This document discusses medical emergencies related to renal disorders and their oral manifestations. It covers various renal diseases including renal failure, glomerular diseases, and end stage renal disease. For patients with impaired renal function, oral manifestations can include xerostomia, parotitis, pigmentation, enamel hypoplasia, and candidiasis. Management of dental treatment for these patients requires consulting their physician, carefully monitoring blood pressure and drug dosages, and preventing infections. Special considerations are outlined for patients undergoing dialysis, renal transplants, or who have received a transplant.

1. MEDICAL EMERGENCIES
SUMAIRA SAEED
319
3RD YEAR BDS

2. RENAL DISORDERS

3.  Diseases of hydrogen ion concentration
and electrolytes
 Glomerular diseases
 Acute renal failure
 Chronic renal failure
 End stage renal failure or uremic
syndrome
 RENAL transplants
CLASSIFICATION

4.  Ammonia like taste and smell
 Uremic stomatitis
 Gingivitis
ORAL MANIFESTATIONS WITH
IMPAIRED RENAL FUNCTION

5. Xerostomia
Parotitis

6.  Petechiae and echymosis
of oral mucosa
 Pigmentation of oral mucosa
 Enamel hypoplasia

7.  Candidiasis
 Osteodystrophy
(radiolucent jaw lesion)

8.  An inflammation of the glomerular
capillaries
 Acute nephritic syndrome
 Chronic glomerulonephritis
 Nephrotic syndrome
GLOMERULAR DISEASES

9.  Acute and reversible deterioration of
renal function which develops over a
period of days, or rarely weeks and
results in uremia is called acute renal
failure
ACUTE RENAL FAILURE

10.  Hypovolemia
 Hypotension
 Reduced cardiac output and heart
failure
 Obstruction of renal arteries or veins
 Obstruction of the kidney or lower
urinary tract
CAUSES

11.  Chronic renal failure is the irreversible
deterioration in renal function which results
from a diminished mass of the excretory,
metabolic and endocrine functions of the
kidney which leads to the development of
the clinical syndrome of uremia
CHRONIC RENAL FAILURE

12.  Diabetes mellitus
 Hypertension
 Chronic glomerulonephritis,
 Pyelonephritis or other infections
 Obstruction of urinary tract
 Hereditary lesions
 Vascular disorders
 Medications or toxic agents
CAUSES

13. MANAGEMENT

14.  Consultation with patient’s physician
 Avoid dental treatment if disease is unstable
 Monitor blood pressure closely
 Pay meticulous attention to good surgical
technique
 Avoid nephrotoxic drugs
 Adjust doses of drugs metabolized by the
kidney
UNDER CONSERVATIVE
CARE

15.  If medical parameters permit
 Try to eliminate all foci of infection
 Keep only the easily maintainable teeth
 Insist on keeping a good oral hygiene
 If patient is in advance stages, dental care may
best be provided after physician’s consultation
and in a hospital like setting

16.  Because of the potential for bleeding
problems:
1. Pretreatment screening for bleeding
time and platelet count
2. A hematocrit level and hemoglobin
count should be obtained to assess
the status of anemia

17. If an oro facial infection exists,
aggressive management is
necessary using culture and
sensitive tests and appropriate
antibiotics

18. Consider corticosteroid
supplementation as
indicated

19.  Tetracyclines
 Streptomycin
 Vancomycin
 Gentamycin
 Acyclovir
 Acetaminophen
 Phenacetine
 NSAIDs
 Asprin
 Antihistamines,
 Phenobarbitones
NEPHROTOXIC DRUGS

20. Cephalosporins
Penicillins
Ampicillin
Metronidazole
Acyclovir
Paracetamol
Benzodiazpine
DECREASED DOSES

21. Cloxacillin
Erythromycin
Minocycline
Codiene
Diazepam
Lidocaine
NORMAL DOSE

22.  Same as conservative care conditions
 Beware of concerns of arteriovenous shunt
 Consult with the physician about risk for
infective endocarditis
 Avoid blood pressure cuff and IV medications
in arm with shunt
 Avoid dental care on day of treatment; best
to treat on day after
 Consider antimicrobial prophylaxis
PATIENT RECEIVING
DIALYSIS

23.  Consider corticosteroid supplementation as
indicated
 Assess status of liver function and presence
of opportunistic infection in these patients
because of increased risk for carrier state of
hepatitis B and C viruses and human
immunodeficiency virus

24.  Infection in such patients is life –threatening
 Before transplantation easily only maintained
teeth should be determined by dental team
approach
 Teeth with furcation involvement, periodontal
abscesses, or extensive surgical requirements
should be extracted
RENAL TRANSPLANT
PATIENT

25. 1- Emergency treatment only for 1st 6 month
2-Prophylactic antibiotics according to AHA
recommendations
3- Erythromycin is contraindicated in patients on
cyclosporins
4-Cyclosporin causes gingival overgrowth
5-Immunosuppressed patient requires
supplemental corticosteroids
MANAGEMENT

26. THANK YOU!!