Defeitos de desenvolvimento de esmalte, cárie dentária e impacto na qualidade de vida de crianças e adolescentes com doença renal crônica: um estudo transversal pareado

Abstract

Chronic kidney disease (CKD) is a clinical condition resulting from irreversible kidney damage that persists for three months or longer. The classic oral implications of CKD include periodontal disease and xerostomia, while the prevalence of dental caries and developmental enamel defects (DDE) remains controversial. The perception of children and adolescents with CKD regarding their quality of life related to general health (HRQoL) and oral health (OHRQoL) is also underexplored in the literature. Therefore, the aim of this study was to analyze the prevalence of DDE and dental caries and to compare sociodemographic, health-related, gestational, and oral clinical variables, as well as the impact on HRQoL and OHRQoL between children and adolescents with and without CKD. A matched cross-sectional study was conducted with a sample of 81 participants aged 5 to 18 years, matched by age and sex in a 1:2 ratio. Participants undergoing orthodontic treatment or those with syndromes, systemic, neurological, or oncological conditions were excluded. Data collection included administering questionnaires on participants' health, sociodemographic aspects, gestational history, and measuring quality of life using PedsQL™ and PedsQL™-OH. Participants underwent an oral clinical examination to detect dental caries (ICDAS) and its pulp consequences (pufa/PUFA), DDE (modified DDE), and dental trauma (Andreasen index) by a trained and calibrated examiner (Kappa >0.90). Data analysis was conducted using SPSS 23.0 and included frequency analysis, Shapiro-Wilk normality test, bivariate analyses with Chi-Square test, Fisher's exact test, and Mann-Whitney test, in addition to adjusted and unadjusted Poisson regression (PR, 95% CI, p<0.05). The study included 27 children/adolescents with CKD and 54 without CKD. In the bivariate analyses, the mean HRQoL scores obtained by PedsQL™ indicated that children/adolescents with CKD, as well as their parents/guardians, had worse perceptions of HRQoL (p= 0.012). The domains most affected in the CKD group compared to the control group were "school activities" and "psychosocial aspects." The CKD group also had worse perceptions of OHRQoL, particularly in the domains of "dental sensitivity" and "dark teeth." CKD was also associated with prematurity (p=0.006), medication use (p<0.001), hospitalization (p<0.001), a higher mean number of teeth with DDE (5.22 vs. 2.89; p=0.002), and a lower mean number of decayed teeth (0.40 vs. 5.07; p<0.001). In the final multivariate analysis, it was observed that children/adolescents with CKD had a 78% higher prevalence of medication use (PR: 1.78; 95% CI: 1.42-2.23), a 22% higher prevalence of prematurity (PR: 1.22; 95% CI: 1.03-1.44), and a 2% lower prevalence of the mean number of decayed teeth (PR: 0.98; 95% CI: 0.96-0.99). It is concluded that children/adolescents with CKD have a higher occurrence of prematurity, higher medication use, a lower mean number of decayed teeth, and perceive their HRQoL and OHRQoL with lower scores, highlighting the importance of multidisciplinary approaches. Thus, understanding the needs and impact on HRQoL/OHRQoL of children/adolescents with CKD is essential for public policies and personalized care.