Periodontal disease prevelance and oral hygiene in adults with cystic fibrosis

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Coffey, Niamh
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University College Cork
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Objectives This research had four objectives: 1. To review the available literature regarding studies on oral hygiene levels and prevalence of periodontal disease in people with Cystic Fibrosis (PWCF) -Chapter 3 2. To assess and analyse the oral hygiene and dental attendance patterns of adults with Cystic Fibrosis (CF) – Chapter 4 3. To explore the attitudes of PWCF towards dental attendance and any perceived barriers to treatment – Chapter 5 4. To determine and analyse the prevalence of gingivitis and periodontitis in a cohort of adults with Cystic Fibrosis – Chapter 6 Methods There were three methods of investigation employed to achieve these objectives: 1. A systematic review of available literature regarding oral hygiene and periodontal disease in PWCF 2. A cross-sectional mixed-methods study in the form of a structured anonymous questionnaire 3. A clinical study examining the oral hygiene levels, gingival and periodontal condition in adults with Cystic Fibrosis Results Objective 1. The search resulted in 614 publications from databases. One more publication was identified by searching bibliographies. Thirteen studies were included in the qualitative analysis. Five studies found lower levels of gingivitis in the CF group compared to the control group/general population. Four studies found no difference in gingivitis levels between CF and non-CF groups. Three studies found higher levels of calculus in PWCF. Objective 2. A total of 71 adults with Cystic Fibrosis responded to the survey. While the majority of respondents (66.2%) saw a dentist in the preceding year, 15.5% had not attended a dentist for over two years. Smoking and alcohol consumption levels were low. 63.4% brushed twice or more daily, with 70.4% using a Fluoride containing toothpaste. 62% did not use any interdental cleaning aid. 5.6% changed their toothbrush at least once a month, but for 22.5% it was over six months. 38% snacked three or more times daily and 29.5% consumed fizzy drinks at least once daily. Objective 3. The qualitative portion of the survey found that 54.9% of respondents were unhappy with their teeth. 63.4% felt that CF had an impact on oral health. 33.8% were anxious about attending their dentist. 54.9% felt that dentists should be part of the multidisciplinary team. Respondents believed that CF has impacted on their oral health due to the medications and dietary requirements involved, as well as tiredness and other side effects of CF. Some reasons for being anxious about attending the dentist involved cross infection concerns, issues with the dentist, with tolerating treatment, and with the teeth themselves. They wanted dentists to be aware of the practicalities of dental treatment for people with CF, especially their discomfort with lying back. They also want the dentist to be aware of the impact their medication, treatment and diet has on their oral health. Objective 4. A total of 92 PWCF took part in the clinical study. The median age was 31 years, with an interquartile range (IQR) of 25-35.75 (control group: median age 27 years, IQR 25-35.75). The CF group was comprised of 54 men and 38 women (control group: 43 men and 49 women). This study found that PWCF brushed less frequently than the control group, interdental cleaning was lower, and more PWCF were unsure if their toothpaste contained fluoride, or if they qualified for dental check-ups under the PRSI dental scheme. They had similar rates of dental attendance; however, they were more likely to be symptomatic attenders, i.e., attend for pain/a problem. Assessment of the oral hygiene status showed that the plaque and calculus levels were statistically higher in the CF group. Despite this, there were lower levels of gingivitis, mild periodontitis and severe periodontitis in the CF group. There were no links between the use of Pancreatic Enzyme Replacement Therapy (PERT) or Cystic Fibrosis Transmembrane conductance Regulator (CFTR) modulators or diabetic status on either the periodontal or oral hygiene status of the CF group. Gingivitis, mild periodontitis and plaque levels are all higher in PWCF who do not take antibiotics, however the difference was not statistically significant. Conclusions Objective 1. The majority of previous studies showed lower levels of gingivitis and plaque among PWCF compared to controls. However, a number of studies showed that PWCF had higher levels of dental calculus. Three studies found no difference in oral hygiene levels. Objective 2. The alcohol and tobacco consumption in the qualitative study was low. However, a large proportion of PWCF frequently consumed sugar-rich foods, and they did not change their toothbrush, brush their teeth or attend the dentist as regularly as is advised. More targeted advice is necessary to improve the oral hygiene habits of adults with CF. Objective 3. Over a third of adults with CF are anxious regarding attending the dentist. Reasons for this include fear, embarrassment, cross infection concerns and problems with treatment, especially being in the supine position. Dentist and dental care professionals should be aware of the impact that CF can have upon dental treatment and oral health care. Objective 4. Adults with CF had higher levels of plaque and calculus than a control group. Despite this, they had lower levels of clinical gingivitis and periodontitis. Further study is required to examine the causes of this phenomenon. More targeted oral hygiene advice should be given to PWCF in order to reduce their future risk of development of periodontal conditions, as well as inhalation of oral pathogens.
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Cystic fibrosis , Periodontal disease , Oral health
Coffey, N. 2023. Periodontal disease prevelance and oral hygiene in adults with cystic fibrosis. PhD Thesis, University College Cork.
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