Unique to You

About kidney disease

Your kidneys filter waste, minerals, and excess fluids from your blood, which are then excreted in your urine. They also play a key role in the regulation of blood pressure and the metabolism of calcium. it_2 (CRD), or kidney disease, describes the gradual loss of kidney function. When kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes, and wastes can build up in your body.¹ Kidney disease can be brought about by several things, including your lifestyle choices, genetics, or other health conditions.

CRD can impact many different systems in your body. One area not to be overlooked when diagnosing and treating CRD is your mouth.

Kidney disease and your oral health

As with any disease, early detection and treatment play an important role in achieving positive outcomes. Researchers estimate that up to 90% of renal patients will show oral symptoms.² This is why dentists play an important role in early diagnosis and treatment intervention. Since CRD progresses slowly, your dentist may be the first healthcare provider to identify signs and symptoms.

Poor oral hygiene can lead to bacterial infections like periodontal disease that impact your ability to fight infections in your kidneys. CRD may cause or be a factor in a wide range of oral issues and symptoms³ including:

• Periodontal disease and general soft tissue inflammation.
• Impaired immune response to infection.
• Loose teeth or tooth loss from a calcium imbalance which can make it harder to chew and swallow.
• Suspicious lesions, rashes, or other abnormalities in the soft and hard tissues of your mouth caused by fungal or bacterial infections.
• Reduced saliva, which negatively affects your ability to naturally wash away bacteria from your teeth.
• Dry mouth, either from reduced saliva flow or medications you may take.
• Increased bleeding and inflammation.
• Abnormal lip hyperpigmentation
• Burning mouth or tongue pain
• Loss of bone or altered bone density in your jaws.
• Vitamin and mineral deficiencies (especially vitamins B and C, and iron and zinc). These can lead to conditions on your tongue, cheeks, and lips.
• Enlarged gums, which can affect your appearance, speech, and proper tooth development in children.
• Bad breath resulting from your kidney's inability to eliminate waste and toxins from your blood. In this case, your breath can take on the scent of urine.
• Changes in your sense of taste.

If you have been diagnosed with kidney disease, taking care of any dental issues before beginning your treatment, maintaining a strict oral hygiene routine while treatment is ongoing, and working together with your dentist and doctor are the three most important elements of ensuring a more positive outcome.

Oral hygiene guidelines

• Have your dentist treat any oral health issues before your kidney treatment begins. Not all mouth problems can be avoided, but the fewer side effects you have, the more likely you will stay on your treatment schedule and help improve your outcome.
• Practice good oral hygiene before, during, and after your treatment to reduce bacteria levels and inflammation in your mouth.
• Visit your dentist for exams and professional tooth cleanings on the schedule your dentist recommends to prevent and treat tooth decay, gingivitis, and periodontal disease. Your dentist may suggest additional fluoride or antimicrobial rinses to aid in your treatment.
• Be honest with your dentist about your health history and current health status. Tell your dentist if you have been diagnosed with kidney disease, are on dialysis, or are preparing for or have received a kidney transplant. Your dentist may speak with your doctor to determine that you are stable enough for any oral treatment needed.
• Let your dentist know if you have any loose teeth. This may indicate or be complicated by a calcium imbalance. Missing teeth can have profound effects on your oral health.
• Let your dentist know if you have diabetes, anemia, or high blood pressure (hypertension).
• If dental treatment is recommended, ask your doctor if any of the medications you are taking for CRD may cause dry mouth, which can accelerate oral conditions. In some cases, there are alternative medications that can reduce this effect. Be sure to relay this information to your dentist.

Nutrition

Healthy teeth are important for chewing high-quality protein foods such as meat, fish, and poultry. If you have trouble chewing or swallowing or have had to change your diet, contact your dentist and doctor immediately.

For children

Early-onset kidney disease can affect a child's teeth even before birth. The effects can result in vitamin deficiencies, poor development of tooth enamel, discolored teeth, lesions, and more.⁴ Ask your obstetrician to check for potential issues as part of your normal pregnancy visits.

Oral complications from CRD treatment

The oral side effects and complications of kidney disease therapy can vary. Before your treatment begins, it is important for you to understand the causes of the possible side effects and complications so you, your dentist, and your doctor can take steps to minimize them. In severe cases, oral complications can even impact how kidney disease treatment is provided. Some necessary steps may include changing medications or dosages, altering treatment schedules, or stopping treatment altogether until the complications are controlled.

Dialysis

• If you require dialysis, you will have a flexible tube called a shunt inserted (normally through your non-dominant elbow or upper arm) to access blood in a vein that allows fluids and wastes to be passed to a machine for cleaning. It will typically remain in place until your kidney function has improved to the point where dialysis is no longer required. Because accessing your blood in this fashion requires a surgical procedure, it may increase your risk of infection.⁵ To reduce the risk of infection during dental treatment, your doctor may recommend antibiotics before and after certain procedures.
• Patients on dialysis may receive blood-thinning medications to prevent clotting. If you require any dental procedures that may cause bleeding (tooth removal, periodontal surgery, bone grafts, dental implants, etc.) be sure to schedule treatment on a non-dialysis day, and encourage your dentist to coordinate with your primary care physician or renal specialist.
• If your blood pressure needs to be taken at a dental visit, let your dentist or their staff know where your shunt is located so they can avoid placing the blood pressure cuff in that area. Blood pressure readings in the area of a stunt can be uncomfortable and lead to inaccurate readings.

Transplant surgery

• To improve your chances of a successful kidney transplant, you are generally required to have an oral exam before your surgery. In fact, the presence of serious dental infections can delay or even prevent approval for a kidney transplant. It's critical that you have any dental issues that may lead to infection addressed beforehand. Research has demonstrated that "more than 80% of transplant recipients develop at least one infection, and 40% of deaths are due to complications of infections."⁶
• Following organ or stem-cell transplant surgery, you will be on medication to help prevent rejection. These medications can weaken your immune system and lead to a higher risk of infection, swelling, mouth sores, salivary gland issues, and other conditions in your mouth. This is why you should maintain your strict oral hygiene regimen at home and routinely visit your dentist following transplant surgery.
• Kidney transplant recipients that are taking immunosuppressive drugs to prevent the body's rejection of the donor organ often experience enlarged, inflamed gingiva. It is important to work closely with your dentist to ensure you reduce inflammation and control bacterial levels in your mouth. This involves excellent oral hygiene and regular dental visits.