Knowledge and Attitude of Renal Medicine physician about the Relationship of Renal Disease and Periodontitis

Knowledge and Attitude of Renal Medicine physician about the Relationship of Renal Disease and Periodontitis.

introduction. Periodontitis is defined as “an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with increased probing depth formation, recession, or both. Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of months or years. It is defined by National kidney foundation of USA as – “Kidney damage or glomerular filtration rate <60 mL/min/1.73 m for more than three months”. CKD is classified into stage one to five based on glomerular filtration rate and stage five CKD is also called as end-stage renal disease..

It is a systemic condition which significantly affects oral hard and soft tissues. One of the main effects is enamel hypoplasia due to disturbance in enamel formation and mineralization, Other manifestations of chronic kidney disease and hemodialysis (HD) therapy are xerostomia, enamel hypoplasia, calcification of root canals, abnormal pH of saliva and abnormal delay in eruption of teeth. This would be of utmost benefit in resource limited hospital settings in Sudan, where the morbidity and mortality associated with CKD is high due to unaffordability of regular dialysis and poor access to renal replacement therapy. It is however not certain how often Nephrologists and their trainees in Sudan perform oral assessment on their CKD patients and how regularly such patients are referred to dentists for routine checkup. Although, some recent studies have reported physicians’ knowledge of PD and systemic interactions amongst medical doctors, no study has reported the opinions and oral hygiene and referral practice patterns of physicians involved in the care of CKD patients in Sudan. The present study aimed to evaluate the knowledge and attitude of nephrologists in the relation between chronic kidney disease and periodontitis and explore the views of kidney care physicians about PD, how it affects CKD and their referral practices to dentists with the end point of improving their patient’s overall management..

Literature review:. On 2010 Jorge Hernán Ramirezet al ask Why Must Physicians Know About Oral Diseases? And found Periodontal disease is associated with multiple systemic conditions of medical interest, a large number of systemic diseases have oral manifestations, many drugs are associated with oral adverse drug reactions, physicians are generally not sufficiently trained to detect oral cancer manifestations, physicians could play a pivotal role in oral public health, and early detection of oral diseases by physicians could improve the oral health status of the population. They Concluded Physicians need to get more involved in oral health promotion. Moreover, oral health education should be included in the curriculum of future medical students. (16) On 2011 Jessica do Amaral Bastos et al in his article Assessment of knowledge toward periodontal disease among a sample of nephrologists and nurses who work with chronic kidney disease not yet on dialysis found the study Most physicians and nurses interviewed correctly answered the questions on general knowledge about PD. 42.2% of the physicians and 38% of the nurses did not routinely examine the oral cavity of their patients. Most patients seen by nephrologists (59.4%) and nurses (61.5%) were referred to dental care in less than 30% of the consultations sample, composed of nephrologists and nurses, showed good self-reported knowledge about PD, although with limited clinical practice, as expressed by the low rate of referral to specialist care. The findings point to the need for theoretical and practical training in oral health during graduatin and post-graduation (medical and multiprofessional residency programs. (17).

On 2012 Mohammad Abdul Baseer et al did Oral health knowledge, attitude and practices among health professionals in King Fahad Medical City, Riyadh. Doctors showed a high mean knowledge score as compared with other health professionals Majority of the health professionals said that the fear of drilling was the main reason for avoiding the dentist. Almost all the health professionals said that they cleaned their teeth by toothbrush and toothpaste. Less than 50% of the health professionals used mouth wash and dental floss. Less than 10% used Miswak and toothpick as part of their oral hygiene. Conclusion: Oral health knowledge among the health professionals working in KFMC, Riyadh was lower than expected of these groups, which had higher literacy levels in health care, but they showed a positive attitude toward professional dental care (18).

Umeizudike KA et al on 2015 There was a cross-sectional study in which 120 questionnaires were sent to Nephrologists and Nephrology trainees in Nigeria via their electronic mail between March and August 2015. The questionnaires had sections on socio-demography, knowledge of PD, PD link with CKD and other systemic illnesses, attitude, oral hygiene and referral practices. Fifty-three nephrologists and trainees responded. Oral health information was mostly from social media (52.8%) and the press (52.8%). Over 60% were knowledgeable about PD with positive attitudes towards periodontal care, but less than 50% knew PD to be a risk factor for CKD and poor glycemic control. Oral hygiene practices were unsatisfactory. Only 3.8% referred their patients with CKD to dentists regularly, while 51.9% had never examined their CKD patients’ oral cavity for signs of PD. This study has highlighted good PD knowledge and positive attitudes among nephrologists in Nigeria. However, knowledge of PD as a risk factor for CKD and poor glycemic control, oral hygiene and dental referral practices still fall short of expectation and hence need to be improved upon. (23.

Aims and objectives. Research Hypothesis (problem statement): To assess the knowledge and attitude of Sudanese nephrologists (renal medicine) regarding the association between renal disease and periodontitis and to evaluate the implication for patient care and interdisciplinary collaboration..

Objectives:. General Objectives: To assess the knowledge and attitude of nephrologist regarding the association between renal disease and periodontitis Specific Objectives: To evaluate the level of knowledge nephrologist, have about potential links renal disease and periodontal health. To analyse nephrologist attitude toward screening and management of periodontal disease in patient with renal condition. To assess how nephrologist integrate knowledge of periodontal health into their clinical practice and patient management strategy. To explore the potential for collaboration between nephrologist and dental professional in managing patient with overlapping health issues..

Materials and methods 1. Study design: A cross-sectional survey study to assess the knowledge and attitudes of renal medicine physicians regarding periodontitis and its associations with renal failure. 2. Study area: This research will be conducted at the Sudanese nephrologist register in Sudanese medical counsel. Sudan.

A Study population: Renal medicine physicians from various settings (hospitals, outpatient clinics, and private practice)..

Methodology (Eligibility Criteria of Participants):.

2. Exclusion criteria: Individual who are not formally train or licensed as nephrologist will be excluded. Nephrologist should have less than 1 year of experience in field. Participants who does not complete the survey may be excluded from the analysis to insure data integrity. Nephrologist who specialize exclusively in narrow subset of nephrology that may limit their experience with systemic disease.

SAMPLE SIZE:. Sample size will be calculated using the Raosof ( http://www.raosoft.com/samplesize.html) Online sample size calculator. The calculation will be based on a 15 % response distribution, 5 % margin of error and 95 % confidence interval the sample size 51 participants.

SAMPLING TECHNIQUE:. Distribute the questionnaire via email or online survey platforms to avoid geographical constraints.

Study variables:. 1. Dependent Variables: . The extent to which nephrologist recognize the relationship between periodontitis and renal disease. Whether nephrologist include periodontal assessment in there clinical practice for patient with renal disease. Frequency and willingness to refer patient to dental specialist for periodontal evaluation and treatment. Changes in treatment plans based on the recognition of the connection between oral health and renal disease 2. Independent Variables: Demographical characteristics (age and gender and years of experience). Assess the level of understanding nephrologist have regarding pathophysiology. Access to continuing education and availability resource or training.

Study duration: The study period from October 2025 to July 2026 Data Collection Tools and Techniques: A structured questionnaire will be used to collect relevant information about the ESRD.

Materials Needed for Data Collection:. - Develop a structured questionnaire that includes: - Demographic Information: Age, gender, years of experience, and type of practice. - Knowledge Assessment: - Multiple-choice questions about the relationship between renal failure and periodontitis. - True/false statements to assess understanding of relevant pathophysiological mechanisms. - Attitudes and Beliefs: - Likert scale questions (e.g., strongly agree to strongly disagree) regarding the importance of periodontitis in renal patients. - Questions about perceived barriers to referral to periodontists. - Referral Practices: - Questions regarding when and why they would refer patients to a periodontist. - Case scenarios that explore clinical decision-making regarding referrals..

Statistical Analysis:. The data will be analysed using the Statistical Package for the Social Sciences (SPSS) version 23. Descriptive statistics will be determined, such as mean and standard deviation (SD) for continuous variables and frequency and percentage for categorical variables. Inferential statistics will then be followed using a parametric and non-parametric test for univariate analysis. The level of significance is set at p < 0.05..

Ethical Considerations: Ethical approval will be obtained from the Research and Publication Unit at the Sudan Medical Specialization Board and the State Ministry of Health Ethics Committees. Written and verbal informed consent will be obtained from all participants. Participants are free to participate or withdraw from the study at any time. Confidentiality and anonymity of participants will be ensured: Assigning code names/numbers for participants that will be used on all research notes and documents Data collected will be coded and locked in a password-protected computer on the candidates' laptop to ensure patient data confidentiality and privacy.

Expected Outcomes and limitation of the research : Identify gaps in knowledge and attitudes regarding the interaction between renal failure and periodontitis. - Provide recommendations for continuing education and guidelines for improving referral practices for periodontists - Acknowledge potential biases such as self-reporting bias and limited generalizability if the sample isn’t representative of all renal medicine physicians..

3. APPENDICES 3.1. Appendix I - Gantt Chart. Tasks to be performed Oct Nov Dec Jan Feb Mar Apr May Writing up and finalizing research proposal Ethical and institutional clearance Hospital director's approval Preparation of resources, personnel, instrument and research tools Questionnaire and Clinical Examination Data clearing Data entry in the computer Data Analysis and report writing Feedback the hospital authority Finalising the report.

3.2. Appendix II Estimated Budget. Item Cost Analysis of biomarker 400000 SDG Stationeries 35000 SDG Transportation 100000 SDG Data analysis 30000 SDG Data entry 10000 SDG Thesis first drafts & editing 00 SDG Copies of exam 5000 SDG Final copies of the exam 10000 SDG Personnel 00 SDG Unforeseen expenses 100000SDG Total 780000 SDG.

3.4 Appendix E: Data collection sheet. KnoxMedge and Attitude Of Renal Medicine physicians about the Relationship Of Renal Disease and Periodontitis. DO you agree to participate in this study? o Agree o Dis-agree Sociodernographic characteristics: 1. Age: O e-25 years 0 25-45 years 0 45 years 2. Gender: o Fe rnale o Male 3. Years Of experience in nephrology". o 3 years Of clinical experience 0 3-10 years clinical experience 0 10 years' experience 4. Type Of practice: O O O Acadernic private Hospital-based Other: Knowledge Of periodontitis and Renal Disease 1. HOW' farniliar are you 'Nith the concept of periodontitis? o O Very farmiliar farniliar Not farniliar at all.