Oro-dental health in children with chronic renal failure and after renal transplantation: a clinical review

Abstract

As a consequence of chronic renal failure (CRF) and its treatment, a number of oro-dental changes occur that persist after the end-stage is reached. An early effect is enamel hypoplasia due to a defect of enamel development and mineralisation. This is usually reparable to a high aesthetic standard using dental composite filling material. Children with CRF have significantly less dental caries than healthy children due to the inhibitory effect of increased salivary urea levels. Grafted patients frequently develop gingival enlargement as a result of immunosuppression with cyclosporine A, which is further exacerbated by the additional use of antihypertensive calcium-blocking agents. Surgical reduction of gingival hyperplasia is effective and is required in approximately one third of adolescents. A very high standard of home care should be encouraged for all children with CRF in the form of thorough mechanical tooth cleaning and plaque inhibition through the use of an antibacterial mouthwash. In transplanted children presenting an increased risk of infection, antibiotic prophylaxis may be indicated for dental treatment procedures. The drug dosage should be adapted to the reduced renal function. Pediatric nephrologists should be aware that dental surgeons can make a considerable contribution to the general health and well-being of children with CRF. Thus, only oro-dental problems that are mainly encountered and treated by dental surgeons are reviewed.

Hallazgos estomatológicos en insuficiencia renal crónica debido a síndrome de Prune Belly: reporte de caso

“…Los factores responsables de esta interrupción incluyen hipocalcemia, niveles disminuidos de 1.25 -dihidroxicolecalciferol en suero y niveles elevados de fosfato inorgá-nico y de hormona paratiroidea en suero (8).…”

“…producción de vitamina D que es esencial para la absorción de calcio (8). Como consecuencia de la alteración en los niveles de calcio en suero se produce un incremento de la actividad de la hormona paratiroidea ocasionando hiperparatiroidismo secundario (7).…”

“…En la cavidad oral se pueden presentar: petequias, equimosis, estomatitis urémica, gingivitis, periodontitis, prevalencia reducida de caries, hipoplasia de esmalte, obliteraciones de la pulpa (6). Así mismo, la alteración en el metabolismo de calcio y fósforo producen desmineralización de los huesos maxilares, pérdida de trabeculación, pérdida parcial o total de la lámina dura, lesiones de células gigantes y calcificaciones metastásicas (8).…”

Oral Health in Chronic Kidney Disease Patients: A Literature Review

“…The most frequently observed types are enamel hypoplasia or fluorosis, and lesions of this type are observed in patients, in whom kidney pathology developed earlier in the developmental period [12][13][14]. These lesions are mostly caused by impairment in the calcium-phosphorus metabolism, and are statistically significantly more frequent in pediatric patients, in whom kidney disorders have already developed during the stage of dental hard tissues mineralization.…”

Avaliação das manifestações bucais nos pacientes com insuficiência renal

“…As alterações da saliva compreendem alterações na sua composição e diminuição do fluxo salivar. A xerostomia poderia também aumentar o risco de cáries cervicais (BOTS et al, 2007;CASTILLO et al, 2007;IMIRZALIOGLU et al, 2007;ROBERTS, 2005;MARTINS et al, 2006;PROCTOR et al, 2005;SHARMA;PRADEEP, 2007 O hiperparatireoidismo secundário também poderia estar relacionado com alterações periodontais ao destruir tecido ósseo produzindo um alargamento do ligamento, muitas vezes com severa destruição periodontal e mobilidade dentária (PROCTOR et al, 2005).…”