite resin to enamel and dentin substrates with the assessment of the micromorphological pattern of etched enamel and dentin surfaces using atomic force microscopy (AFM). It was concluded that uremia adversely affects bonding of composite resin to enamel and dentin and confers an altered micromorphological-etching pattern.  Accordingly, two new terms were added to dental scientific knowledge; uremic - "enamel" and "dentin." Considering the preceding information and because the success of modern esthetic restoratives is greatly dependent on the quality and the performance of their bonds to dental substrates, deteriorated or weak bonding of these materials to tooth tissues of uremic patients could be expected.
In 2012, our group conducted another study to overcome this structure difference problem. The aim of this study was to investigate the effect of phosphoric acid concentration and etching duration on surface roughness (Ra) and micromorphology of enamel and dentin substrates of uremic patients receiving hemodialysis. The output of this study showed that increasing the concentration of the etchant gel into 42%, as well as, increasing the etching time into 60s instead of 15s (conventional regimen used with normal enamel) improved bonding to uremic enamel.  Not only the adhesion to uremic teeth was investigated by our studies but also the effect of bleaching agents was comprehensively evaluated. Another study was conducted to investigate the effect of 16% carbamide peroxide bleaching gel on surface micromorphology and roughness of enamel and root dentin of uremic patients receiving hemodialysis using AFM.  The results of this study revealed that the negative effects of the bleaching gel on uremic tooth substrates are less dramatic and nondestructive compared to healthy substrates because uremia confers different micromorphological surface changes.
Hopefully, the abovementioned information can add some knowledge to JDRR readers and wishing to be considered in their routine clinical practice during restoring uremic patient's teeth.
| References|| |
Mahmoud SH, Abdel Kader Sobh M, Zaher AR, Ghazy MH, Abdelaziz KM. Bonding of resin composite to tooth structure of uremic patients receiving hemodialysis: Shear bond strength and acid-etch patterns. J Adhes Dent 2008;10:335-8.
Mahmoud SH, Ahmed ME, Mahmoud KM, Grawish Mel-A, Zaher AR. Effects of phosphoric acid concentration and etching duration on enamel and dentin tissues of uremic patients receiving hemodialysis: An AFM study. J Adhes Dent 2012;14:215-21.
Mahmoud SH, Elembaby Ael S, Zaher AR, Grawish Mel-A, Elsabaa HM, El-Negoly SA, et al.
Effect of 16% carbamide peroxide bleaching gel on enamel and dentin surface micromorphology and roughness of uremic patients: An atomic force microscopic study. Eur J Dent 2010;4:175-82.