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dental management of a renal disorder patient
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.
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dental management of a renal disorder patient
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- 3. Diseases ofhydrogen ion concentration and electrolytes Glomerular diseases Acute renal failure Chronic renal failure End stage renal failure or uremic syndrome RENAL transplants CLASSIFICATION
- 4. Ammonia liketaste and smell Uremic stomatitis Gingivitis ORAL MANIFESTATIONS WITH IMPAIRED RENAL FUNCTION
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- 6. Petechiae andechymosis of oral mucosa Pigmentation of oral mucosa Enamel hypoplasia
- 7. Candidiasis Osteodystrophy (radiolucentjaw lesion)
- 8. An inflammationof the glomerular capillaries Acute nephritic syndrome Chronic glomerulonephritis Nephrotic syndrome GLOMERULAR DISEASES
- 9. Acute andreversible 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 renalfailure 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
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- 14. Consultation withpatient’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 medicalparameters 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 ofthe 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 orofacial infection exists, aggressive management is necessary using culture and sensitive tests and appropriate antibiotics
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- 19. Tetracyclines Streptomycin Vancomycin Gentamycin Acyclovir Acetaminophen Phenacetine NSAIDs Asprin Antihistamines, Phenobarbitones NEPHROTOXIC DRUGS
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- 22. Same asconservative 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 corticosteroidsupplementation 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 insuch 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 treatmentonly 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
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