American Journal of Medicine and Medical Sciences

p-ISSN: 2165-901X    e-ISSN: 2165-9036

2025;  15(11): 4147-4149

doi:10.5923/j.ajmms.20251511.87

Received: Oct. 10, 2025; Accepted: Nov. 3, 2025; Published: Nov. 25, 2025

 

Clinical and Microbiological Features of Generalized Periodontitis in Patients After Kidney Transplantation

Rizaev E. O.1, Mirzaev Kh. Sh.2

1Faculty Therapeutic Dentistry Department, Tashkent State Medical University, Tashkent, Uzbekistan

2Therapeutic Dentistry Propaedeutics Department, Tashkent State Medical University, Tashkent, Uzbekistan

Copyright © 2025 The Author(s). Published by Scientific & Academic Publishing.

This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract

Periodontitis is a chronic inflammatory disease of the oral cavity that progressively destroys the tooth-supporting structures. In patients with chronic kidney disease (CKD), particularly those after kidney transplantation, periodontal disease often presents in more severe forms due to systemic comorbidities, impaired microcirculation, and compromised immune response. The present study aimed to improve the effectiveness of diagnosis and treatment of generalized periodontitis in kidney transplant recipients. A total of 105 patients aged 20–60 years were examined, including 54 kidney transplant recipients with generalized periodontitis (main group), 30 patients with generalized periodontitis without renal pathology (comparison group), and 20 healthy controls. Clinical and microbiological methods were applied. Results demonstrated more severe periodontal manifestations in kidney transplant recipients compared with controls, including higher bleeding indices, probing pocket depth, and tooth mobility. Oral microbiota analysis revealed marked dysbiosis with increased facultative microorganisms (Staphylococcus spp., Streptococcus spp., Candida spp.) in both groups, but less pronounced in transplant patients compared to those with generalized periodontitis without renal pathology. It was established that comorbidity and polymorbidity distort the clinical course of periodontitis, contribute to more severe progression, and increase the risk of complications. Tailored diagnostic and therapeutic protocols are therefore essential for kidney transplant patients.

Keywords: Periodontitis, Kidney transplantation, Chronic kidney disease, Oral microbiota, Comorbidity

Cite this paper: Rizaev E. O., Mirzaev Kh. Sh., Clinical and Microbiological Features of Generalized Periodontitis in Patients After Kidney Transplantation, American Journal of Medicine and Medical Sciences, Vol. 15 No. 11, 2025, pp. 4147-4149. doi: 10.5923/j.ajmms.20251511.87.

Article Outline

1. Introduction
2. Object of Research
3. Material and Methods of Research
4. The Results of the Study
5. Conclusions

1. Introduction

Periodontitis is a chronic inflammatory disease of the oral cavity that progressively destroys the periodontal tissues and leads to tooth mobility and loss. It usually develops as a complication of gingivitis and represents a major dental and systemic health problem. According to various studies, periodontal diseases affect up to 98% of the adult population and show an increasing prevalence [1,2,7,8].
Patients with chronic kidney disease (CKD), especially those who have undergone kidney transplantation, exhibit a higher frequency of severe generalized periodontitis (Community Periodontal Index 3.43–3.52). These patients often demonstrate poor oral hygiene (Silness-Löe index 2.44–3.56) and high rates of oral mucosal diseases (16.3–39.0%) [2,3,4,5]. Thus, the development of targeted diagnostic and treatment strategies for this population is of great clinical significance.

2. Object of Research

The study included 105 patients aged 20-60 years, 54 of whom had chronic generalized periodontitis and had undergone kidney transplants. The main group included 28 women and 22 men; 30 patients with chronic generalized periodontitis who had undergone kidney transplants, including 18 women and 12 men, formed the comparison group; 20 healthy individuals served as a control.

3. Material and Methods of Research

Clinical examination included assessment of gingival bleeding (Muhlemann-Cowell index), oral hygiene (Silness-Löe index), probing pocket depth (PPD), and tooth mobility (Miller-Fleszar index). Radiographic studies were performed. Microbiological analysis of oral fluid was conducted to evaluate aerobic and anaerobic flora. Statistical analysis was performed using standard methods with p<0.05 considered significant.
The comparison groups were randomized by sex, age and frequency of underlying somatic pathology, which ensured the representativeness of the data obtained during treatment.

4. The Results of the Study

Clinical manifestations of periodontitis varied according to disease severity.
- Healthy controls: No complaints, normal gingiva, no bleeding, no periodontal pockets.
- Mild periodontitis: Gingival hyperemia, bleeding on brushing, pockets ≤3 mm, tooth mobility grade I, radiographic bone loss up to one-third of root length.
- Moderate periodontitis: Gingival edema, cyanosis, suppuration, pockets ≤5 mm, tooth mobility grades I–II, radiographic bone loss up to half the root length.
- Severe periodontitis: Persistent gingival pain, suppuration, halitosis, tooth mobility II–III, deep pockets (>5 mm), marked granulation and fibrosis.
Table 1. Clinical periodontal indices in patients
     
Table 1 presents the results of the examination of the condition of periodontal tissues and a quantitative assessment of the hygienic condition of the oral cavity in patients with kidney transplantation (main group) and individuals without kidney pathology (comparison group).
Most of the patients examined had poor oral hygiene. The average values of the Silness - Loe hygiene index were 2.25±0.17 in patients in the main group and 2.08±0.11 in the comparison group; no significant differences were noted between the groups (p > 0.05).
One of the main signs of periodontal inflammation is gingival bleeding, the severity of which is assessed using the Muhlemann - Cowell index. This index is useful not only for identifying the early stages of periodontal damage but also for determining the severity of the inflammatory process, as it reflects the intensity and depth of periodontal inflammation.
Muhlemann - Cowell index assessment Signs of periodontal tissue inflammation in the form of bleeding of varying severity were present in all examined patients. The average bleeding index in patients of the main group was 2.40±0.17, while in patients of the comparison group it was 1.80±0.07; the differences between the groups were statistically significant (p < 0.05). The degree of destruction of the periodontal complex, reflected by such indicators as the depth of the periodontal complex and tooth mobility, also differed significantly, which was due to the different proportions of patients with chronic generalized moderate periodontitis in the study groups.
We conducted quantitative and qualitative studies of the oral microflora in most of the patients examined with chronic generalized periodontitis following kidney transplantation.
Oral microbiota: Healthy individuals showed predominance of anaerobes (Peptostreptococcus, Lactobacillus) and Streptococcus spp. Patients with generalized periodontitis demonstrated significant dysbiosis: increase in facultative flora (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus mutans, Candida), reduced anaerobic flora. In transplant patients, changes were present but less pronounced compared to non-CKD periodontitis patients.
Gram-negative flora is generally insignificant. Among anaerobic microbes, the majority are Peptostreptococci and Lactobacilli.
At the same time, in patients with chronic generalized periodontitis without kidney disease, we see a completely different picture of developing dysbiosis in the oral cavity. Characteristic features of this dysbiosis include a significant decrease in the anaerobic group of microbes, but against this background, the quantitative indicators of the facultative group increased sharply, reaching lg 7.10 ± 0.5 CFU/ml, with the norm equal to lg 4,85 ±0,2 CFU/ml.
Significant quantitative shifts occurred in the coccal flora. Virtually all cocci groups showed a trend toward increased growth, but staphylococci clearly had the largest numbers, doubling their numbers. Furthermore, a significant increase in the number of gram-negative bacteria and the quantitative parameters of Candida fungi was clearly evident.
However, in patients Dysbiotic changes also occur in patients with chronic generalized periodontitis after kidney transplantation, but their severity is significantly lower than in patients without kidney disease. Although the number of all types of cocci is significantly increased in this group of patients, streptococci are predominant, although the quantitative indicators of Candida fungi also maintain a similar trend. Apparently, these changes in obese patients can be explained by the fact that an increase in lipids in the body leads to a change in pH. habitat of the macroorganism.

5. Conclusions

It has been established that somatic and periodontal pathologies are typically combined with other diseases, which corresponds to the status of polymorbidity. Furthermore, polymorbidity has been shown to distort the classic clinical picture of diseases, leading to a more severe course, increasing the risk of complications, reducing the effectiveness of treatment, and worsening life prognosis.
Dysbiotic changes also occur in patients with chronic generalized periodontitis after kidney transplantation, but their severity is significantly lower than in patients without kidney disease. Although the number of all types of cocci is significantly increased in this group of patients, streptococci are predominant, while Candida species also show a similar trend.

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