Kidney and Liver Disease and Organ Transplantation
The incidence of end-stage renal failure (ESRF) in childhood, either due to a congenital or acquired condition is roughly 10–12 per 1 million children. As for many other chronic childhood illnesses, significant improvements in dialysis and organ transplantation have meant that many children are long-term survivors and, consequently, dentists will be required to provide dental treatment for such children who have either chronic renal failure (CRF), ESRF, or are recipients of renal transplant. Dentists should be aware of two issues:
- oral and dental implications as these conditions have a multi-organ implication (Box 52.1);
- implications of the disease and its treatment for provision of dental care.
- Increased salivary pH due to urea/ammonia
- Reduced Streptococcus mutans levels
- Increased pH
- Increased buffering capacity
- Gingival overgrowth
- Uraemic stomatitis
- Demineralisation of the jaw bones, “ground glass” appearance
- Loss of lamina dura
- Localised radiolucent jaw lesions
- Loss of trabeculation
- Giant cell lesions
- Delayed eruption
- Pulp calcifications
- Bony fractures and bone tumours secondary to hyperparathyroidism may occur
- Liaise with the child’s named paediatrician.
- Check blood indices, in particular the coagulation parameters before invasive dental treatment.
- Adjustment of the dose of several drugs is required due to the kidneys’ reduced ability for metabolism and secretion. For example, the dose of midazolam must be reduced by 50% in patients with a glomerular filtration rate (GFR) <10 ml/min/1.73 m2, check with the paediatrician before making any adjustments.
- Prescription of systemic fluorides is avoided because of the decreased renal clearance of fluoride, and these patients’ low susceptibility to dental caries.
- Any dental infection should be tr/>