Kidney Disease and Oral Health Implications

A couple of days ago, I received a reminder that my expert contributing article was due. Ironically, at this time I had a patient request my support in educating the public on kidney disease and its impact on oral health. I feel privileged to support this patient, and I knew that the “Mequon Beacon” would be the ideal platform.

Chronic Kidney Disease, or CKD, is a worldwide health crisis, and one of the most common causes of premature death in adults. According to the National Kidney Foundation, 10% of the worldwide population has kidney disease, and millions die each year because they do not have access to affordable treatment. Over two million people receive dialysis treatment or kidney transplant to stay alive, and yet this number may only represent 10% of people who actually need treatment to live. The National Institute of Health reports that the most common causes of CKD are diabetes and high blood pressure. Other causes of adult kidney disease include acute kidney injury, polycystic kidney disease, genetic syndromes, autoimmune disorders, certain cancers, kidney stones with complications and chronic infections.

The mouth is a powerful diagnostic tool in the assessment of general systemic health, and CKD is just another example of how routine dental visits are a necessity to evaluate for potential factors that may affect disease progression. Abnormal lip hyperpigmentation was most frequently seen in CKD patients, followed by gum bleeding, xerostomia (dry mouth), candidiasis, burning mouth, and abnormal taste. Radiographically, CKD patients will present with radiolucent lesions and loss of lamina dura, which is the thin, dense bony layer that lines the tooth socket. The National Institute of Health states that there is a “bidirectional relationship” between kidney disease and periodontal disease, meaning each condition exacerbates the other. Similar to the relationship between diabetes and periodontal disease, periodontal disease can worsen kidney function, and CKD can increase the risk of periodontal disease due to the systemic inflammatory imbalance that each trigger.

Treatment for CKD includes lifestyle changes, medications, and in advanced stages dialysis and kidney transplant. Reports suggest that 90% of patients on dialysis present with oral disease. The most common oral findings are mucosal lesions, periodontal disease, and dry mouth, which predispose patients to cavities. Following kidney transplant, oral health care providers are astute to recognize graft versus host disease. 50-70% of transplant patients develop acute GVHD as a sequela. Patients present with painful redness of the gums, ulceration, and sloughing gum tissues. Chronic GVHD develops during the first 3 years following transplantation, presenting similar to autoimmune diseases such as lupus, lichen planus, and sclerosis.

The NIH reports that patients added to the kidney transplant list reached an all-time high in 2019. With this sharp increase your oral health care provider must be able to recognize potential oral findings and help reduce the risks associated with CKD.

Should you have any additional questions on CKD or kidney transplant please visit our website at mequonsmiledesign.com.