Dental Management of Patients With Renal Disease

Treating dental patients with renal disease or kidney transplants requires special care to prevent infection. Dental infections can create serious complications in patients who are undergoing treatment for kidney disease or have received kidney transplants.
If you have kidney problems, your dentist and doctor should develop a plan before any dental work takes place.

Dental Conditions

• Kidney disease and the medications involved in treating the disease can cause a variety of dental problems requiring treatment. Due to an inability to absorb calcium properly, periodontal bone loss is common. With kidney failure, the inability to remove urea from the system can cause halitosis (bad breath) due to ammonia build-up, and patients will often report a bad taste in their mouths. Tooth loss, gum disease, dry mouth and jaw pain can all be results of kidney disease, warranting urgent dental treatment.

Dialysis Patients

• Generally, any necessary dental treatment should occur 24 hours after dialysis in order to have the heparin (blood thinner) completely out of your system, ensuring minimal abnormal bleeding. You should tell your dentist about all medications you are taking, and share all blood test results.

Transplant Candidates

• Patients with end-stage kidney disease who are about to receive a transplant must undergo all dental treatment prior to transplant surgery. Once the patient receives the transplant, the immune system will be seriously suppressed for at least 3 months, if successful, and any dental treatment received during this time could result in a fatal infection for the patient. Therefore, it is vital that all dental conditions be treated prior to transplant to ensure no treatment will be required post-transplant.

Medication Precautions

• Beware of drug interactions

  Patients with renal disease take considerably longer to filter out medications; therefore, dosage must always be adjusted bearing this in mind. Antibiotic prophylaxis may be warranted, and in some cases, a dosage of antibiotics will be recommended by the physician prior to treatment and again after treatment to prevent a systemic infection. Many patients with renal disease will be on anticoagulants, and physicians will at least reduce the dosage prior to necessary dental treatment in order to minimize excessive bleeding.

Other Precautions

• As many patients with renal failure develop other diseases such as diabetes, heart conditions and liver disease, conducting a full patient history and discussing all conditions with the physician prior to dental treatment is crucial. Being fully informed of every medical condition and all medications is vital to providing the safest and most effective treatment for the patient with renal disease.