Dental management of renal disease :
End-stage renal failure leads to a fall in the glomerular filtration rate, which results in progressive hypertension, fluid retention and a build up of metabolites, which are not excreted normally. Conditions affecting kidney functions include ureteric reflux, obstructive uropathy, glomerulonephritis and glomerulosclerosis, medullary cystic disease, systemic lupus erythematosus and cystinosis. Renal patients may be anaemic and have a bleeding tendency because of capillary fragility andthrombocytopenia. Those on dialysis will be taking anticoagulants. Caries rates may be lower, probably because of the ammonia released in saliva. Uraemic stomatitis may develop, with high serum urea. Teeth that are mineralizing during renal failure will exhibit chronological hypoplasia or hypomineralisation.
Dental management :
Dental problems should be minimised by aggressive prevention; otherwise:
- pulpally involved teeth should be extracted; patients on haemodialysis can have extractions 1 day after dialysis under DDAVP cover; sockets should be packed and sutured
- antibiotic prophylaxis for extractions
- inpatient facilities required for general anaesthesia.
Drug interactions in renal disease. End-stage renal failure is managed with antihypertensives and steroids and these patients are anaemic and immunocompromised. Metabolism of drugs by the kidney as well as renal excretion of drugs is impaired. The following drugs should be avoided: