Dental Examination of patients with Renal Disorders |
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Oedema May occur as a result of sodium retention and may be evident both at the ankles and around the face. Periorbital oedema is often seen and the patient may exhibit the characteristic 'moon face' of steroid therapy. The fluid retention may lead to pulmonary oedema, pleural and cardiac effusions, which may present as shortage of breath and an inability to lie flat during dental treatment. Bone pain may result from a disruption of vitamin D metabolism.
Oral Ulceration The incidence of oral ulceration is increased and the oral mucosa may be pale secondary to anaemia but this sign is often rather subjective. Dental infections may become widespread very rapidly and oral candidosis may be present. Herpes simplex, zoster, cytomegalovirus, EBV and toxoplasmosis are increased in incidence and prophylactic acyclovir may be used.
Gingival hyperplasia Occurs with cyclosporin therapy. It is also associated with an increased and rapid build up of calculus. The hyperplasia often reduces with improved oral hygiene involving scaling and polishing.
There is an increased incidence in disorders which can be related to immunosuppression, including lymphoma, skin cancers, hairy leukoplakia, leukoplakia and Kaposi's Sarcoma.
Patients undergoing dialysis may experience swelling of the major salivary glands (especially the parotid glands). Salivary flow may be decreased in CRF leading to increased oral problems.
Palatal and buccal keratosis is sometimes seen. The conditions tend to resolve with established dialysis or transplant. The tongue may be dry and coated.
Periodontal disease may be evident and there may be bleeding from the gingival margins.
In children, CRF leads to decreased growth and sometimes delayed tooth eruption and enamel hypoplasia.
¨ The patient may have an arterio-venous fistula at the wrist or in the antecubital fossa ¨ High blood flow through the fistula leads to a palpable vibration or thrill when the examiner's fingers are placed lightly on the skin over the area of the fistula. ¨ This arm should not be used for routine venepuncture or IV sedation.
Ref: British Dental Journal 23 August 2003; Volume 195, No. 4
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