Evaluation of Oral Hygiene and Gingival Parameters in Pediatric Nephrotic Syndrome within an Interdisciplinary Care Model

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The primary research question was whether interdisciplinary care contributes to better oral health in this medically compromised group. Materials and Methods A cross-sectional study was conducted among 86 children aged 5–17 years, including 40 patients with NS and 46 healthy controls. Clinical evaluation included the Plaque Index (Pl.I.), Approximal Plaque Index (API), Gingival Index (GI), Bleeding on Probing (BoP), and presence of dental calculus. Periodontal pathogens were identified using the PET Plus microbiological test. Results Children with NS had better interdental hygiene and a higher proportion of individuals with good oral hygiene. Gingival inflammation indicators (GI, BoP) did not differ significantly between groups. Notably, the prevalence and bacterial load of Treponema denticola and Fusobacterium nucleatum were lower in the NS group. Dental calculus was also less frequently observed in these patients. Conclusions Despite being a medically vulnerable population, children with nephrotic syndrome under interdisciplinary care demonstrated favorable oral hygiene and reduced colonization by key periodontal pathogens. These findings suggest that systematic dental follow-up integrated with nephrology care may have a protective effect on oral health and help prevent inflammation-associated complications. Clinical Relevance Implementing regular dental screening within pediatric nephrology care can enhance early intervention, reduce oral disease burden, and support systemic health in children with nephrotic syndrome. Health sciences/Diseases/Kidney diseases Health sciences/Diseases/Oral diseases nephrotic syndrome gingivitis oral hygiene periodontal pathogens Introduction Gingivitis induced by the presence of plaque can present with different patterns of visible signs and symptoms of inflammation, confined to the gingiva and triggered by the accumulation of a microbial biofilm on the teeth [ 1 ]. Gingivitis starts when plaque accumulates for an extended period, disrupting the natural balance between oral bacteria and the immune system. This imbalance leads to inflammation and the early development of periodontal disease [ 2 , 3 ]. Systemic factors such as endocrinopathies, hematologic conditions, diet, and medications can significantly alter the body's immune-inflammatory response, making individuals more susceptible to oral diseases. Hormonal fluctuations, as seen in diabetes or pregnancy, may enhance gingival inflammation and worsen periodontal conditions. Additionally, certain medications, including immunosuppressants and anticoagulants, can impact the immune system’s ability to regulate inflammation, further modifying the oral environment [ 1 , 3 ]. The oral microbiota is a significant component of the overall human microbiome, consisting of hundreds to thousands of diverse microbial species. It naturally inhabits the oral cavity and plays a crucial role in preventing the colonization of external bacteria that could negatively impact systemic health. However, microorganisms are also the primary contributors to the development of common oral diseases such as dental caries, gingivitis, and periodontitis [ 4 ]. The influence of oral microorganisms on systemic health is complex and involves multiple mechanisms. Pathological changes in distant organs may arise due to the direct presence of bacteria, their toxins, or antigens. Importantly, the indirect effects of bacteria, particularly those associated with periodontal infections, have gained increasing attention. These pathogens can trigger a systemic inflammatory response, with bacterial endotoxins stimulating the production of cytokines such as interleukin-1, interleukin-6, prostaglandin E2, and tumor necrosis factor-alpha. This widespread inflammation can play a role in the onset or progression of various systemic conditions, including endocarditis, myocarditis, glomerulonephritis, uveitis, retinitis, and rheumatoid arthritis [ 5 , 6 ]. Patients with nephrotic syndrome are particularly susceptible to the development of gingival inflammation, which results from several contributing factors, including immunosuppressive therapy and overall health status. Long-term immunosuppressive treatment, commonly used in the management of nephrotic syndrome, can lead to gingival overgrowth, which increases plaque retention and promotes gingival inflammation. Enlarged gingival tissues hinder effective oral hygiene, thereby facilitating bacterial accumulation and the progression of inflammation [ 7 ]. According to El-Husseini et al. [ 8 ], prolonged use of cyclosporine in the treatment of pediatric nephrotic syndrome may lead to various adverse effects, including metabolic disturbances and immunosuppression, which further predispose to chronic inflammatory conditions, including gingivitis. Immunological dysfunction characteristic of patients with nephrotic syndrome, along with immunosuppressive therapy, promotes the colonization of the oral cavity by pathogenic bacteria such as Porphyromonas gingivalis and Fusobacterium nucleatum, which are recognized as key etiological agents of gingival inflammation [ 9 ]. The presence of oral inflammatory conditions may, in turn, be associated with an increased risk of relapse of the underlying disease. In 2012, a formal collaboration was initiated between the Department of Pediatric Dentistry and the Department of Pediatrics and Nephrology at the Medical University of Warsaw, with the objective of implementing oral health surveillance and promoting adherence to dental treatment and pro-health behavioral changes in patients with nephrotic syndrome [ 10 ]. An integrated care model has been established in which children diagnosed with nephrotic syndrome are referred for dental evaluation at the time of diagnosis and are subsequently monitored at 3–6 month intervals. This approach ensures close coordination between pediatric nephrologists and dentists, including the exchange of medical histories and laboratory data. The system facilitates prompt dental management, potentially lowering the risk of infection-triggered relapses and contributing to improved general health outcomes. The aim of the study was to evaluate the oral hygiene status, gingival condition and the presence of periodontal pathogens, in children with nephrotic syndrome compared to healthy controls, within the framework of an interdisciplinary care model integrating pediatric nephrology and dentistry. Materials and Methods This study was approved by Medical University of Warsaw's Bioethical Commission ((KB/26/2020; 03.02.2020). The study is in compliance with Declaration of Helsinki principles. Study Design and Participants The cross-sectional study enrolled patients between the ages of 5 and 17, categorized into two groups: the study group, which included individuals diagnosed with nephrotic syndrome, and the control group, composed of generally healthy participants. Eligibility for the study group required a confirmed diagnosis of nephrotic syndrome and the absence of other systemic illnesses. The control group consisted of healthy individuals with no prior diagnosis of nephrotic syndrome or other chronic systemic conditions. Both groups were excluded if they had taken antibiotics in the past three months, had systemic disorders affecting salivary secretion, or were on long-term medication. Written informed consent was obtained from the child and/or their parents or legal guardians before participation. Individuals who failed to meet all criteria were not included in the study. Clinical Examination & Microbiological Assessment All participants received a thorough intraoral examination performed by a single calibrated examiner, ensuring consistency (intraexaminer reliability κ = 0.92) under standardized conditions. The clinical evaluation included assessments of oral hygiene parameters using the Plaque Index [ 11 ] and Approximal Plaque Index [ 12 ] and the presence of dental calculus. The gingival condition of gingiva was assessed using the Gingival Index [ 11 ] and Bleeding on Probing Index [ 13 ]. A microbiological analysis of gingival crevicular fluid was performed in all patients to detect the presence of pathogenic infections associated with periodontal and gingival diseases. Bacterial testing was conducted using the PET Plus assay (MIP Pharma Deutschland) to qualitatively and quantitatively assess the presence of the following bacterial species: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Peptostreptococcus micros, Eubacterium nodatum, and Capnocytophaga gingivalis. Statistical Analysis For the analysis of quantitative variables, Student’s t-test for independent samples was employed when the data demonstrated normal distribution; in cases of non-normality, the Mann-Whitney U test was utilized. Effect sizes were calculated using Cohen’s d for statistically significant findings and the r coefficient for results indicating a trend. For categorical and ordinal variables, chi-square tests (χ²) were applied, with Fisher’s exact test used when chi-square assumptions were not satisfied. Cramer's V was used to determine the effect size for significant or near-significant categorical comparisons. To evaluate relationships between selected variables, Spearman's rank correlation was performed. Statistical significance was established at a threshold of p < 0.05. Results The study included 86 patients, with 40 in the study group (nephrotic syndrome) and 46 in the control group (generally healthy individuals). The study group comprised 28 boys (70%) and 12 girls (30%), while the control group included 24 boys (52%) and 22 girls (48%). The mean age of the patients was 11.84 ± 4.09 years. No significant differences were observed between the study and control groups regarding age and sex distribution (p > 0.05). Detailed data on the type of dentition in the study participants are presented in Table 1 . Table 1 Dentition types distribution in patients included to the study. Dentition type Control group (n = 46) n/% Study group (n = 40) n/% Statistical significance Primary 3/7 5/12 p = 0.464 Mixed 11/24 17/43 p = 0.067 Permanent 32/69 18/45 p = 0.021 Oral hygiene parameters differed between the study and control groups. The mean Pl.I. was higher in the control group (1.51 ± 0.83) compared to the study group (1.15 ± 0.87); however, this difference did not reach statistical significance. In contrast, API was significantly lower in the study group (42.55% ± 25.91) than in the control group (54.85% ± 24.58), indicating better interdental hygiene among patients with nephrotic syndrome (p = 0.030). The details are presented in Table 2 . In terms of oral hygiene classification based on the Plaque Index, good oral hygiene (Pl.I. ≤ 1) was observed in a significantly greater number of patients in the study group (n = 21) than in the control group (n = 13). No significant differences were noted between groups in the number of patients with average oral hygiene (1 2) was more prevalent in the control group (n = 20 vs. n = 11), approaching statistical significance. Table 2 Oral hygiene parameters in study and control groups. Control group (n = 46) Study group (n = 40) Statistical significance Plaque Index (mean ± SD) 1,51 ± 0,83 1,15 ± 0,87 t (83) = 1,84; p = 0,070; d = 0,40 Approximal Plaque Index% (mean ± SD) 54,85 ± 24,58 42,55 ± 25,91 Z = -2,17; p = 0,030*; r = 0,23 Number of patients with good oral hygiene (Pl.I.≤1) 13 21 χ 2 (1) = 4,28 p = 0,039* V = 0,22 Number of patients with average oral hygiene (1 2) 20 11 χ 2 (1) = 3,22 p = 0,073 V = 0,20 *statistical significance Gingival condition parameters showed no statistically significant differences between groups. The mean GI was lower in the study group than in the control group, but this difference was not statistically significant. Similarly, the mean percentage of BoP was lower in the study group compared to the control, although the difference did not reach significance. Analysis of the severity of gingival inflammation based on the Gingival Index categories also showed no statistically significant differences between groups. This data are summarized in Table 3 . Table 3 Gingival condition parameters in study and control groups. Control group (n = 46) Study group (n = 40) Statistical significance Gingival Index (mean ± SD) 1,15 ± 0,87 0,81 ± 0,85 Z = -1,77; p = 0,077; r = 0,19 Bleeding on Probing% (mean ± SD) 22,68 ± 17,99 17,12 ± 17,37 Z = -1,45; p = 0,146 Number of patients with no gingivitis (GI = 0) 8 11 χ 2 (1) = 1,27 p = 0260 Number of patients with mild gingivitis (0 < GI ≤ 1) 12 14 χ 2 (1) = 0,81 p = 0,369 Number of patients with moderate gingivitis (1 2) 13 7 χ 2 (1) = 1,39 p = 0,239 Microbiological assessment of gingival crevicular fluid revealed differences in the presence and quantity of specific periodontal pathogens between groups. The total mean bacterial load detected by the PET test was comparable between the study group and the control group (6.48×10¹⁰ vs. 6.45×10¹⁰), with the difference approaching statistical significance (p = 0.054). Significant differences were observed for several pathogens: Treponema denticola was significantly more prevalent in the control group (11 patients) than in the study group (2 patients), as was the mean bacterial count. Fusobacterium nucleatum was found in 25 control patients and 12 study patients, with a significantly higher mean count in the control group. Tannerella forsythia was noted with higher levels in the study group although the prevalence difference was not statistically significant. For other bacteria such as Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Peptostreptococcus micros (Pm), Eubacterium nodatum (En), and Capnocytophaga gingivalis (Cg), no statistically significant differences were observed in either prevalence or mean counts between the groups. Notably, E. nodatum was absent in all participants. The microbiological data is presented in Table 4 . Table 4 Microbiological assessment in study and control groups. Control group (n = 46) Study group (n = 40) Statistical significance Mean PET count 6,45x10^10 6,48x10^10 Z = -1,94; p = 0,054; r = 0,21 Aa prevalence (n) 7 2 Exact Fisher Test p = 0,166 Mean Aa count 25,34x10^2 227,2x10^2 Z = -1,45; p = 0,147 Pg prevalence (n) 2 1 Exact Fisher Test p = 1 Mean Pg count 49,45x10^2 1,1x10^2 Z = -0,49; p = 0,624 Td prevalence (n) 11 2 χ 2 (1) = 5,96 p = 0,015* V = 0,26 Mean Td count 262,86x10^2 3,95x10^2 Z = -2,49; p = 0,013; r = 0,27 Tf prevalence (n) 7 1 Exact Fisher Test p = 0,063 V = 0,22 Mean Tf count 44,27x10^2 85x10^2 Z = -1,98 p = 0,047*; r = 0,21 Pi prevalence (n) 6 2 Exact Fisher Test p = 0,275 Mean Pi count 466,27x10^2 34,25x10^2 Z = -1,29; p = 0,198 Pm prevalence (n) 10 3 χ 2 (1) = 3,38 p = 0,066 V = 0,20 Mean Pm count 11,08x10^2 12,27x10^2 Z = -1,82; p = 0,069; r = 0,20 Fn prevalence (n) 25 12 χ 2 (1) = 5,17 p = 0,023* V = 0,25 Mean Fn count 61,63x10^2 51,54x10^2 Z = -2,11 p = 0,035*; r = 0,23 En prevalence (n) 0 0 - Cg prevalence (n) 38 35 χ 2 (1) = 0,40 p = 0,528 Mean Cg count 314,25x10^2 134,65x10^2 Z = -0,82; p = 0,410 *statistical significance The presence of dental calculus was observed in 12 patients from the control group and in 3 patients from the study group. This difference was statistically significant (χ²(1) = 5.13; p = 0.023; V = 0.24). Spearman’s rank correlation analysis revealed significant associations between the presence of dental calculus and several oral health parameters and bacterial prevalences. Moderate, statistically significant positive correlations were found between dental calculus and key oral hygiene and gingival inflammation indices, including the Plaque Index (p < 0.001), Gingival Index (p < 0.001), Approximal Plaque Index (p < 0.001), and Bleeding on Probing (p < 0.001), indicating that greater calculus accumulation was associated with poorer oral hygiene and more pronounced gingival inflammation. Regarding microbial prevalence, no significant correlation was observed between dental calculus and the overall PET bacterial load. However, weak to moderate positive correlations were noted between calculus and the presence of Treponema denticola (p = 0.030), Tannerella forsythia (p = 0.010), and Prevotella intermedia (p < 0.001). No significant associations were found with the prevalence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum, or Capnocytophaga gingivalis. The details are provided in Table 5 . Table 5 Spearman’s correlation coefficient between presence of dental calculus and periodontal parameters. Dental calculus PL. I r s 0,42 p < 0,001* GI r s 0,46 p < 0,001* API% r s 0,48 p < 0,001* BOP% r s 0,47 p < 0,001* PET – overall r s 0,09 p 0,416 Aa prevalence r s 0,04 p 0,694 Pg prevalence r s 0,08 p 0,466 Td prevalence r s 0,23 p 0,030* Tf prevalence r s 0,27 p 0,010* Pi prevalence r s 0,38 p < 0,001* Fn prevalence r s -0,03 p 0,798 Cg prevalence r s 0,02 p 0,834 *statistical significance Discussion The present study provides evidence that children with nephrotic syndrome, despite their systemic condition and immunosuppressive treatment, exhibited overall better oral hygiene and lower levels of gingival inflammation compared to healthy controls. Although the differences in gingival indices and bleeding on probing did not reach statistical significance, the study group demonstrated significantly lower Approximal Plaque Index scores and a higher proportion of individuals with good oral hygiene. Additionally, the microbiological analysis revealed a significantly lower prevalence and bacterial load of selected periodontal pathogens—particularly Treponema denticola and Fusobacterium nucleatum —in the nephrotic group. These findings suggest that systematic dental monitoring and interdisciplinary collaboration between pediatric nephrologists and dentists may positively influence the oral health outcomes of this vulnerable patient population [ 10 ]. Several studies have investigated the oral health status of children with nephrotic syndrome, providing insights that can be compared to the present findings. A study published by Luong et al. [ 14 ] examined oral health in children with primary nephrotic syndrome (PNS) and found a higher risk of gingivitis and gingival overgrowth compared to healthy controls. The PNS group exhibited a 1.301-fold higher risk of gingivitis and a 14.25-times higher risk of gingival overgrowth. The same study highlighted that most parents of children with PNS were unaware of the association between PNS and oral diseases, leading to neglect of dental check-ups and poor oral hygiene practices, such as infrequent use of dental floss and improper tooth brushing techniques [ 14 ]. The study by Subramaniam et al. [ 15 ] aimed to assess oral health status in children with renal disorders, including nephrotic syndrome. However, the study differs in methodology, sample characteristics, and outcome measures reveal important distinctions in findings. Our findings indicated better oral hygiene and lower interdental plaque accumulation in the nephrotic group compared to controls, with a higher proportion of patients classified as having good hygiene. Gingival indices were also lower, although not significantly. In contrast, Subramaniam et al. [ 15 ] reported a mean OHI-S indicating fair oral hygiene, but did not include comparative statistical analysis across groups. They also noted no gingival overgrowth, whereas our study focused more closely on gingival inflammation and bleeding. These studies collectively suggest that children with nephrotic syndrome are at an increased risk for various oral health issues, including gingival inflammation, gingival overgrowth, developmental defects of enamel, and fungal infections. Factors contributing to these conditions include immunosuppressive therapy, poor oral hygiene practices, and alterations in salivary composition. Regular dental monitoring and interdisciplinary collaboration between healthcare providers are essential to mitigate these risks and improve oral health outcomes in medically compromised patients [ 16 ]. ​The research by Kaczmarek et al. [ 17 ] has demonstrated that chronic kidney diseases (CKD), including nephrotic syndrome, can lead to significant alterations in salivary composition, which may adversely affect oral health. These alterations include changes in electrolyte levels, increased presence of metabolic waste products, and modifications in salivary proteins and enzymes. Studies have shown that patients with CKD often exhibit elevated salivary concentrations of sodium, potassium, calcium, phosphorus, and urea. Anuradha et al. [ 18 ] found significant differences in these salivary components between CKD patients and healthy individuals. Such imbalances can contribute to oral manifestations like xerostomia, altered taste sensations, and an increased risk of dental calculus formation.​ However, we had no such observations in the presented study. Similarly, Kodaman Dokumacıgil et al. [ 19 ] also reported higher Debris Index, Calculus Index, and Simplified Oral Hygiene Index scores in healthy peers (p < 0.001), suggesting better oral hygiene in the CKD group. The differences between CKD and NS in terms of oral health parameters may be attributed to variations in disease pathology, treatment regimens, and the impact on salivary composition. To the best of our knowledge, this is the first study to utilize the PET Plus microbiological test to assess the presence and quantity of periodontal pathogens in children with nephrotic syndrome. As such, there are currently no directly comparable data available in the literature regarding this patient population. This novelty highlights the need for further research to confirm our findings and explore the clinical implications of microbial profiles in nephrotic patients, particularly in the context of interdisciplinary care. Porphyromonas gingivalis and Fusobacterium nucleatum are significant contributors to periodontal diseases, including gingivitis. These bacteria are commonly found in dental plaque and are associated with inflammatory conditions of the gingiva [ 9 ]. Porphyromonas gingivalis is a key periodontal pathogen implicated in the initiation and progression of gingivitis and periodontitis. It possesses virulence factors that enable it to invade gingival tissues, evade the host immune response, and induce inflammation.​ F. nucleatum is frequently detected in the oral cavity and is associated with periodontal diseases. It acts as a bridge organism, facilitating the coaggregation of early and late colonizers in dental plaque, thereby contributing to the complexity and pathogenicity of the biofilm. Both P. gingivalis and F. nucleatum have been shown to interact synergistically, enhancing each other's virulence and ability to invade gingival epithelial cells, leading to increased inflammation and tissue destruction characteristic of gingivitis [ 9 , 20 ]. This study has several limitations that should be acknowledged. First, the cross-sectional design precludes assessment of causal relationships between nephrotic syndrome and oral health outcomes; longitudinal studies would be necessary to evaluate the progression of changes over time. Second, while the sample size was sufficient for detecting differences in certain parameters, a larger cohort might allow for more robust subgroup analyses, especially regarding specific microbiological findings. Third, potential confounding factors such as dietary habits, oral hygiene routines at home, socioeconomic status, and level of parental involvement were not controlled for, all of which could influence oral health status. Finally, the study was conducted in a single clinical center, which may limit the generalizability of the findings to other populations or healthcare settings. Children with nephrotic syndrome under regular interdisciplinary care demonstrated better oral hygiene and a lower prevalence of key periodontal pathogens compared to healthy controls. Although no significant differences were observed in gingival inflammation parameters, microbiological findings suggest a reduced bacterial burden in the nephrotic group. These results support the value of systematic dental monitoring in medically compromised children. The implementation of integrated nephrology-dental care may play a protective role in maintaining oral health in this population. Declarations Data availability statement The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Medical University of Warsaw. Conflicts of interest The authors have no conflicts of interest to declare. 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Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 19 May, 2025 Reviews received at journal 17 May, 2025 Reviewers agreed at journal 17 May, 2025 Reviews received at journal 13 May, 2025 Reviewers agreed at journal 13 May, 2025 Reviewers invited by journal 12 May, 2025 Editor assigned by journal 12 May, 2025 Editor invited by journal 07 May, 2025 Submission checks completed at journal 07 May, 2025 First submitted to journal 06 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6601091","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":456456074,"identity":"6d9084ee-62c3-4362-b84b-eaaa97a26830","order_by":0,"name":"Paula Piekoszewska-Ziętek","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYFACxgbGBgiLmYGhAsKSAGIZIrWcQWjhwW8PTAtjGxFazKWbGx/OqKiz55dIf2zwc97hxLUNzAdv8zDcwanFcs7BZsMNZw4zS87IMU7s3XY4cdsBtmRrHoZnOLUY3Ehsk3zYdoDN4HYO8wHebbeBWnjMpHkYDuPT0v7zYVsdj/3t9McH/84BaeH/RkhLG+PGNmYJA+kE42TeBrAtbHi1gPwiOePMYQOJ+2+MjWWO/TfedpjN2HKOAW6/mEu3P/zYAwqxnuOPJd/UpMluO9788MabijtyOB0mgSHEDBY/gEsHNi0QgFvLKBgFo2AUjDgAAIB8XHsgd3ThAAAAAElFTkSuQmCC","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":true,"prefix":"","firstName":"Paula","middleName":"","lastName":"Piekoszewska-Ziętek","suffix":""},{"id":456456075,"identity":"ffad9450-13a2-4b42-ae63-92ee71693126","order_by":1,"name":"Małgorzata Pańczyk-Tomaszewska","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Małgorzata","middleName":"","lastName":"Pańczyk-Tomaszewska","suffix":""},{"id":456456076,"identity":"e1b5a808-0f37-4c83-b6b1-b662a26049ff","order_by":2,"name":"Dorota Olczak-Kowalczyk","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Dorota","middleName":"","lastName":"Olczak-Kowalczyk","suffix":""}],"badges":[],"createdAt":"2025-05-06 09:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6601091/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6601091/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-06687-2","type":"published","date":"2025-07-01T15:57:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86179735,"identity":"e7d04d95-9a4c-4a02-8f59-b364f4ef3069","added_by":"auto","created_at":"2025-07-07 16:19:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":655036,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6601091/v1/a61bf034-fd2b-48f9-be6c-1e6ce90add06.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Oral Hygiene and Gingival Parameters in Pediatric Nephrotic Syndrome within an Interdisciplinary Care Model","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGingivitis induced by the presence of plaque can present with different patterns of visible signs and symptoms of inflammation, confined to the gingiva and triggered by the accumulation of a microbial biofilm on the teeth [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Gingivitis starts when plaque accumulates for an extended period, disrupting the natural balance between oral bacteria and the immune system. This imbalance leads to inflammation and the early development of periodontal disease [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Systemic factors such as endocrinopathies, hematologic conditions, diet, and medications can significantly alter the body's immune-inflammatory response, making individuals more susceptible to oral diseases. Hormonal fluctuations, as seen in diabetes or pregnancy, may enhance gingival inflammation and worsen periodontal conditions. Additionally, certain medications, including immunosuppressants and anticoagulants, can impact the immune system\u0026rsquo;s ability to regulate inflammation, further modifying the oral environment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe oral microbiota is a significant component of the overall human microbiome, consisting of hundreds to thousands of diverse microbial species. It naturally inhabits the oral cavity and plays a crucial role in preventing the colonization of external bacteria that could negatively impact systemic health. However, microorganisms are also the primary contributors to the development of common oral diseases such as dental caries, gingivitis, and periodontitis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe influence of oral microorganisms on systemic health is complex and involves multiple mechanisms. Pathological changes in distant organs may arise due to the direct presence of bacteria, their toxins, or antigens. Importantly, the indirect effects of bacteria, particularly those associated with periodontal infections, have gained increasing attention. These pathogens can trigger a systemic inflammatory response, with bacterial endotoxins stimulating the production of cytokines such as interleukin-1, interleukin-6, prostaglandin E2, and tumor necrosis factor-alpha. This widespread inflammation can play a role in the onset or progression of various systemic conditions, including endocarditis, myocarditis, glomerulonephritis, uveitis, retinitis, and rheumatoid arthritis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with nephrotic syndrome are particularly susceptible to the development of gingival inflammation, which results from several contributing factors, including immunosuppressive therapy and overall health status. Long-term immunosuppressive treatment, commonly used in the management of nephrotic syndrome, can lead to gingival overgrowth, which increases plaque retention and promotes gingival inflammation. Enlarged gingival tissues hinder effective oral hygiene, thereby facilitating bacterial accumulation and the progression of inflammation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. According to El-Husseini et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], prolonged use of cyclosporine in the treatment of pediatric nephrotic syndrome may lead to various adverse effects, including metabolic disturbances and immunosuppression, which further predispose to chronic inflammatory conditions, including gingivitis. Immunological dysfunction characteristic of patients with nephrotic syndrome, along with immunosuppressive therapy, promotes the colonization of the oral cavity by pathogenic bacteria such as Porphyromonas gingivalis and Fusobacterium nucleatum, which are recognized as key etiological agents of gingival inflammation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The presence of oral inflammatory conditions may, in turn, be associated with an increased risk of relapse of the underlying disease.\u003c/p\u003e \u003cp\u003eIn 2012, a formal collaboration was initiated between the Department of Pediatric Dentistry and the Department of Pediatrics and Nephrology at the Medical University of Warsaw, with the objective of implementing oral health surveillance and promoting adherence to dental treatment and pro-health behavioral changes in patients with nephrotic syndrome [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. An integrated care model has been established in which children diagnosed with nephrotic syndrome are referred for dental evaluation at the time of diagnosis and are subsequently monitored at 3\u0026ndash;6 month intervals. This approach ensures close coordination between pediatric nephrologists and dentists, including the exchange of medical histories and laboratory data. The system facilitates prompt dental management, potentially lowering the risk of infection-triggered relapses and contributing to improved general health outcomes.\u003c/p\u003e \u003cp\u003eThe aim of the study was to evaluate the oral hygiene status, gingival condition and the presence of periodontal pathogens, in children with nephrotic syndrome compared to healthy controls, within the framework of an interdisciplinary care model integrating pediatric nephrology and dentistry.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This study was approved by Medical University of Warsaw's Bioethical Commission ((KB/26/2020; 03.02.2020). The study is in compliance with Declaration of Helsinki principles.\u003c/p\u003e \u003cp\u003eStudy Design and Participants\u003c/p\u003e \u003cp\u003eThe cross-sectional study enrolled patients between the ages of 5 and 17, categorized into two groups: the study group, which included individuals diagnosed with nephrotic syndrome, and the control group, composed of generally healthy participants. Eligibility for the study group required a confirmed diagnosis of nephrotic syndrome and the absence of other systemic illnesses. The control group consisted of healthy individuals with no prior diagnosis of nephrotic syndrome or other chronic systemic conditions. Both groups were excluded if they had taken antibiotics in the past three months, had systemic disorders affecting salivary secretion, or were on long-term medication. Written informed consent was obtained from the child and/or their parents or legal guardians before participation. Individuals who failed to meet all criteria were not included in the study.\u003c/p\u003e \u003cp\u003eClinical Examination \u0026amp; Microbiological Assessment\u003c/p\u003e \u003cp\u003eAll participants received a thorough intraoral examination performed by a single calibrated examiner, ensuring consistency (intraexaminer reliability κ\u0026thinsp;=\u0026thinsp;0.92) under standardized conditions. The clinical evaluation included assessments of oral hygiene parameters using the Plaque Index [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and Approximal Plaque Index [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and the presence of dental calculus. The gingival condition of gingiva was assessed using the Gingival Index [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and Bleeding on Probing Index [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A microbiological analysis of gingival crevicular fluid was performed in all patients to detect the presence of pathogenic infections associated with periodontal and gingival diseases. Bacterial testing was conducted using the PET Plus assay (MIP Pharma Deutschland) to qualitatively and quantitatively assess the presence of the following bacterial species: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Peptostreptococcus micros, Eubacterium nodatum, and Capnocytophaga gingivalis.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eFor the analysis of quantitative variables, Student\u0026rsquo;s t-test for independent samples was employed when the data demonstrated normal distribution; in cases of non-normality, the Mann-Whitney U test was utilized. Effect sizes were calculated using Cohen\u0026rsquo;s d for statistically significant findings and the r coefficient for results indicating a trend. For categorical and ordinal variables, chi-square tests (χ\u0026sup2;) were applied, with Fisher\u0026rsquo;s exact test used when chi-square assumptions were not satisfied. Cramer's V was used to determine the effect size for significant or near-significant categorical comparisons. To evaluate relationships between selected variables, Spearman's rank correlation was performed. Statistical significance was established at a threshold of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 86 patients, with 40 in the study group (nephrotic syndrome) and 46 in the control group (generally healthy individuals). The study group comprised 28 boys (70%) and 12 girls (30%), while the control group included 24 boys (52%) and 22 girls (48%). The mean age of the patients was 11.84\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09 years. No significant differences were observed between the study and control groups regarding age and sex distribution (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Detailed data on the type of dentition in the study participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDentition types distribution in patients included to the study.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDentition type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003cp\u003en/%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy group (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003cp\u003en/%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical significance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.464\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11/24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17/43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32/69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e Oral hygiene parameters differed between the study and control groups. The mean Pl.I. was higher in the control group (1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83) compared to the study group (1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87); however, this difference did not reach statistical significance. In contrast, API was significantly lower in the study group (42.55% \u0026plusmn; 25.91) than in the control group (54.85% \u0026plusmn; 24.58), indicating better interdental hygiene among patients with nephrotic syndrome (p\u0026thinsp;=\u0026thinsp;0.030). The details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eIn terms of oral hygiene classification based on the Plaque Index, good oral hygiene (Pl.I. \u0026le; 1) was observed in a significantly greater number of patients in the study group (n\u0026thinsp;=\u0026thinsp;21) than in the control group (n\u0026thinsp;=\u0026thinsp;13). No significant differences were noted between groups in the number of patients with average oral hygiene (1\u0026thinsp;\u0026lt;\u0026thinsp;Pl.I. \u0026le; 2), while poor oral hygiene (Pl.I. \u0026gt; 2) was more prevalent in the control group (n\u0026thinsp;=\u0026thinsp;20 vs. n\u0026thinsp;=\u0026thinsp;11), approaching statistical significance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOral hygiene parameters in study and control groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy group (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical significance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlaque Index (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,51\u0026thinsp;\u0026plusmn;\u0026thinsp;0,83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,15\u0026thinsp;\u0026plusmn;\u0026thinsp;0,87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e(83)\u0026thinsp;=\u0026thinsp;1,84; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,070; \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproximal Plaque Index% (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54,85\u0026thinsp;\u0026plusmn;\u0026thinsp;24,58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42,55\u0026thinsp;\u0026plusmn;\u0026thinsp;25,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -2,17; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,030*; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients with good oral hygiene (Pl.I.\u0026le;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;4,28\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,039*\u003c/p\u003e \u003cp\u003e\u003cem\u003eV\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients with average oral hygiene (1\u0026thinsp;\u0026lt;\u0026thinsp;Pl.I. \u0026le; 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;0,12\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients with bad oral hygiene (Pl.I. \u0026gt;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;3,22\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,073\u003c/p\u003e \u003cp\u003e\u003cem\u003eV\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*statistical significance\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGingival condition parameters showed no statistically significant differences between groups. The mean GI was lower in the study group than in the control group, but this difference was not statistically significant. Similarly, the mean percentage of BoP was lower in the study group compared to the control, although the difference did not reach significance. Analysis of the severity of gingival inflammation based on the Gingival Index categories also showed no statistically significant differences between groups. This data are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGingival condition parameters in study and control groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy group (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical significance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGingival Index (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,15\u0026thinsp;\u0026plusmn;\u0026thinsp;0,87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,81\u0026thinsp;\u0026plusmn;\u0026thinsp;0,85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ = -1,77; p\u0026thinsp;=\u0026thinsp;0,077; r\u0026thinsp;=\u0026thinsp;0,19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding on Probing% (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22,68\u0026thinsp;\u0026plusmn;\u0026thinsp;17,99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17,12\u0026thinsp;\u0026plusmn;\u0026thinsp;17,37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ = -1,45; p\u0026thinsp;=\u0026thinsp;0,146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients with no gingivitis (GI\u0026thinsp;=\u0026thinsp;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;1,27\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0260\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients with mild gingivitis (0\u0026thinsp;\u0026lt;\u0026thinsp;GI\u0026thinsp;\u0026le;\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;0,81\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients with moderate gingivitis (1\u0026thinsp;\u0026lt;\u0026thinsp;GI\u0026thinsp;\u0026le;\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;1,39\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients with severe gingivitis (GI\u0026thinsp;\u0026gt;\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;1,39\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMicrobiological assessment of gingival crevicular fluid revealed differences in the presence and quantity of specific periodontal pathogens between groups. The total mean bacterial load detected by the PET test was comparable between the study group and the control group (6.48\u0026times;10\u0026sup1;⁰ vs. 6.45\u0026times;10\u0026sup1;⁰), with the difference approaching statistical significance (p\u0026thinsp;=\u0026thinsp;0.054).\u003c/p\u003e \u003cp\u003eSignificant differences were observed for several pathogens:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eTreponema denticola\u003c/em\u003e was significantly more prevalent in the control group (11 patients) than in the study group (2 patients), as was the mean bacterial count.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eFusobacterium nucleatum\u003c/em\u003e was found in 25 control patients and 12 study patients, with a significantly higher mean count in the control group.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eTannerella forsythia\u003c/em\u003e was noted with higher levels in the study group although the prevalence difference was not statistically significant.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eFor other bacteria such as \u003cem\u003eAggregatibacter actinomycetemcomitans\u003c/em\u003e (Aa), \u003cem\u003ePorphyromonas gingivalis\u003c/em\u003e (Pg), \u003cem\u003ePrevotella intermedia\u003c/em\u003e (Pi), \u003cem\u003ePeptostreptococcus micros\u003c/em\u003e (Pm), \u003cem\u003eEubacterium nodatum\u003c/em\u003e (En), and \u003cem\u003eCapnocytophaga gingivalis\u003c/em\u003e (Cg), no statistically significant differences were observed in either prevalence or mean counts between the groups. Notably, \u003cem\u003eE. nodatum\u003c/em\u003e was absent in all participants. The microbiological data is presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMicrobiological assessment in study and control groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy group (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical significance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean PET count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,45x10^10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,48x10^10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -1,94; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,054; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAa prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExact Fisher Test\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Aa count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25,34x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e227,2x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -1,45; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePg prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExact Fisher Test\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Pg count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49,45x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,1x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -0,49; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTd prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;5,96\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,015*\u003c/p\u003e \u003cp\u003e\u003cem\u003eV\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Td count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e262,86x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,95x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -2,49; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,013; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTf prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExact Fisher Test\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,063\u003c/p\u003e \u003cp\u003e\u003cem\u003eV\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Tf count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44,27x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -1,98 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,047*; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePi prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExact Fisher Test\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Pi count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e466,27x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34,25x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -1,29; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePm prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;3,38\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,066\u003c/p\u003e \u003cp\u003e\u003cem\u003eV\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Pm count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,08x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12,27x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -1,82; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,069; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFn prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;5,17\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,023*\u003c/p\u003e \u003cp\u003e\u003cem\u003eV\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Fn count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61,63x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51,54x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -2,11 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,035*; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEn prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCg prevalence (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;0,40\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,528\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Cg count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e314,25x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134,65x10^2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e = -0,82; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0,410\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*statistical significance\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe presence of dental calculus was observed in 12 patients from the control group and in 3 patients from the study group. This difference was statistically significant (χ\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;5.13; p\u0026thinsp;=\u0026thinsp;0.023; V\u0026thinsp;=\u0026thinsp;0.24). Spearman\u0026rsquo;s rank correlation analysis revealed significant associations between the presence of dental calculus and several oral health parameters and bacterial prevalences. Moderate, statistically significant positive correlations were found between dental calculus and key oral hygiene and gingival inflammation indices, including the Plaque Index (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Gingival Index (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Approximal Plaque Index (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and Bleeding on Probing (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that greater calculus accumulation was associated with poorer oral hygiene and more pronounced gingival inflammation.\u003c/p\u003e \u003cp\u003eRegarding microbial prevalence, no significant correlation was observed between dental calculus and the overall PET bacterial load. However, weak to moderate positive correlations were noted between calculus and the presence of Treponema denticola (p\u0026thinsp;=\u0026thinsp;0.030), Tannerella forsythia (p\u0026thinsp;=\u0026thinsp;0.010), and Prevotella intermedia (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant associations were found with the prevalence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum, or Capnocytophaga gingivalis. The details are provided in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman\u0026rsquo;s correlation coefficient between presence of dental calculus and periodontal parameters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDental calculus\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePL. I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0,001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0,001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAPI%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0,001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBOP%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0,001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePET \u0026ndash; overall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAa prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,694\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePg prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTd prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,030*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTf prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,010*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePi prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0,001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFn prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0,03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCg prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*statistical significance\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study provides evidence that children with nephrotic syndrome, despite their systemic condition and immunosuppressive treatment, exhibited overall better oral hygiene and lower levels of gingival inflammation compared to healthy controls. Although the differences in gingival indices and bleeding on probing did not reach statistical significance, the study group demonstrated significantly lower Approximal Plaque Index scores and a higher proportion of individuals with good oral hygiene. Additionally, the microbiological analysis revealed a significantly lower prevalence and bacterial load of selected periodontal pathogens\u0026mdash;particularly \u003cem\u003eTreponema denticola\u003c/em\u003e and \u003cem\u003eFusobacterium nucleatum\u003c/em\u003e\u0026mdash;in the nephrotic group. These findings suggest that systematic dental monitoring and interdisciplinary collaboration between pediatric nephrologists and dentists may positively influence the oral health outcomes of this vulnerable patient population [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies have investigated the oral health status of children with nephrotic syndrome, providing insights that can be compared to the present findings. A study published by Luong et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] examined oral health in children with primary nephrotic syndrome (PNS) and found a higher risk of gingivitis and gingival overgrowth compared to healthy controls. The PNS group exhibited a 1.301-fold higher risk of gingivitis and a 14.25-times higher risk of gingival overgrowth. The same study highlighted that most parents of children with PNS were unaware of the association between PNS and oral diseases, leading to neglect of dental check-ups and poor oral hygiene practices, such as infrequent use of dental floss and improper tooth brushing techniques [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The study by Subramaniam et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] aimed to assess oral health status in children with renal disorders, including nephrotic syndrome. However, the study differs in methodology, sample characteristics, and outcome measures reveal important distinctions in findings. Our findings indicated better oral hygiene and lower interdental plaque accumulation in the nephrotic group compared to controls, with a higher proportion of patients classified as having good hygiene. Gingival indices were also lower, although not significantly. In contrast, Subramaniam et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] reported a mean OHI-S indicating fair oral hygiene, but did not include comparative statistical analysis across groups. They also noted no gingival overgrowth, whereas our study focused more closely on gingival inflammation and bleeding. These studies collectively suggest that children with nephrotic syndrome are at an increased risk for various oral health issues, including gingival inflammation, gingival overgrowth, developmental defects of enamel, and fungal infections. Factors contributing to these conditions include immunosuppressive therapy, poor oral hygiene practices, and alterations in salivary composition. Regular dental monitoring and interdisciplinary collaboration between healthcare providers are essential to mitigate these risks and improve oral health outcomes in medically compromised patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e​The research by Kaczmarek et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] has demonstrated that chronic kidney diseases (CKD), including nephrotic syndrome, can lead to significant alterations in salivary composition, which may adversely affect oral health. These alterations include changes in electrolyte levels, increased presence of metabolic waste products, and modifications in salivary proteins and enzymes. Studies have shown that patients with CKD often exhibit elevated salivary concentrations of sodium, potassium, calcium, phosphorus, and urea. Anuradha et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] found significant differences in these salivary components between CKD patients and healthy individuals. Such imbalances can contribute to oral manifestations like xerostomia, altered taste sensations, and an increased risk of dental calculus formation.​ However, we had no such observations in the presented study. Similarly, Kodaman Dokumacıgil et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] also reported higher Debris Index, Calculus Index, and Simplified Oral Hygiene Index scores in healthy peers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting better oral hygiene in the CKD group. The differences between CKD and NS in terms of oral health parameters may be attributed to variations in disease pathology, treatment regimens, and the impact on salivary composition.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, this is the first study to utilize the PET Plus microbiological test to assess the presence and quantity of periodontal pathogens in children with nephrotic syndrome. As such, there are currently no directly comparable data available in the literature regarding this patient population. This novelty highlights the need for further research to confirm our findings and explore the clinical implications of microbial profiles in nephrotic patients, particularly in the context of interdisciplinary care. \u003cem\u003ePorphyromonas gingivalis\u003c/em\u003e and \u003cem\u003eFusobacterium nucleatum\u003c/em\u003e are significant contributors to periodontal diseases, including gingivitis. These bacteria are commonly found in dental plaque and are associated with inflammatory conditions of the gingiva [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. \u003cem\u003ePorphyromonas gingivalis\u003c/em\u003e is a key periodontal pathogen implicated in the initiation and progression of gingivitis and periodontitis. It possesses virulence factors that enable it to invade gingival tissues, evade the host immune response, and induce inflammation.​ \u003cem\u003eF. nucleatum\u003c/em\u003e is frequently detected in the oral cavity and is associated with periodontal diseases. It acts as a bridge organism, facilitating the coaggregation of early and late colonizers in dental plaque, thereby contributing to the complexity and pathogenicity of the biofilm. Both \u003cem\u003eP. gingivalis\u003c/em\u003e and \u003cem\u003eF. nucleatum\u003c/em\u003e have been shown to interact synergistically, enhancing each other's virulence and ability to invade gingival epithelial cells, leading to increased inflammation and tissue destruction characteristic of gingivitis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has several limitations that should be acknowledged. First, the cross-sectional design precludes assessment of causal relationships between nephrotic syndrome and oral health outcomes; longitudinal studies would be necessary to evaluate the progression of changes over time. Second, while the sample size was sufficient for detecting differences in certain parameters, a larger cohort might allow for more robust subgroup analyses, especially regarding specific microbiological findings. Third, potential confounding factors such as dietary habits, oral hygiene routines at home, socioeconomic status, and level of parental involvement were not controlled for, all of which could influence oral health status. Finally, the study was conducted in a single clinical center, which may limit the generalizability of the findings to other populations or healthcare settings.\u003c/p\u003e \u003cp\u003eChildren with nephrotic syndrome under regular interdisciplinary care demonstrated better oral hygiene and a lower prevalence of key periodontal pathogens compared to healthy controls. Although no significant differences were observed in gingival inflammation parameters, microbiological findings suggest a reduced bacterial burden in the nephrotic group. These results support the value of systematic dental monitoring in medically compromised children. The implementation of integrated nephrology-dental care may play a protective role in maintaining oral health in this population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eData availability statement\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Medical University of Warsaw.\u003c/p\u003e\n\u003cp\u003eConflicts of interest\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare. This study did not receive any grant support, commercial support, or other credit.\u003c/p\u003e\n\u003cp\u003eFunding declaration\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding, grant support, commercial support, or other credit.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMurakami S, Mealey BL, Mariotti A, Chapple ILC (2018) Dental plaque-induced gingival conditions. J Periodontol 89(Suppl 1):S17\u0026ndash;S27\u003c/li\u003e\n \u003cli\u003eOlczak-Kowalczyk D, Turska-Szybka A, Studnicki M, Piekoszewska-Ziętek P (2024) Gingivitis and its causes in children aged 3\u0026ndash;7 years. Diagnostics (Basel) 14:2690\u003c/li\u003e\n \u003cli\u003eJepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J et al. (2018) Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop. 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J Clin Pediatr Dent 37:89\u0026ndash;93\u003c/li\u003e\n \u003cli\u003e\u0026Ccedil;eting\u0026uuml;\u0026ccedil; A, Tek\u0026ccedil;i\u0026ccedil;ek M, G\u0026uuml;ng\u0026ouml;r HC (2004) Oral health status of medically compromised children referred for dental consultations: a retrospective study. J Clin Pediatr Dent [insert volume/pages if available]\u003c/li\u003e\n \u003cli\u003eKaczmarek U, Wrzyszcz-Kowalczyk A, Jankowska K et al. (2021) Selected salivary parameters in children with idiopathic nephrotic syndrome: a preliminary study.\u0026nbsp;BMC Oral Health 21:17\u003c/li\u003e\n \u003cli\u003eAnuradha BR, Katta S, Kode VS, Praveena C, Sathe N, Sandeep N, Penumarty S (2015) Oral and salivary changes in patients with chronic kidney disease: a clinical and biochemical study. J Indian Soc Periodontol 19:297\u0026ndash;301\u003c/li\u003e\n \u003cli\u003eKodaman Dokumacıgil N, Sezer B, Oktay Ş et al. (2025) Dental caries, oral hygiene and salivary characteristics in children with chronic kidney disease: a case\u0026ndash;control study. Pediatr Nephrol. https://doi.org/10.1007/s00467-025-06730-4\u003c/li\u003e\n \u003cli\u003eJung YJ, Jun HK, Choi BK (2017) Porphyromonas gingivalis suppresses invasion of Fusobacterium nucleatum into gingival epithelial cells. J Oral Microbiol 9:1320193\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"nephrotic syndrome, gingivitis, oral hygiene, periodontal pathogens","lastPublishedDoi":"10.21203/rs.3.rs-6601091/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6601091/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjectives\u003c/p\u003e\n\u003cp\u003eThis study aimed to evaluate oral hygiene, gingival condition, and the presence of selected periodontal pathogens in children with nephrotic syndrome (NS) compared to healthy controls. The primary research question was whether interdisciplinary care contributes to better oral health in this medically compromised group.\u003c/p\u003e\n\u003cp\u003eMaterials and Methods\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted among 86 children aged 5–17 years, including 40 patients with NS and 46 healthy controls. Clinical evaluation included the Plaque Index (Pl.I.), Approximal Plaque Index (API), Gingival Index (GI), Bleeding on Probing (BoP), and presence of dental calculus. Periodontal pathogens were identified using the PET Plus microbiological test.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eChildren with NS had better interdental hygiene and a higher proportion of individuals with good oral hygiene. Gingival inflammation indicators (GI, BoP) did not differ significantly between groups. Notably, the prevalence and bacterial load of Treponema denticola and Fusobacterium nucleatum were lower in the NS group. Dental calculus was also less frequently observed in these patients.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eDespite being a medically vulnerable population, children with nephrotic syndrome under interdisciplinary care demonstrated favorable oral hygiene and reduced colonization by key periodontal pathogens. These findings suggest that systematic dental follow-up integrated with nephrology care may have a protective effect on oral health and help prevent inflammation-associated complications.\u003c/p\u003e\n\u003cp\u003eClinical Relevance\u003c/p\u003e\n\u003cp\u003eImplementing regular dental screening within pediatric nephrology care can enhance early intervention, reduce oral disease burden, and support systemic health in children with nephrotic syndrome.\u003c/p\u003e","manuscriptTitle":"Evaluation of Oral Hygiene and Gingival Parameters in Pediatric Nephrotic Syndrome within an Interdisciplinary Care Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-15 09:43:38","doi":"10.21203/rs.3.rs-6601091/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-19T06:53:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-17T23:45:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278606673368637239164176481517688450023","date":"2025-05-17T09:29:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-13T05:32:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97927977906925899756181150631656478763","date":"2025-05-13T04:33:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-13T00:37:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T00:34:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-07T12:58:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-07T04:49:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-05-06T08:55:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"87ddffb0-d3be-4a10-ba5f-408ad94eeb6d","owner":[],"postedDate":"May 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":48516422,"name":"Health sciences/Diseases/Kidney diseases"},{"id":48516423,"name":"Health sciences/Diseases/Oral diseases"}],"tags":[],"updatedAt":"2025-07-07T16:11:17+00:00","versionOfRecord":{"articleIdentity":"rs-6601091","link":"https://doi.org/10.1038/s41598-025-06687-2","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-01 15:57:55","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-05-15 09:43:38","video":"","vorDoi":"10.1038/s41598-025-06687-2","vorDoiUrl":"https://doi.org/10.1038/s41598-025-06687-2","workflowStages":[]},"version":"v1","identity":"rs-6601091","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6601091","identity":"rs-6601091","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}