Renal disease

Resident’s Name: Joanne Lewis Date: January 15, 2010

Chapter 23: Renal Disease (The Handbook of Pediatric Dentistry)

Definitions:

Renal Insufficiency – damage past the point of compensation; impaired ability to maintain the internal invironment.

Renal Failure – reduction in glomerular filtration rate; normal homeostasis cannot be maintained.

End-Stage Renal Disease (ESRD) – chronic, irreversible, progressive disease; most common causes are diabetes mellitus, hypertension and chronic glomerulonephritis.

Medical Treatment of ESRD:

Dialysis – peritoneal dialysis or hemodialysis

Renal Transplantation

Oral Manifestations of ESRD

- Malodor

- Metallic taste

- Xerostomia

- Glossitis

- Increased deposition of calculus

- Low caries

- Tooth erosion (due to vomiting)

Prophylactic Antibiotics Prior to Dental Treatment

AHA guidelines do not address prophylactic antibiotic use in ESRD and renal transplant patients. In patients with recent placement of a shunt (<6>

Dental Management During Renal Therapy and Before Transplantation

Stabilize or eliminate existing and potential sources of oral infection.

OH training.

Radiographic exam to look for changes in bone.

Xerostomia? Taking any meds high in sucrose?

Consult with physician.

More aggressive treatment (ext. vs. pulp therapy/endo) may be indicated – dental infections during immunosuppression can have significant impact on medical therapy.

Ortho – only if OH is excellent.

Extractions – at least 7-10 days prior to transplant.

Dental care should be done soon after dialysis; avoid the day before dialysis.

Dental Management After Transplantation

Defer all elective procedures during immunosuppression periods.

Increased risk of oral malignancy – monitor.

Ortho – may start or resume after at least a 2 year disease-free survival.