Oral health and hemodialysis: summary of literature review.
\\n\\n
Dr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\\n\\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\\n\\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\\n\\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\\n\\nThank you all for being part of the journey. 5,000 times thank you!
\\n\\nNow with 5,000 titles available Open Access, which one will you read next?
\\n\\nRead, share and download for free: https://www.intechopen.com/books
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Preparation of Space Experiments edited by international leading expert Dr. Vladimir Pletser, Director of Space Training Operations at Blue Abyss is the 5,000th Open Access book published by IntechOpen and our milestone publication!
\n\n"This book presents some of the current trends in space microgravity research. The eleven chapters introduce various facets of space research in physical sciences, human physiology and technology developed using the microgravity environment not only to improve our fundamental understanding in these domains but also to adapt this new knowledge for application on earth." says the editor. Listen what else Dr. Pletser has to say...
\n\n\n\nDr. Pletser’s experience includes 30 years of working with the European Space Agency as a Senior Physicist/Engineer and coordinating their parabolic flight campaigns, and he is the Guinness World Record holder for the most number of aircraft flown (12) in parabolas, personally logging more than 7,300 parabolas.
\n\nSeeing the 5,000th book published makes us at the same time proud, happy, humble, and grateful. This is a great opportunity to stop and celebrate what we have done so far, but is also an opportunity to engage even more, grow, and succeed. It wouldn't be possible to get here without the synergy of team members’ hard work and authors and editors who devote time and their expertise into Open Access book publishing with us.
\n\nOver these years, we have gone from pioneering the scientific Open Access book publishing field to being the world’s largest Open Access book publisher. Nonetheless, our vision has remained the same: to meet the challenges of making relevant knowledge available to the worldwide community under the Open Access model.
\n\nWe are excited about the present, and we look forward to sharing many more successes in the future.
\n\nThank you all for being part of the journey. 5,000 times thank you!
\n\nNow with 5,000 titles available Open Access, which one will you read next?
\n\nRead, share and download for free: https://www.intechopen.com/books
\n\n\n\n
\n'}],latestNews:[{slug:"intechopen-authors-included-in-the-highly-cited-researchers-list-for-2020-20210121",title:"IntechOpen Authors Included in the Highly Cited Researchers List for 2020"},{slug:"intechopen-maintains-position-as-the-world-s-largest-oa-book-publisher-20201218",title:"IntechOpen Maintains Position as the World’s Largest OA Book Publisher"},{slug:"all-intechopen-books-available-on-perlego-20201215",title:"All IntechOpen Books Available on Perlego"},{slug:"oiv-awards-recognizes-intechopen-s-editors-20201127",title:"OIV Awards Recognizes IntechOpen's Editors"},{slug:"intechopen-joins-crossref-s-initiative-for-open-abstracts-i4oa-to-boost-the-discovery-of-research-20201005",title:"IntechOpen joins Crossref's Initiative for Open Abstracts (I4OA) to Boost the Discovery of Research"},{slug:"intechopen-hits-milestone-5-000-open-access-books-published-20200908",title:"IntechOpen hits milestone: 5,000 Open Access books published!"},{slug:"intechopen-books-hosted-on-the-mathworks-book-program-20200819",title:"IntechOpen Books Hosted on the MathWorks Book Program"},{slug:"intechopen-s-chapter-awarded-the-guenther-von-pannewitz-preis-2020-20200715",title:"IntechOpen's Chapter Awarded the Günther-von-Pannewitz-Preis 2020"}]},book:{item:{type:"book",id:"1882",leadTitle:null,fullTitle:"Earth and Environmental Sciences",title:"Earth and Environmental Sciences",subtitle:null,reviewType:"peer-reviewed",abstract:"We are increasingly faced with environmental problems and required to make important decisions. 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He is listed in the Committee of IAMSET (International Association of Management Science and Engineering Technology, Hong Kong) and he is working with InTech (Croatia) on a new journal project.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Tamil University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"151751",title:"Dr.",name:"Mithas Ahmad",middleName:null,surname:"Dar",slug:"mithas-ahmad-dar",fullName:"Mithas Ahmad Dar",profilePictureURL:"https://mts.intechopen.com/storage/users/151751/images/system/151751.jpg",biography:"Mithas Ahmad Dar completed his BSc at the University of Kashmir, India in January 2003, followed by an MSc in Environmental Sciences from the University of Kashmir, India in January 2005. 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Anemometry",doi:"10.5772/51989",slug:"analytical-and-experimental-investigation-about-heat-transfer-of-hot-wire-anemometry",body:'
The hot-wire anemometer is a famous thermal instrument for turbulence measurements [1]. The principle of operation of the anemometer is based on the heat transfer from a fine filament where it is exposed to an unknown flow that varies with deviation in the flow rate. The hot-wire filament is made from a special material that processes a temperature coefficient of resistance [2]. Thermal anemometry is the most common method employed to measure instantaneous fluid velocity. It may be operated in one of these two modes, constant current (CC) mode and constant temperature (CT) mode.
Constant-Current (CC) mode: In this mode, the current flow through the hot wire is kept constant and variation in the wire resistance caused by the fluid flow is measured by monitoring the voltage drop variations across the filament.
Constant Temperature (CT) mode: In this mode, the hotwire filament is positioned in a feedback circuit and tends to maintain the hotwire at a constant resistance and hence at a constant temperature and fluctuations in the cooling of the hot wire, filaments are similar to variations in the current flow through the hotwire.
Hot wire anemometers are normally operated in the constant (CTA) mode. The hot-wire anemometry has been used for many years in fluid mechanics as a relatively economical and effective method of measuring the flow velocity and turbulence. It is based on the convective heat transfer from a heated sensing element.Briefly; any fluid velocity change would cause a corresponding change of the convective heat loss to the surrounding fluid from an electrically heated sensing probe. The variation of heat loss from the thermal element can be interpreted as a measure of the fluid velocity changes. In subsonic incompressible flow the heat transfer from a hot wire sensor is dependent on the mass flow, ambient temperature and wire temperature. Since density variations are assumed to be zero, the mass flow variations are only function of velocity changes. The major advantage of maintaining the hot wire at a constant operational temperature and thereby at a constant resistance is that the thermal inertia of the sensing element is automatically adjusted when the flow conditions are varied. The electronic circuit of chosen CTA is shown schematically in Fig. 1. This mode of operation is achieved by incorporating a feedback differential amplifier into the hot-wire anemometer circuit. Such set-up obtains a rapid variation in the heating current and compensates for instantaneous changes in the flow velocity [2]. The sensing element in case studied in this research is a tungsten wire that is heated by an electric current to a temperature of approximately 250 oC. The heat is transferred from the wire mainly through convection. This heat loss is strongly dependent on the excess temperature of the wire, the physical properties of the sensing element and its geometrical configuration. The authors strive to present an analytical solution for heat transfer equation of hotwire for states that can ignore the radiation term for the wire. The fundamental principle of hot-wire anemometer is based on the convective heat transfer, thus in the research, an attempt is made to develop a better perception from the heat transfer of the hot-wire sensor. Also, the effect of air flow temperature variations on the voltage of hot wire, CTA has been studied experimentally. Furthermore, on the basis of air flow velocity and ambient temperature variations, the percentage errors in velocity measurements have been calculated. Finally, based on results, an accurate method has been proposed to compensate for air flow temperature variations.
Schematic of a constant temperature anemometer
The hot-wire involves one part of a Wheatstone bridge, where the wire resistance is kept constant over the bandwidth of the feedback loop. The electrical power dissipation
I and Rw are the current passing through the sensor and the resistance of the sensor at the temperature Tw, respectively. The convection heat transfer rate to the fluid can be expressed in terms of the heat-transfer coefficient h, as:
Where Aw is the surface area of sensor and (Tw-Ta) is the difference between the temperature of the hot-wire sensor and the temperature of the fluid. For steady-state operation, the rate of electric power dissipation equals to the rate of convective heat transfer (assuming the conductive heat transfer to the two prongs is negligible). Thus,
By introducing the wire voltage
According to the pioneering experimental and theoretical work by King, the convective heat transfer is often expressed in the following form:
Where A and B are empirical calibration constants. For long wires in air, King found that A=0.338, B=0.69 and n=0.5. It is interesting to note that King based his derivations on the assumption of potential flow, which is a poor approximation of the real flow around a wire at low Reynolds’ numbers, so King’s derivation is in a sense approximately erroneous. Nevertheless, King’s law has been the considered tool for fitting calibration data in practical hot-wire anemometry for almost a hundred years [3].
By introducing equation (5) into equation (4) can give:
Equation (6) states that the hot-wire voltage is sensitive both to the velocity and temperature of air. Here, rearranging the equation (6) gives:
Where π, l, k, d, ρ and μ have been included in the constant coefficients A and B.
According to equation (7), Kanevce and Oka [4] introduced the following expression to correct the hot-wire output voltage for the temperature drift:
Ta,r is ambient reference temperature during sensor calibration and Ta is ambient temperature during data acquisition where Ecorr is corrected voltage. For a hot wire probe with a finite length active wire element, the conductive heat transfer to prongs must be taken into account. In practice this is often achieved by the modifying equation [7] as:
The values of A, B and n can be determined by a suitable calibration procedure. It should be noted that the term (Tw-Ta) and physical properties of fluid are dependent on the ambient temperature. In the previous related studies, the effect of term (Tw-Ta) is considered only to compensate the ambient temperature variations [5]. In other word, the variations of physical properties of fluid and Nusselt number are ignored. So in this study, the variations of Nusselt number with the fluid temperature have been considered. The following equation for correction of output voltage E. has been proposed by the relations extended in Ref. [6].
In Ref. [7], equation (10) is employed to correct the voltage of CTA output. Results showed that the required error correction factor (m) depends on whether the fluid temperature decreases or increases with respect to the calibration temperature of the CTA.
The CT mode velocity and temperature sensitivities corresponding to equation (9) are:
Where θ is a small fluctuation in the fluid temperature. Equations (11) and (12) show that the value of Su increases and the value of Sθ decreases by increasing the value of (Tw-Ta). A high over-heat ratio (Rw/Ra) is recommended for the measurement of velocity fluctuations [2]. In Ref. [7], it is stated that for an over-heat ratio of 1.4, the error incurred amounts to about 2.5% per degree Celsius temperature change. With the increase in the overheat ratio to 1.6, the error in CTA output is reduced to about 2% per degree Celsius temperature change.
The heat transfer process from a hot-wire sensor is usually expressed in a non-dimensional form where involve a relationship between the Nusselt number, the Reynolds number and the Prandtl number. The Nusselt number is usually assumed to be a function of Reynolds and Prandtl numbers and under most flow conditions, the Prandtl number is constant.
In hot-wire anemometry, the sizes of the sensing element are small, so that the Reynolds number of the flow is very low and the flow pattern over the sensor can be assumed to be symmetrical and quasi-steady. Due to the statement of the flow continuity, the mean free path of the particles is very much less than the diameter of the wire and conventional heat transfer theories are applicable [8]. Furthermore, the length of the sensor is much greater than its diameter. Hence, it may be assumed that the loss conduction through the ends is negligible and the relation for the heat transfer from an infinite cylinder can be applied. Kramers [9] has proposed the following equation based on heat-transfer experimental results for wires (with infinite length-to-diameter ratio), placed in air, water and oil:
He selected the film temperature Tf = (Tw+Ta)/2 as the reference temperature for the fluid properties.
An air condition unit was used to carry out the experiments (Fig. 2). A laminar airflow was achieved by means of honeycombs network and screens. The air condition unit is powered by a small variable speed electric fan and four controllable heating elements provide a stable air temperature. The air flow velocity was measured by a pitot tube and a pressure transducer during the calibration and test. The output voltage from the hot-wire, pressure transducer output voltage, and the thermometer (NTC) output voltage are transferred to a computer, via an A/D card, having a 12 bit resolution and up to 100 kHz frequency.
The sensing element in our case is a standard 5μm diameter tungsten wire that is heated by an electric current to a temperature of approximately 250 oC. The active wire length is 1.25 mm. For such probes, the convective heat transfer is about 85 percent of the total heat transfer from the heated-wire element [2].
Before measurements, the hot-wire sensor was calibrated in a wind tunnel and the response of the anemometer bridge voltage was also expanded as a least square fit with a 5th order polynomial (U=C0+C1E+C2E2+C3E3+C4E4+C5E5).
The experiments were carried out on a hot wire sensor operating at an over-heat ratio (Rw/Ra) of 1.8. The sensor, after calibration, was tested at different temperatures. The velocity range was 1-2 m/s, which corresponds to a Reynolds number of 0.18-0.35, and the temperature range, was 17.5-40 °C.
The laboratory air condition unit
To examine the behavior of the hot wire sensor in different conditions and determine the temperature distribution along it, the general hot wire equation must be derived initially. By considering an incremental element of the hot wire, Fig.3, an energy balance can be performed where assume that there is the uniform temperature over its cross-section according to the equation (14).
Heat balance for an incremental element [2].
Where I is electrical current, χw is the electrical resistant of the wire material at the local wire temperature, Tw, and Aw is the cross-sectional area of wire where h is the heat-transfer coefficient, cw is the specific heat of the wire material per unit mass, kw is the thermal conductivity of the wire material and d is the diameter of wire. With using the fourth-order Runge-Kutta method, this nonlinear secondary differential equation is solved in two conditions: with radiation term and without radiation term. Fig.4 shows the results for this step. As it is shown, the radiation term does not have any effect on the temperature distribution. The previous results achieved in Ref.[3] indicate that, the error due to radiation is in the range 0.1-0.01% and is quite negligible.
The solution of equation (14) with and without radiation term
Under steady conditions,
With assuming the ambient temperature is constant along the wire, this equation is of the following form (16):
Where
T1=Tw-Ta
AndThe value of K1 may be negative or positive. Therefore, the solution of equation (16) and temperature distribution along the wire are dependent on the value of K1. Equation (16) is solved in three states: K1<0, K1=0, K1>0.
For more hot-wire applications, K1 will be negative [2]. In Ref. [2], it is declared that in this state, the solution for a wire of length L will become:
The mean wire temperature, Tw,m is obtained by integrating equation (17):
Inserting equation (17) into equation (18) gives:
The non-dimensional steady state wire temperature distribution will be achieved such as equation (20) [2]:
Where Ta is the ambient fluid temperature and Tw,m is the mean wire temperature.
The convective and conductive heat transfer rate can be found from the flow conditions and the wire temperature distribution will earn according to the following equations:
To achieve a reasonable accuracy, the ratio of conductive heat transfer to convective heat transfer should be as low as possible.
According to equation (23), to reduce the effect of the conductive heat transfer rate, the wire should be as long as possible and the thermal conductive of the wire material should have a low value.
The temperature distribution in the form (Tw-Ta)/ (Tw,m-Ta), is shown in Fig.5. It is shown that the uniformity of the temperature distribution along the wire increases for longer length wires. Also, the value of temperature in different parts of the wire approaches to mean temperature with escalating the length wire.
The temperature distribution along a hot wire for various values of L (K1<0).
The effect of wire length on the percent of conduction and convection heat transfer is shown in Fig. 6. (Diameter of wire is 5μm and the air velocity is equal to 20 m/s). As it is shown the conductive end losses reduces with increasing the wire length but it should be noted, the maximum value of tanh (0.5L |K1|0.5) is approximately 1, so exceeding the wire length over 5.3/|K1|0.5 will not cause a reduction in the conductive heat transfer rate.
The percent of conduction and convection heat transfer for different wire length.
For hot-wire anemometer applications it is usually advantageous to minimize the rate of conductive heat transfer rate relative to the forced convective heat transfer rate [2]. Fig.7 shows the effect of wire diameter on the non-dimensional temperature distribution. It is shown, the uniformity of temperature distribution decreases with increasing the wire diameter. This variation is due to increasing the wire diameter that will cause the conductive heat transfer rate to the two prongs to be increased as well.
The temperature distribution along the hot wire for various values of d (K1<0).
Comparing between Figs. 6 and 7 shows that the wire diameter has the greater influence on the temperature distribution rather than the wire length.
In this state, the temperature distribution equation is obtained as:
According to equations (24) and (18), the mean wire temperature is determined as:
By using equations (24) and (25), the non-dimensional wire temperature distribution can be expressed as:
For this state, the non-dimensional temperature distribution is shown in Fig.8. It can be observed that the temperature distribution along the wire is independent of the wire length and for various values of L, all temperature profiles are identical. Also, it can be observed from equation (26) that the non-dimensional temperature distribution does not depend on the wire diameter.
The temperature distribution along a hot wire for various values of L (K1=0).
Furthermore, the ratio of conductive heat transfer rate to the forced convective heat transfer rate can be expressed as:
While it is shown, this ratio is directly proportional to the length and it will increase with inverse proportion to the wire diameter.
Using the mathematical analysis, it can be demonstrated that temperature distribution equation is:
The mean wire temperature and the non-dimensional wire temperature distribution can be expressed as:
Fig.9 shows the non-dimensional temperature distribution (K1>0). As it is shown, in this state some fluctuations appear in the temperature profiles. It can be demonstrated from equation (28) that, with approaching the wire length to π/|k1|0.5, these fluctuations increases wherever the amplitude oscillatin decreases with growing the wire length.
The temperature distribution along a hot wire for various values of L (K1>0).
It should be noted that the temperature profile is strongly dependent on the value of K1 which is relevant to the heat transfer coefficient (Nusselt number). With setting the value of K1 to zero, one could determine the critical Nusselt number as the following equation:
In summary, the authors consider the temperature distribution along the hot-wire in the following cases:
Case I, Nu>Nu critical: in this case, increasing the wire length and decreasing the wire diameter will cause the uniformity of temperature distribution to be increased considerably.
Case II, Nu=Nu critical:in this case, the temperature distribution is independent of length and diameter of wire.
Case III, Nu<Nu critical: here, temperature distribution is non-uniform and there are some fluctuations in temperature distribution.
According to equation (4), by knowing Ew, Rw, Tw and Ta in the anemometer, one can calculate the Nu number. The electrical resistance of the wire’s material increases linearly with temperature, so that the resistance can be described as:
Where R0 is the value of the resistance at a reference temperature T0 and α is the temperature coefficient of resistance. The recommended value for over-heat ratio is equal to 1.8 and the wire temperature of the chosen probe is then 249.22 oC.
In practical application, the hot-wire anemometer output is bridge voltage E (Fig. 1) whereas for determining the Nusselt number, the value of Ew is required. For a balanced anemometer bridge, the relationship between E (bridge voltage) and Ew (hot-wire sensor voltage) is:
For comparison, the calculated Nusselt number by equation (4) that it is based on the fluid properties evaluated at the film temperature defined as the mean of the upstream flow temperature and temperature on the hot wire versus Reynolds number where based on the fluid properties evaluated at the film temperature is presented in Fig.10 with Kramer’s experimental formula.
As it is shown, the data does not collapse to one curve and the deviation increases with increasing Reynolds number. Our results are lower than those given by Kramer’s formula and the differences may be caused by the effect of conductive heat transfer to the prongs and three-dimensional effect encountered in experiments. In Ref. [2], it is stated that for a standard probe (d=5μm and l=1.25 mm), the conductive heat transfer to the two prongs is about 15 percent of the total heat transfer from the heated-wire element. Although, the results in this study show that at the high velocity, the percentage of error between the predicted Nusselt number by Kramer’s formula and the achieved Nusselt number in this study is 50%. This result confirms that, there is a significant difference between the heat transfer process from finite length hot-wire sensor and infinite length one.
Heat transfer from a hot wire in a free stream flow.
In the next phase, the thermal response of the hot-wire anemometer relative to the velocity and also the air ambient temperature variation is investigated [11]. Figs. 11 and 12 show the variation of convection heat transfer coefficient (h) and Nusselt number versus Reynolds number at different ambient temperatures where fluid properties evaluated at the film temperature Tf =(Ta+Tw)/2.
The achieved results indicate convection heat transfer coefficient and Nusselt number vary with variation of air flow temperature and as expected, both of them decrease with increasing the ambient temperature.
Different equations have been proposed to modify the Nusselt number. Lundström et al. [3] claim that it was necessary to evaluate the fluid properties at the air temperature and their results show that evaluating the properties at the film temperature is not enough to achieve a temperature independent calibration law. Collis and Williams [10] realized, using the film reference temperature, that it was necessary to include a temperature loading factor in the Nusselt number King’s law according to the following equation;
Nusselt number (hd/k) includes both the heat-transfer coefficient and the thermal conductivity of the fluid and these parameters are dependent on the ambient temperature. The temperature role on k can be expressed as:
T and Tr are in absolute temperature but the variation of h with ambient temperature is unknown.
Variations of heat-transfer coefficient Vs. velocity at different ambient temperatures. [11]
Variations of Nusselt number Vs. Re at different ambient temperatures. [11]
However, the fundamental mechanism for variation of Nusselt number is not known yet but it can be compensated empirically by introducing the modified Nusselt number according to the following equation [11]:
Where temperatures are in absolute temperature and Ta,r is the reference temperature at which the sensor calibration is performed. When the correction is applied to the data in Fig. 12, the data collapse approximately to a single curve as shown in Fig.13.
The achieved Nusselt number Vs. Re by employing equation (36) [11].
Fig. 14 presents the response of the CTA on wind speed approximately equal to 1 and 2 m/s at various temperatures. The temperature varies between 22.5 and 37.5oC. As it is shown, the bridge voltage decreases as the higher ambient temperature.
Calibration equations do not include ambient temperature variations, so a correction procedure should be applied. There are three main practical ways [2]:
Automatic compensation: Use a temperature sensor in the Wheatstone bridge.
Manual adjustment: Manual adjustment can be made by changing the value of the resistant, Rw, to compensate the changes in Ta.
Analytical correction: Measure the flow temperature separately and compensate using the heat transfer equation.
Response of CTA at various ambient temperatures. [11]
In this research, the voltage error due to changes in the ambient temperature is corrected using equation (10) and (37):
Equation (10) only considers the effect of ambient temperature variation but equation (37) regards the effect of Nusselt variation as well the ambient temperature variation.
The percentage error is presented in Fig.15 as a function of flow temperature. The other parameters are reference temperature, Ta,r=25 °C, average sensor temperature, Tw=249.22 °C and flow velocity, U=1.5 m/s.
It can be seen that the achieved results from equation (37) are more reasonable. It should be noted that by increasing the air temperature, the fluid properties will be changed and these changes have to be taken into consideration. This factor is considered in equation (37) so that at high air temperature it can compensate the ambient temperature variations adequately.
Error in the measurement of flow velocity for the hot wire sensor [11]
The analytical solutions for heat transfer equation of hotwire indicate that the temperature distribution along a hot-wire sensor is dependent on the critical Nusselt number. Nu<Nucritical leads to increasing the wire length and decreasing the wire diameter which will cause the uniformity of temperature distribution to be increased considerably. For Nu=Nucritical, wire length and diameter don’t have any effect on the temperature distribution. If Nu>Nucritical, some fluctuations will appear in the temperature profiles.
The results from experimental investigation show that the values of both the air temperature and Nusselt number have influence on the output voltage of the CTA. In this study, two ways have been employed to compensate the ambient temperature changes. In the first case, the effect of ambient temperature variation is only considered but in the second case, the effect of Nusselt variation is also regarded. At low temperature variation, the accuracy of two methods is almost the same whereas by increasing the air temperature, the second method which consider the changes in fluid properties, provide more accurate results in compare with the first method.
Aw Surface area of sensor,m2
Cw Specific heat of the wire material per unit mass, J/Kg. K
D Wire diameter, m
E Bridge voltage,V
Ecorr Corrected voltage, V
Ew Hot-wire sensor voltage, V
H heat-transfer coefficient, W/m2.K
I Electrical current passing through the sensor, A
K Thermal conductivity of the fluid, W/m. K
kw Thermal conductivity of the wire material, W/m. K
L Wire length, m
M Temperature loading factor used in equation (10)
N Constant used in equation (7)
Nu Nusselt Number, hd/k
Pr Prandtl number, μCp/K
Re Reynolds number, ud/ν
Rw Sensor resistance
Ta Ambient temperature during data acquisition, K
Ta,r Ambient reference temperature during sensor calibration, K
Tw Temperature of hot-wire sensor, K
Tw,m Mean wire temperature, K
U Instantaneous velocity, m/s
Αo Temperature coefficient of resistivity at 0°C
Ε Emissivity of the sensor
Σ Stefan-Boltzmann constant
Μ Dynamic viscosity, N.s/m2
Healthy life is the most significant virtue of one’s existence. The physical, social, and economical productivity of an individual depends mostly on the quality of life led by an individual. Human beings have always strived to achieve an optimum milieu of internal and external environment [1]. The diseases affecting mankind can be broadly classified into two types—communicable and noncommunicable diseases. With improvement in health-care facilities, sanitation, litigation services, and treatment modalities, the reign of communicable diseases is on a decline. However, a contrary rise of noncommunicable diseases (NCDs) has been observed primarily due to changing lifestyles and diet [2].
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Kidneys play one of the vital roles in human beings as excretory organs. Their major functions include excretion of metabolic wastes, electrolyte regulation, and endocrine regulatory functions. Each human kidney is composed of about one million anatomical and functional units called nephron which is further composed of glomerule and tubule. Renal diseases pose a major health problem of modern world [5]. Compromised renal function might lead finally to renal failure which is characterized by the loss of functional capacity of nephrons associated with reduced glomerular functional rate [6]. The most frequent etiology of chronic renal failure includes diabetes mellitus, hypertension, glomerulonephritis, polycystic kidney disease, and pyelonephritis. Previously, glomerulonephritis was known to be the main cause of chronic renal failure; however, now diabetes mellitus and hypertension are the etiologic factors of the disease today which are considered to have genetic origin mostly [7, 8].
Transplantation is the ideal treatment for patients with end-stage renal disease. But, due to limited availability of matched donors for kidney transplantation, there has been an increased focus on alternative treatment modalities like hemodialysis and peritoneal dialysis. In the last three to four decades, improvements in dialysis and transplantation have reduced morbidity and mortality among patients with end-stage renal disease.
Hemodialysis treatment modality is usually prescribed for prolonged duration with weekly frequency of once, twice, or more than twice a week, thus, creating a stressful environment for the patients [9]. This long-standing treatment modality has affected the survival rate among the patients positively. However, the chronic condition might influence the incidence of other systemic diseases in these patients primarily due to the lack of their ability to control water and electrolyte balance and filtrate waste products [10].
Further, oral health among these patients undergoing hemodialysis has been reported to be poor primarily due to their delicate state, neglect of oral hygiene, manifestations of systemic conditions, and immunosuppression [11, 12]. The specific effects of chronic renal disease and renal replacement therapy on periodontal tissues include gingival hyperplasia, increased level of plaque, calculus, and destructive periodontal disease. The findings have been reported by many studies [10, 13, 14]. It is interesting to note further that the dental diseases have coherent relation with the treatment duration of hemodialysis as well [8]. Very few studies have presented a cumulative data concerning the effect of duration of hemodialysis therapy on oral health of the patients undergoing hemodialysis. Hence the present chapter gives an insight of the oral health manifestations of hemodialysis and the underlying kidney disease correlating it with the duration of the treatment modality.
Hemodialysis has emerged as an optimum treatment modality for the patients with compromised renal function significantly reducing the mortality rate of these diseases. Researchers have provided with substantial evidence that chronic systemic diseases like renal failure and its treatment modalities have a significant effect on the oral environment resulting in an increased burden of oral diseases among these patients [2, 10, 11]. An insight into the various studies conducted worldwide would help us understand the topic (Table 1).
Klassen and Krasko [7] conducted a study to assess the dental health of dialysis patients. A questionnaire and a noninvasive oral examination were obtained from hemodialysis and peritoneal dialysis patients registered in the dialysis program at St. Paul’s Hospital in Saskatoon, Saskatchewan. A detailed medical history was obtained and recorded of a total of 373 dialysis patients in Central and Northern Saskatchewan. The clinical examination revealed that 64% of the patients who were dentate had been on dialysis for a mean of more than 2 years. Majority of the patients were diabetic, and almost all were hypertensive. Sixty (64%) of the dentate patients were candidates for kidney transplantation. The oral findings revealed an increased prevalence of tooth mobility, fractures, erosion, attrition, recession, gingivitis, and a high plaque index. Majority of the patients reported brushing once or more daily, but they flossed infrequently or never. Dental visits were infrequent, less than every 5 years in 59 (63%) of the dentate patients. Almost 81% of the treating dentists were aware about the medical condition of their patients. The author has concluded that the oral health of hemodialysis patients was compromised and required urgent attention and intervention.
Ertugrul [14] assessed the oral health status of children suffering from end-stage renal disease identifying the causes of low caries prevalence in this population in comparison with the control group. The study group consisted of 38 children, aged 4–17 years being treated in pediatric nephrology units at three different hospitals in Izmir, Turkey. The study and control groups had similar baseline oral hygiene habits with respect to daily tooth brushing frequency and periodic dental checkup frequency. Oral examination findings indicated severe enamel hypoplasia in the study group with significant difference for DMFT and gingival and plaque indices when compared with the control group. It was further observed that study group showed high salivary buffer capacity in 89.5% of patients. Salivary levels of cariogenic streptococcus mutans and lactobacilli in the study group were significantly lower than in the control group. It was concluded that high salivary buffer capacity was observed due to increased concentrations of antibacterial chemicals such as urea in the saliva of children with ESRD. Also decreased levels of cariogenic microorganisms were detected. Thus, the authors suggested that all hemodialysis patients should receive dental health education, including oral hygiene instruction, in order to improve their overall oral health.
Marakogolu et al. [15] carried out a study to assess the microbial dental plaque load among the patients undergoing hemodialysis. For clinical parameters, gingival Index (GI), plaque index (PI) scores, and probing depths (PD) were recorded for hemodialysis patients and controls matched with the patient group. However, the results showed no statistically significant difference regarding clinical parameters between the two groups attributed mostly to the small sample size evaluated.
Bayraktar et al. [16] compared the periodontal and oral health status of hemodialysis patients and healthy controls. Seventy-six hemodialysis patients and 61 controls were examined for plaque deposits, gingivitis, periodontitis, calculus accumulation, and oral health status. The results showed no statistical difference in the probing pocket depths (PPD) but a highly significant difference for plaque index (P < 0.001), gingival index (GI) (P = 0.007), and calculus surface index (P < 0.001). There was a highly significant difference for GI (P = 0.001) and PPD scores (P < 0.001) between subgroups receiving hemodialysis 3 years or more. A positive correlation between time on dialysis and parameter of missing teeth, GI scores, and measurement of PPD was found in the patient group. The hemodialysis group showed less DMFT than the controls.
Torkzaban et al. [10] conducted a survey to assess the prevalence of periodontal disease and its related characteristics in 31 hemodialysis patients from the dialysis department of educational Ekbatan Hospital in Hamadan. Clinical parameters that were assessed were periodontal disease index (PDI), papillary bleeding index (PBI), and plaque control record index (PCRI), and medical history was recorded. Then, the recorded data were analyzed. It was observed that all hemodialysis patients had periodontal disease. Plaque control record index was higher than 50% in nearly all patients. Despite the high accumulation of plaque in the patients, the rate of gingival bleeding was low. Also, it was observed that more than half of the patients did not brush their teeth. Renal transplantation patients had a lower plaque accumulation than the others, and consequently periodontal disease was less observed. Periodontal condition debilitated with the duration of hemodialysis.
Joseph [13] carried out a study with an aim to assess the prevalence of periodontal disease among a group of patients with renal disease and healthy controls. A total of 77 renal disease patients and 77 healthy controls were examined for clinical parameters like oral hygiene status, gingival inflammation, probing pocket depth, and clinical attachment loss. Periodontal findings were grouped into three as no/mild, moderate, and severe periodontitis. All periodontal parameters were significantly high in patients as compared to controls (p < 0.001). The prevalence and severity of periodontal disease was also significantly higher in the case group (p < 0.001). This study provides evidence for a greater prevalence and severity of periodontal disease among patients with renal disease. The periodontal health of all patients with renal disease needs to be carefully monitored.
Dencheva [17] conducted a study to estimate the periodontal conditions and treatment needs by CPITN of 150 patients out of which 45 (30%) were on hemodialysis, 45 (30%) were renal transplanted patients, and 60 (40%) were healthy controls, aged between 18 and 84 years. All patients were asked not to brush their teeth before the examination. Periodontal examination was done after dialysis. The results showed that CPI score 3 and CPI score 2 in the control group were more significant than those in hemodialysis groups and transplanted group. Sixty percent from transplanted group have gingival pockets of up to 3.5 mm and sub- and/or supragingival calculus. The percentage of patients with code CPI 3 is also high and shallow. Most patients in control group (71%) were with CPI 2. None of the three groups of patients with healthy periodontium in all sextants existed.
Dumitrescu et al. [18] assessed oral health status and behaviors among Romanian adult individuals on renal dialysis along with self-reported anxiety, stress, and depression level. A cross-sectional study was conducted on a total sample size of 61 adults (mean age 53.9 years; 44% women; 66% married). The questionnaire included information about sociodemographic factors, behavioral factors, self-reported oral health status, anxiety, stress, and depression. The clinical parameters revealed that 99.4% of the participants reported to have current non-treated caries, 94.4% were not satisfied by appearance of own teeth, 97.5% presented extracted teeth, and 64.6% of them reported to have gum bleeding. 34.5% of the individuals brushed once a day or less, 92.5% of them never used dental floss, and 78.3% never used mouth rinse. Regarding oral hygiene practices, only 13% of participants availed dental treatment services, and 89.4% had consulted the dentist only when treatment is needed or when in pain. The main reasons for non-consultation from a dentist were anxiety and financial roadblock. A high percentage of dialysis patients presented anxiety (85.1%), stress (60.9%), and depression in everyday life (61.5%). Duration of hemodialysis did not affect the clinical oral parameters examined. The results supported the view that there was an increased risk for anxiety, stress, depression, and impaired dental/gingival health and behaviors among individuals on renal dialysis. Early dental treatment and psychological interventions were recommended.
Malekmakan [12] aimed to assess the oral health status and related risk factors in Iranian hemodialysis patients. Sociodemographic information, medical history, and dental health findings were recorded for 72 patients (mean age and HD time of 53.4 ± 15.3 years and 36.9 ± 33.8 months, respectively). The results showed that 48.6% of the patients complained of dry mouth, 49.3% of taste change, and 31% of bad breath. A high 46.9% of the hemodialysis patients had dental calculus. The mean DMFT score was 18.6 ± 9.9. The authors observed that DMFT score was significantly lower in patients with dental calculus than in patients without it (P = 0.001).
Parkar et al. [11] assessed the periodontal status of patients in hemodialysis patients in two super specialty renal institutes in Gujarat, India, through a cross-sectional study in 152 hemodialysis patients and 152 controls. Clinical parameters were evaluated through simplified oral hygiene index, community periodontal index (CPI), and loss of attachment (LOA) as per WHO methodology 1997. The findings of the study highlighted that the dialysis group had compromised oral hygiene than controls (P < 0.001). There was a high severity of periodontitis in the dialysis group as compared with the control group (P < 0.001). None of the subjects had healthy periodontium. There was a high severity of periodontitis (for both in terms of CPI and LOA) in the dialysis group as compared with control group that was found to be statistically highly significant (P < 0.001). For the intergroup comparison for CPI and LOA, there was no statistical significant difference regarding the periodontal findings. It was thus concluded that periodontal diseases are prevalent in chronic renal failure patients emphasizing the need for concurrent dental treatment among these patients.
Bhatsange et al. [19] conducted a study to gain an insight into whether duration of dialysis therapy influences the oral and periodontal health of hemodialysis patients. A total of 75 hemodialysis patients and 25 controls was assessed. Depending upon the duration of dialysis, the study groups were divided into three subgroups. Simplified oral hygiene index and periodontal disease index by Ram-fjord were recorded. The results showed that the prevalence of periodontal disease was evident in the dialysis group. Oral hygiene status was poor in comparison with the control group. Clinical and biochemical parameters showed a statistically significant difference between the groups rather than within the groups.
Ziebolz et al. [20] evaluated oral hygiene behavior and oral health status of hemodialysis patients in Germany. Dental examination findings consisted of DMFT and the degree of gingival inflammation (PDI: periodontal disease index) among 129 patients. The findings revealed the average dialysis duration was 4.1 years. The underlying kidney diseases were glomerulonephritis in 30% of patients and diabetic nephropathy in 22% of patients. Only 63% of the patients (n = 34) visited a dentist when they had complaints. In 46 cases (85%), the dentist had been informed about the patient’s requirement for dialysis, and in most cases (70%), the dental treatment took place on the day after dialysis. The clinical parameters showed that the mean DMFT of the patients was 22.1 ± 6.5. The median degree of gingival inflammation (PDI) was 1. In addition to a high proportion of missing teeth, a good level of restoration of caries was found. The gingiva showed only a low level of inflammatory changes.
Jenabian et al. [8] assessed the periodontal status of hemodialysis patients in Babol, Northern Iran. A total of 115 patients were studied (63 males, 52 females). The clinical parameters which were assessed were plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing pocket depth (PPD). The data were collected and analyzed. The results showed that PI, GI, CAL, and PPD scores were 2.37 ± 0.55, 2.36 ± 0.63, 3.98 ± 1.61, and 4.41 ± 1.4, respectively. It was observed that the PI scores deteriorated with increasing age (p < 0.024). Also, CAL was significantly higher in males than in females (4.39 ± 1.57 vs. 3.53 ± 1.56, p < 0.02). The results showed that longer duration of hemodialysis is associated with severe periodontal diseases, especially in males.
Kaushik et al. [21] assessed the changing oral and salivary environment in patients suffering from end-stage renal disease (ESRD) and undergoing hemodialysis. A cross-sectional study was conducted on 100 ESRD patients over a period of 15 months out of which 25 patients were randomly selected to assess the salivary changes and compared with 25 controls. The study showed that most common oral manifestations in these patients were oral malodor, dry mouth, taste change, increased caries incidence, calculus formation, and gingival bleeding. The salivary findings revealed that the rates of both unstimulated and stimulated whole saliva decreased in patients; however, pH and buffer capacity of unstimulated whole saliva increased. The authors have suggested that ESRD patients undergoing hemodialysis require special considerations during dental treatment as they have varied oral manifestations primarily due to their treatment modality.
Xie et al. [22] evaluated oral health status and oral hygiene behavior among hemodialysis patients in China. Caries status was examined and recorded along with the sociodemographic information of 306 patients, aged 24–88 (58.09 ± 14.06). It was interesting to note that that majority of the patients followed good oral hygiene practices and brushed their teeth twice daily. However, limited use of other oral hygiene aids like floss or mouth wash was reported. The oral health treatment seeking behavior was compromised since the commencement of hemodialysis therapy. The mean DMFT scores of the patient were 9.63 ± 7.54. It was concluded that hemodialysis therapy seemed to prevent patients from visiting a dentist and there was a great need for dental treatment among these patients.
Jain et al. [23] conducted a study to assess the effect of duration of hemodialysis and the underlying kidney disease on the dental health status of patients undergoing hemodialysis and to compare their dental health status with that of healthy controls. A cross-sectional study was conducted on 400 patients and 400 controls selected through stratified random sampling method from five zones of Delhi. Based on the duration of hemodialysis, the patient group was divided into subgroups ranging from less than 3 months to more than 12 months. The complete oral health status was recorded using the WHO dentition status and treatment need, community periodontal index, oral hygiene index, and prosthetic status and prosthetic needs. It was observed that with increasing duration of hemodialysis, periodontal status worsened as per maximum CPI scores (p value = 0.018). Majority of patients (81.25%) reported the presence of calculus. It was interesting to observe that the severity of periodontal disease was higher among the patient group (p value 0.035). Oral hygiene status was also compromised among patients (mean OHI scores 5.15 ± 1.975). No significant difference was observed regarding caries status among patients and controls. Prosthetic needs were higher among patients. It was thus concluded that the duration of hemodialysis had a significant influence on oral hygiene status and prosthetic needs signifying the need of preventive dental treatment.
S. No. | Oral findings in hemodialysis patients | Previous studies |
---|---|---|
1. | Debilitated periodontal status | 1. Klassen and Krasko [7] 2. Bayraktar et al. [16] 3. Torkzaban et al. [10] 4. Joseph [13] 5. Dencheva [17] 6. Malekmakan [12] 7. Parkar et al. [11] 8. Bhatsange et al. [19] 9. Ziebolz et al. [20] 10. Jenabian et al. [8] 11. Kaushik et al. [21] 12. Jain et al. [23] |
2. | Poor dental caries status | 1. Dumitrescu et al. [18] 2. Ziebolz et al. [20] |
3. | Poor oral hygiene behavior | 1. Klassen and Krasko [7] 2. Dumitrescu et al. [18] 3. Xie et al. [22] |
4. | Neglected oral health care seeking behavior among hemodialysis patients | 1. Klassen and Krasko [7] 2. Dumitrescu et al. [18] 3. Xie et al. [22] 4. Jain et al. [23] |
5. | Increased salivary buffer capacity | 1. Ertugrul [14] 2. Kaushik et al. [21] |
Oral health and hemodialysis: summary of literature review.
The present chapter highlights the fact that oral health status is debilitated and compromised among the hemodialysis patients and gets worsened with increasing duration and hemodialysis and underlying kidney disease which might contribute significantly to morbidity and potential mortality among these patients. This further emphasizes the concept of common risk factor approach with multidisciplinary patient care approach.
The dental health is compromised in patients undergoing hemodialysis therapy, and with the increasing duration of hemodialysis, various clinical oral health-related parameters get worsened with increasing duration of hemodialysis. The chronic disease condition and time-taking treatment (hemodialysis) affect the oral health-care habits resulting in poor periodontal condition among the patients. The psychological effect of long-standing kidney diseases resulting in high stress level and depression in hemodialysis patients compromises the periodontal health further. Hence, oral health promotive and preventive intervention early in the hemodialysis patients can influence the oral health status positively.
This warrants the need for intensified preventive oral health-care modalities in these patients, so as to improve their dental health which can have a significant impact on their overall health. The dialysis team should be encouraged to make the dental referral as early as possible, if needed, and regular monthly dental checkups should be advocated. Further emphasis on the effective implementation of oral health promotion program for medically compromised patients is recommended. Oral health education and counseling regarding oral health-care-seeking behavior during the hemodialysis appointment can motivate and educate patients along with their family members. At the same time, dental fraternity should receive appropriate training for treatment of these medically compromised patients to cater to the needs of this special group.
Analysis of the effect of duration of dialysis on the periodontal tissues did not show confirmatory relationship. However the frequency of hemodialysis has a significant influence on the periodontal status of the patients with a deteriorated CPI scores with the increased frequency of hemodialysis from once to twice and more than twice a week.
Also, there is a significant existence of higher prosthetic needs concerning to mouth among the patients undergoing hemodialysis. Hence, oral health-care delivery system may be strengthened to cater to the prosthetic needs of these patients as well. Increased prosthetic needs of the patients with the duration of dialysis might be attributed to the dental care denial by the dental practitioners owing to their compromised medical status.
The hemodialysis patients usually report poor oral hygiene. These patients exhibit immunocompromised state although they are not completely immune deficient and are still able to deal with bacterial challenge. The patients with chronic kidney disease showed poor oral hygiene which could probably be due to long-standing disease duration leading to a debilitated oral hygiene. Further there is high deposit of calculus on teeth due to uremic salivary pH in hemodialysis patients.
Majority of the hemodialysis patients suffer from diabetic nephropathy and have strict dietary pattern. Further, increased alkalinity of the oral cavity is reported in the uremic patients as a result of high urea level in saliva inhibiting bacterial growth and increasing salivary buffer capacity [23].
Further studies are required to correlate the dental findings with the biochemical serum markers over a duration of time so as to validate the influence of duration of dialysis therapy on dental health.
The current chapter highlights the relation between oral health and hemodialysis. This further necessitates more interdisciplinary research on this topic. Medical and dental health-care professionals need to join hands and work together ensuring optimum patient care.
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",metaTitle:"Prior Publication Policy",metaDescription:"Prior Publication Policy",metaKeywords:null,canonicalURL:"/page/prior-publication-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"A significant number of working papers, early drafts, and similar work in progress are openly shared online between members of the scientific community. It has become common to announce one’s own research on a personal website or a blog to gather comments and suggestions from other researchers. Such works and online postings are, indeed, published in the sense that they are made publicly available. However, this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
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\\n"}]'},components:[{type:"htmlEditorComponent",content:'A significant number of working papers, early drafts, and similar work in progress are openly shared online between members of the scientific community. It has become common to announce one’s own research on a personal website or a blog to gather comments and suggestions from other researchers. Such works and online postings are, indeed, published in the sense that they are made publicly available. However, this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
\n\nThe significance of Peer Review cannot be overstated when it comes to defining, in our terms, what constitutes a published scientific work. Peer Review is widely considered to be the cornerstone of modern publishing processes and the key value-adding contribution to a scholarly manuscript that a publisher can make.
\n\nOther than the issue of originality, research misconduct is another major issue that all publishers have to address. IntechOpen’s Retraction & Correction Policy and various publication ethics guidelines identify both redundant publication and (self)plagiarism to fall within the definition of research misconduct, thus constituting grounds for rejection or the issue of a Retraction if the work has already been published.
\n\nIn order to facilitate the tracking of a manuscript’s publishing history and its development from its earliest draft to the manuscript submitted, we encourage Authors to disclose any instances of a manuscript’s prior publication, whether it be through a conference presentation, a newspaper article, a working paper publicly available in a repository or a blog post.
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\n\nSome basic information about the editorial treatment of different varieties of prior publication is laid out below:
\n\n1. CONFERENCE PAPERS & PRESENTATIONS
\n\nGiven that conference papers and presentations generally pass through some sort of peer or editorial review, we consider them to be published in the accepted scholarly sense, particularly if they are published as a part of conference proceedings.
\n\nAll submitted manuscripts originating from a previously published conference paper must contain at least 50% of new original content to be accepted for review and considered for publication.
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\n\nAlthough such papers are regularly made publicly available via personal websites and institutional repositories, their general purpose is to gather comments and feedback from Authors’ colleagues in order to further improve a manuscript intended for future publication.
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