Oral manifestations in chronic uremia patients

Abstract

The incidence of chronic renal failure (CRF) is approximately 200 cases per million people in different Western countries. Recent data indicate that the incidences of these pathologies are increasing. Ninety percent of patients with CRF report oral signs and symptoms that affect both the bone and soft tissues. A broad range of lesions may be observed in chronic uratemia patients, including the following: gingival hyperplasia, enamel hypoplasia, petechiae, gingival bleeding, and others lesions. These patients require various types of treatment ranging from dietary and lifestyle changes to dialysis and kidney transplantation. CRF often leads to multiple oral manifestations that are difficult for dentists to manage. The present study examined the characteristics of this disease, the existing therapeutic options and the relevant considerations for dental professionals.

Otorhinolaryngological dysfunctions induced by chronic kidney disease in pre- and post-transplant stages

“…Might be an effect of downregulation of intracortical suppression that is linked to the cochlear damage [9] Commonly coexisting with SNHL Oropharyngeal changes Xerostomia 28.2-91% of patients with CKD are affected (higher with coexisting DM) [19,20,24] Results from dehydration, reduced saliva flow and urea-induced changes in salivary gland morphology (fibrosis and atrophy) [21] In patients with CKD saliva flow is 20-55% reduced [20] Cases with no measurable saliva flow are also present in these patients [20] Dysgeusia 43-90% of patients with CKD are affected [19,25] Exact mechanism is unknown It might emerge from the influence of uremic toxins on both, the central nervous system and on the teste receptors located in the peripheral nervous system [17]. High levels of urea, dimethyl and trimethylamine in saliva, reduced saliva production, altered saliva composition, reduced number of taste buds, metabolic disorders, and drugs used in treatment (mainly antihypertensive agents) play a role [17] Commonly accompanied with "metallic taste"; sour and sweet tastes might be more significantly affected than salty and bitter tastes [17] Halitosis 91% of patients with CKD not on HD; 90% of patients with CKD on HD are affected [25] Results from high urea levels (above 55 mg/dl) Alkaline nature of urea and ammonia maintain increased pH levels of saliva promoting bacteria development and unpleasant odor from oral cavity [23] Increased risk of dental calculus formation and reduced risk of caries because of alkaline saliva pH [23] Sore throat Higher than in GP * [17] Might be a consequence of reduced saliva production, dehydration and urea decomposing commensal bacteria [17] Mucosal ulceration 8.6% of patients with ESKD 1.3% of RTRs [16] Might be a consequence of reduced saliva production, dehydration and urea decomposing commensal bacteria [17] [23] It mainly results from drug-induced changes in gingival fibroblasts and lamina propria that lead to formation of deposits of the intercellular matrix and increase in vascularity [26] In patients in pre-dialysis or HD stage of CKD it is mainly induced by calcium channel blockers, while in RTRs by cyclosporine [26] Lichenoid changes/leukoplakia 8-11% of RTRs are affected [27] Mechanism is unknown Might be a result of drug-induced reactivation of EBV in the oral epithelium [28] Negative EBV cases were also pres...…”

“…Renal osteodystrophy in H&N area Higher than in GP* [16] Bone metabolic changes induced by chronic renal insufficiency [16,26] Phosphate retention and reduced vitamin D conversion result in hypocalcaemia and subsequent production of parathormone (PTH) that stimulates bone resorption [16,26] May present as demineralization of the mandible and maxilla, loss of the lamina dura, and metastatic calcification in hard tissues [26] The most common abnormalities are temporomandibular joint deformation, maxillofacial fractures and malocclusion [26] Brown tumor 1.5-1.7% of patients with CKD-induced secondary parathyroidism are affected [29] Occurs secondary to CKD-induced hyperparathyroidism [29] Mainly observed in mandible, palate or facial bones; less frequently in skull bones and paranasal sinuses [29] Middle ear dysfunction Tympano-scle-…”

“…Gingival overgrowth in patients in pre-dialysis and hemodialysis stage of CKD was mainly induced by calcium channel blockers, while in RTRs it mainly resulted from cyclosporine use [26]. The combined therapy based on both, cyclosporine and calcium channel blocker (nifedipine) might have increased the incidence and severity of gingival overgrowth [23].…”

Risk factors associated with xerostomia in haemodialysis patients

“…The most frequent oral disorders observed are xerostomia, hyposalivation, adverse effects related to drug therapy, mucosal lesions as petechiae, gingival hyperplasia, oral infections, dental anomalies and bone lesions (1,3,4). …”

Oral disorders in patients with chronic renal failure. Narrative review.

“…These may be caused by dialysis, kidney transplantation and etiologic factors of CRF 2,3,7,8,26,27 . CRF patients have medical, psychological and socioeconomic characteristics that may predispose them to dental problems.…”