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KIDNEY DISEASE

ORAL EFFECTS

People with kidney disease often have other health issues. They often have compromised immune systems, so they may be more likely to get infections, including oral diseases such as gum disease (periodontitis). Chronic kidney disease is associated with an increase in the number of bacteria in the mouth that can cause dental cavities. >/p?

People with renal (kidney) problems may have a bad taste in their mouths and bad breath (halitosis). This occurs because the kidneys fail to remove urea from the blood. The urea breaks down to form ammonia, which has a foul smell. Bone changes also can occur because the body cannot absorb calcium properly. Therefore, people with kidney disease are at risk for losing bone from their jaws. Their teeth may become loose and eventually fall out.

Many symptoms and complications of kidney disease can affect dental treatment. These include:

  • Anorexia (an eating disorder)
  • Anemia (a blood disorder)
  • High blood pressure and heart disease
  • Dry mouth (xerostomia)
  • Periodontal (gum) disease, which leads to loose teeth, and eventually to tooth loss
  • Inflammation of the mouth and salivary glands

Kidney disease itself causes some of these symptoms. Others are caused by medicines and treatments for the disease.

AT THE DENTIST

If you are on dialysis (either hemodialysis or peritoneal dialysis), you and your dentist should plan to schedule your dental treatments on the day after a dialysis treatment. If you have a shunt, you may be given a blood thinner, which can increase the risk of bleeding. Because of the shunt, you may be at higher risk for certain infections. For this reason, your doctor may prescribe antibiotics for you to take before dental treatment.

Tell anyone who takes your blood pressure that you have a shunt. The blood pressure cuff should not be placed on the arm with the shunt. Your blood pressure should be taken on the other arm, or on a leg.

Tell your dentist and physician about all the medicines you take. This should include over-the-counter vitamins and herbal supplements. Also, let your dentist know if you have had a sensitive or allergic reaction to any medicine.

Your dentist will consider the medicines you take before prescribing other drugs. Some medicines may make kidney failure worse. Some may build up in the body until the next dialysis. Kidney disease can affect your blood counts. Give a copy of your most recent blood tests to your dentist as often as it is available.

For patients who are being evaluated for a kidney transplant a dental examination is required to make sure that dental infections are addressed prior to approval for the transplant procedure. For patients post kidney transplant already on immunosuppressive medicines, it is particularly important to eliminate all potential sources of infection. This includes the teeth and supporting structures of the mouth. These patients, as well as all chronic kidney disease patients, need to have meticulous home care and visit the dentist regularly.

There is ongoing research about the possible effect of periodontal disease on chronic kidney disease. The chronic inflammation associated with periodontal disease causes proteins (cytokines) to be released into the bloodstream. These may exacerbate chronic diseases like chronic kidney disease.

 

Last updated June 30, 2021

 

References:

  • Swapna L, Koppolu P at al. Oral health in diabetic and non-diabetic patients with chronic kidney disease. Saudi j Kidney Dis Transplant. Sep-Oct 2017;28(5):1099-1105. Doi:10.4103/1319-2442.215123 PMID: 28932069
  • Kopic V,Barbic J et al. Periodontal disease in different stages of chronic kidney disease. Acta Clin Croat. 2019 Dec;58(4):709-715. Doi:10.20471/acc2019.58.04.18. PMID:32595256
  • Ruokonen H, Nylund K, Meurman JH, Heikkinen AM, Furuholm J, Sorsa T, Roine R, Ortiz F. Oral symptoms and oral health-related quality of life in patients with chronic kidney disease from predialysis to posttransplantation. Clin Oral Investig. 2019 May;23(5):2207-2213. doi: 10.1007/s00784-018-2647-z. Epub 2018 Oct 2. PMID: 30276517.
  • Menezes CR, Pereira AL, Ribeiro CC, Chaves CO, Guerra RN, Thomaz ÉB, Monteiro-Neto V, Alves CM. Is there association between chronic kidney disease and dental caries? A case-controlled study. Med Oral Patol Oral Cir Bucal. 2019 Mar 1;24(2):e211-e216. doi: 10.4317/medoral.22737. PMID: 30818314; PMCID: PMC6441594.