Dental Management In Renal Failure: Patients On Dialysis

Dental management in renal failure: Patients on dialysis

Alba Jover Cerveró 1, José V. Bagán 2, Yolanda Jiménez Soriano 3, Rafael Poveda Roda 4

(1) Dentist. Private practice

(2) Head of the Service of Stomatology. Valencia University General Hospital. Chairman of Oral Medicine, Valencia University

Medical and Dental School

(3) Assistant Professor Doctor Valencia University

(4) Staff physician. Service of Stomatology. Valencia University General Hospital. Valencia (Spain)

Correspondence:

Dr. Alba Jover Cerveró

Sevicio de Estomatología

Hospital General Universitario

Avda/ Tres Cruces s/n

46014 Valencia. Spain

E-mail: [e-mail]

Received: 18/11/2007

Accepted: 23/05/2008

Jover-Cerveró A, Bagán JV, Jiménez-Soriano Y, Poveda-Roda R. Dental

management in renal failure: Patients on dialysis. Med Oral Patol Oral

Cir Bucal. 2008 Jul 1;13(7):E419-26.

© Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946

http://www.medicinaoral.com/medoralfree01/v13i7/medoralv13i7p419.pdf

Abstract

Chronic renal failure is an important health care problem throughout the world, with an incidence of 337, 90, 107

and 95 new cases per million inhabitants/year in the United States, Australia, New Zealand and the United Kingdom,

respectively. These figures moreover invariably tend to increase. During the progression of renal damage, clinical

manifestations are noted in practically all body organs and systems, and 90% of all affected patients experience oral

symptoms. The existing management options range from simple measures based on changes in diet and life style, to

different forms of dialysis (hemodialysis and peritoneal dialysis), and also kidney transplantation. Given the multiple

oral manifestations of chronic renal failure, and the different repercussions of its treatment upon the oral cavity,

these patients require special considerations and precautions in the face of dental treatment. Consultation with the

nephrologist is essential before any dental treatment is carried out, in order to determine the condition of the patient,

define the best moment for dental treatment, introduce the necessary pharmacological adjustments, or to establish

other important aspects for preventing complications in the dental clinic.

The present study reviews the characteristics of the disease, the existing therapeutic options, and the considerations

of relevance for the dental professional.

Key words: Chronic renal failure, glomerular filtration rate, dialysis, renal transplant, immunosuppressive therapy, renal

osteodystrophy, oral lesions, gingival hyperplasia, dental management.

Indexed in:

-Index Medicus / MEDLINE / PubMed

-EMBASE, Excerpta Medica

-SCOPUS

-Indice Médico Español

-IBECS

Article Number: 111111156

© Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946

eMail: [e-mail]

Introduction

Each human kidney is composed of about one million

anatomical and functional units called nephrons. In

turn, each nephron is composed of a glomerule and

tubule. The glomerule consists of an interconnected

network of capillaries contained within a cup-like sac

known as Bowman’s capsule, which continues with the

proximal convoluted tubule. The latter in turn gives rise

to different sequential segments: the loop of Henle, the

distal convoluted tubule, and the collector ducts. The

final segment collects the urine from a number of distal

convoluted tubules and drains it directly into the renal

papilla (1).

The kidneys have a number of important functions: (a)

Excretion of metabolic waste products. (b) Electrolyte

regulation through the control of sodium, potassium and

water excretion, and acid-base homeostasis. (c) Endocrine

regulatory functions: eicosanoids (prostaglandins, thromboxanes,

leukotrienes, prostacyclins, etc.), erythropoietin

(EPO), the renin-angiotensin system, and vitamin D metabolism

(2). In particular, the renin-angiotensin system

comprises one of the mechanisms involved in the control

E420

Med Oral Patol Oral Cir Bucal. 2008 Jul 1;13(7):E419-26. Chronic renal failure and dental car care of blood pressure (BP): when the latter decreases, the

kidney releases renin, which in turn triggers an enzymatic

cascade that produces abundant blood angiotensin II – a

hormone that increases global peripheral vascular resistance

and