52 Kidney and liver disease and organ transplantation

52

Kidney and Liver Disease and Organ Transplantation

Kidney Disease

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.

Box 52.1 Possible Oral Effects of Kidney Disease
Enamel hypoplasia
Predentine changes – thickened predentine layer
Decreased levels of dental caries:

  • Increased salivary pH due to urea/ammonia
  • Reduced Streptococcus mutans levels
Salivary pH and buffering capacity:

  • Increased pH
  • Increased buffering capacity
Gingival health:

  • Gingival overgrowth
  • Uraemic stomatitis
  • Petechiae
  • Ecchymoses
Changes in oral microflora
Bone metabolism:

  • 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
Oral malodour/bad taste

Dental Management

  • 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/>
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Jan 17, 2015 | Posted by in Pedodontics | Comments Off on 52 Kidney and liver disease and organ transplantation
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