Dental Management of Chronic Renal Failure and Dialysis Chronic renal failure Chronic renal failure: slowly progressive and non- reversible loss of kidney function Uraemia: metabolic outcome of chronic renal failure End-stage renal disease: requirement for renal replacement therapy Diabetes mellitus (28%) Hypertension (25%) Glomer ulonephritis (21%) Polycystic Kidney Disease (4%) Other (23%): Obstruction, infection, etc. Progressive chronic disease leading to end-state renal failure Different primary disease can cause chronic renal failure Diabetic nephropathy is a frequent cause for chronic renal failure Symptoms can be very different and depend on primary disease and stage of chronic renal failure The consequences are complex according to the different function of the kidney and involve many organ systems Treatment Options for Renal Failure Medical management Dialysis Kidney transplant Oral Changes in Renal Failure Pallor of mucosa (anemia) Red-orange discoloration of mucosa (carotene-like pigments) Xerostomia, parotid infections and candidiasis Ammonia-like breath odor (high urea content) Metallic taste Uremic stomatitis (red, burning mucosa covered with gray exudates that may ulcerate) seen with high BUN levels Osseous changes – lytic bone lesions among others * Hemodialysis can lessen the severity or reverse many of these changes ½ of patients with CRF eventually require dialysis Diffuse harmful waste out of body Control BP Keep safe level of chemicals in body 2 types Hemodialysis Peritoneal dialysis Dental Management Conservative Care Medical consultation to determine stability and control Avoid dental treatment in patients whose disease is poorly controlled Screen for bleeding disorder prior to surgery – BT, PT, platelet count, hemoglobin, hematocrit Anemia generally well tolerated with HCT>25 Monitor blood pressure closely Use good surgical technique Avoid nephrotoxic drugs Consider reduction of dosage or increase time intervals between doses of active drugs excreted by the kidney Manage orofacial infections aggressively Consider hospitalization for patients with severe infection or needing major dental procedures

1. Dental Management of Chronic Renal
Failure and Dialysis
ACHIEVED BY: Dr.Maen Dawodi

2. Chronic renal failure
 Chronic renal failure: slowly
progressive and non- reversible loss of
kidney function
 Uraemia: metabolic outcome of chronic
renal failure
 End-stage renal disease: requirement
for renal replacement therapy

3. ETIOLOGY
 Diabetes mellitus (28%)
 Hypertension (25%)
 Glomer ulonephritis (21%)
 Polycystic Kidney Disease (4%)
 Other (23%): Obstruction, infection,
etc.

4. Conclusion – chronic renal failure
 Progressive chronic disease leading to end-state renal failure
 Different primary disease can cause chronic renal failure
 Diabetic nephropathy is a frequent cause for chronic renal
failure
 Symptoms can be very different and depend on primary
disease and stage of chronic renal failure
 The consequences are complex according to the different
function of the kidney and involve many organ systems

5. • Treatment Options for Renal Failure
• Medical management
• Dialysis
• Kidney transplant

6. •Oral Changes in Renal Failure
• Pallor of mucosa (anemia)
• Red-orange discoloration of mucosa (carotene-like pigments)
• Xerostomia, parotid infections and candidiasis
• Ammonia-like breath odor (high urea content)
• Metallic taste
• Uremic stomatitis (red, burning mucosa covered with gray exudates that
may ulcerate) seen with high BUN levels
• Osseous changes – lytic bone lesions among others
• * Hemodialysis can lessen the severity or reverse many of these changes

7. Dialysis
 ½ of patients with CRF eventually require dialysis
 Diffuse harmful waste out of body
 Control BP
 Keep safe level of chemicals in body
 2 types
 Hemodialysis
 Peritoneal dialysis

8. • Oral Changes - Renal Failure
• Red-orange discoloration of buccal
mucosa due to deposition of
carotene-like pigments
• Pallor of the oral mucosa secondary
to anemia.

9. Oral Manifestations - Renal Failure
• Uremic stomatitis consisting
of ragged plaques on the
ventral surface of tongue and
floor of the mouth
• Same patient after
hemodialysis

10. • - Palatal enlargement due to
secondary hyperparathyroidism

11. • Periapical radiograph showing
the “ground glass” appearance
of the trabeculae and loss of
lamina dura in a patient with
secondary hyperparathyroidism

12. • Multiple lucencies
associated with
secondary
hyperparathyroidism

13. •Dental Management Conservative Care
• Medical consultation to determine stability and control
• Avoid dental treatment in patients whose disease is poorly controlled
• Screen for bleeding disorder prior to surgery – BT, PT, platelet count, hemoglobin,
hematocrit
• Anemia generally well tolerated with HCT>25
• Monitor blood pressure closely
• Use good surgical technique
• Avoid nephrotoxic drugs
• Consider reduction of dosage or increase time intervals between doses of active
drugs excreted by the kidney
• Manage orofacial infections aggressively
• Consider hospitalization for patients with severe infection or needing major
dental procedures

14. A, Panoramic image showing trabecular changes. Also note erupted lower third molars without
fullly developed root formations. B, Mandibular anterior loss of trabeculation. C, Maxillary anterior
loss of trabeculation. D, Loss of lamina dura

15. • Dental Management Hemodialysis
• Same as those recommended for patients receiving conservative
care
• Be aware of presence of arteriovenous shunt; avoid blood pressure
cuff and IV medications in arm with shunt
• Avoid dental treatment on day of dialysis due to heparin (half life
1.5 hours), best to treat day after dialysis to avoid excessive
bleeding
• Assess status of liver function because of increased risk of hepatitis
B, C viruses and HIV infection

16. Reference
• Fouque D, Mitch WE (2012). Dietary approaches to kidney disease. In
MW Taal et al., eds., Brenner and Rector's The Kidney, 9th ed., vol. 2,
pp. 2170-2204. Philadelphia: Saunders.
• Kendrick J, et al, (2015). Kidney disease and maternal and fetal
outcomes in pregnancy. American Journal of Kidney Diseases, 66(1):
55-59. DOI:

17. Thank you