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LETTER TO EDITOR
Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 41-42

Optimization of complex dental status of patients with hemodialysis and renal transplantation


Department of Oral Medicine and Radiology, ACPM Dental College, Dhule, Maharashtra, India

Date of Web Publication23-Jan-2015

Correspondence Address:
Ujwala R Newadkar
Department of Oral Medicine and Radiology, ACPM Dental College, Dhule - 424 003, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2225-1243.150012

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How to cite this article:
Newadkar UR. Optimization of complex dental status of patients with hemodialysis and renal transplantation. J Integr Nephrol Androl 2015;2:41-2

How to cite this URL:
Newadkar UR. Optimization of complex dental status of patients with hemodialysis and renal transplantation. J Integr Nephrol Androl [serial online] 2015 [cited 2019 Jul 22];2:41-2. Available from: http://www.journal-ina.com/text.asp?2015/2/1/41/150012

Dear Editor,

Patients with chronic renal failure (CRF) may present as unique signs of multi-system disease affecting the kidneys (such as vasculitis or diabetes mellitus) or as common oral pathologies found at an increased prevalence in patients with CRF. [1] The treatment proposed for a patient with CFR will depend on the stage of the renal disease and on his/her current clinical status. These patients have had their life extended by replacing renal function by either peritoneal dialysis or artificial kidney dialysis, and transplantation is the best treatment choice for them. [2] Dental health appears to be yet another area where attention has been lacking. The early evaluation of oral health status of renal patients is essential to eliminate potential infection foci from the oral cavity. Dental treatment of these patients should preferably be carried out before the transplant. Participation of the dentist in the preparation of a recipient for kidney grafting is vitally important. Infection is the major complication of renal transplant patients, which means that a periodontal abscess, for example, is a potentially life-threatening condition. An advanced disease of periodontal tissues can be compared to ulceration of soft tissues on an area of 50 cm 2 . Teeth with furcation lesions, periodontal abscesses or requiring more invasive surgical procedures indications must be extracted. Therefore, it is important that renal patients needing transplant are examined by an experienced dentist before surgery to determine which teeth can be preserved without representing an infection focus after transplantation. [3],[4]

Primary preventive measures for patients undergoing dialysis for kidney failure have previously been overshadowed by concerns about more urgent health problems. In the last 3 to 4 decades, improvements in dialysis and transplantation have reduced morbidity and mortality among patients with end-stage renal disease. The incidence of a variety of dental conditions, such as periodontal disease, narrowing of the pulp chamber, enamel abnormalities, premature tooth loss and xerostomia, seems greater among dialysis patients. [5],[6],[7],[8],[9] This necessitates the periodic meetings of these patients to the dentist. The need for prophylactic antibiotic therapy to prevent local or distant infection, patient's ability to tolerate dental treatment, coagulation profile and severity of cardiac arrhythmias should also be assessed. [2]

Patients undergoing dialysis are exposed to a large number of blood transfusions and are therefore at a higher risk of contracting hepatitis B and C. In addition, bacterial endocarditis has been reported as an uncommon but serious complication in the dental management of individuals undertaking hemodialysis. They are considered moderate-risk patients and the prescription of a prophylactic antibiotic therapy is particularly important for end-stage renal disease (ESRD) patients under treatment with dialysis. On the other hand, patients undertaking peritoneal dialysis do not need prophylaxis with antibiotics. Dental treatment will be safer if performed on the day following dialysis when there is no risk of prolonged bleeding, blood impurities have been eliminated, heparin administered during dialysis has already been metabolized and the patient is in better health conditions regarding the intravascular volume and products resulting from heparin metabolism. [10] Hence, the importance of an early diagnosis and appropriately planned dental treatment involving various specialists cannot be overestimated. Efficient cooperation of the dentist with the nephrologist in terminal renal insufficiency patients may help avoid injury and dysfunction of the stomatognathic system resulting in disorders of speech and chewing or problems with facial aesthetics. [11]

 
  References Top

1.
Greenberg M, Glick M.Ship J. Burket′s oral medicine 11 th ed. Hamilton, USA: BC Decker INC; 2008. p. 363-83.  Back to cited text no. 1
    
2.
Hamid MJ, Dummer CD, Pinto LS. Systemic conditions, oral findings and dental management of chronic renal failure patients: General considerations and case report. Braz Dent J 2006;17:166-70.  Back to cited text no. 2
    
3.
Carranza FA, Newman MG. Clinical periodontology. 8 th ed. Philadelphia: WB Saunders Company; 1996.  Back to cited text no. 3
    
4.
Slade GD, Offenbacher S, Beck JD, Heiss G, Pankow JS. Acute phase inflammatory response to periodontal disease in the US population. J Dent Res 2000;79:49-57.  Back to cited text no. 4
    
5.
Locsey L, Alberth M, Mauks G. Dental management of chronic hemodialysis patients. Int Urol Nephrol 1986;18:211-3.  Back to cited text no. 5
    
6.
Naugle K, Darby ML, Bauman DB, Lineberger LT, Powers R. The oral health status of individuals on renal dialysis. Ann Periodontol 1998;3:197-205.  Back to cited text no. 6
    
7.
Potter JL, Wilson NH. A dental survey of renal dialysis patients. Public Health 1979;93:153-6.  Back to cited text no. 7
    
8.
Galili D, Berger E, Kaufman E. Pulp narrowing in renal end stage and transplanted patients. J Endod 1991;17:442-3.  Back to cited text no. 8
    
9.
Woodhead J, Nowak A, Crall J, Robillard J. Dental abnormalities in children with chronic renal failure. Pediatr Dent 1982;4:281-5.  Back to cited text no. 9
    
10.
Peterson LJ, Ellis E III, Hupp JR, Tucker MR. Contemporary oral and maxillofacial surgery. 3 rd ed. St. Louis: CV Mosby Co.; 2000.  Back to cited text no. 10
    
11.
Williams RC. Periodontal disease. N Engl J Med 1990;322:373-82.  Back to cited text no. 11
    




 

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