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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 238-240

Oral manifestations in patients with renal diseases


Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission04-Mar-2019
Date of Decision06-Mar-2020
Date of Acceptance10-Mar-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Namrata Jidewar
Department of Oral Pathology and Microbiology, Datta Meghe Institute of Medical Sciences, Sharad Pawar Dental College, Sawangi (M), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_48_19

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  Abstract 


Background: Chronic renal diseases (CRDs), a progressive and irreversible decline in renal function with the most implications in dentistry. Kidneys have the following functions: filtering waste metabolic products, maintaining electrolyte balance and the volume of extracellular liquid, and regulating the acid–base balance and endocrine secretions (prostaglandins, erythropoietin, rennin, and Vitamin D). Objectives: To find a correlation between chronic renal conditions and oral cavity and to evaluate the manifestations of CRDs in the oral cavity. Results: Various oral manifestations such as mucosal pallor, petechiae, ecchymosis, uremic stomatitis, and periodontal changes are observed in patients with CRDs. Conclusions: CRDs have a significant impact on oral health, which needs intervention at an early stage of disease and its management to improve the general health status of patients.

Keywords: Oral health, oral manifestations, renal


How to cite this article:
Hande A, Jidewar N, Gadge R. Oral manifestations in patients with renal diseases. J Datta Meghe Inst Med Sci Univ 2020;15:238-40

How to cite this URL:
Hande A, Jidewar N, Gadge R. Oral manifestations in patients with renal diseases. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 19];15:238-40. Available from: http://www.journaldmims.com/text.asp?2020/15/2/238/304263




  Introduction Top


Chronic renal diseases (CRDs), a progressive and irreversible decline in renal function with the most implications in dentistry. Kidneys have the following functions: filtering waste metabolic products, maintaining electrolyte balance and the volume of extracellular liquid, and regulating the acid–base balance and endocrine secretions (prostaglandins, erythropoietin, rennin, and Vitamin D).[1]

Several medical conditions can affect the oral health of patients. With several improvements in medical treatment and improved survival rates for many disorders, dentists can be expected to treat an increasing number of patients with complex medical conditions. In particular, the prevalence of CRD is increasing worldwide.[2]

The importance of CRD for the dental practitioner lies in the fact that an increasing number of patients with this disease will probably demand dental treatment, and that up to 90% of them will show oral signs and symptoms related to this systemic disease, for which dental management must be adapted to these patients at an early stage of disease.[3]

Patients with CRDs also present with many oral manifestations as they also have effects of altered metabolism. The oral cavity is the mirror of systemic health. Chronic renal failure (CRF) is one such disease which presents with a spectrum of oral manifestations, often due to the disease itself and treatment. He plethora of oral manifestations observed in CRF and associated therapies are like altered taste, gingival enlargement, xerostomia, parotitis, enamel hypoplasia, delayed eruption, various mucosal lesions like hairy leukoplakia, lichenoid reactions, ulcerations, angular chelitis, candidiasis etc.[1]

CRF refers to a progressive and irreversible decline in the total number of functioning nephrons, which causes a decline in the glomerular filtration rate. CRF is accompanied by clinical and laboratory changes that are related to the inability of the kidney to excrete metabolites and perform endocrine functions, including the secretion of active Vitamin D and erythropoietin.[3]

CRF affects most parts of the body, and the clinical features depend on the stage of renal failure and the systems involved. Pallor due to decreased erythropoietin secretion, platelet dysfunction, impaired cell-mediated immunity, signs of fluid overload, hypertension, flow murmurs, pruritis, pulmonary edema, and renal osteodystrophy are the common signs of CRD.[2]


  Materials and Methodology Top


The methodology used for completion of the objective and data collection was a combination of a pretested questionnaire and general oral examination of patients with chronic renal conditions.

Systematic random samples of 25 patients with chronic renal conditions undergoing treatment for the same cause were selected. The criterion for selecting patients was that they should have chronic renal conditions and well oriented without any complications or any other systemic disease.

The patients were informed about the procedure, and verbal consent was taken. The questionnaire prepared was translated into the local language (Marathi) or the patient's mother tongue so that patients can understand the questions and answer specifically and to avoid any discrepancies in the answers. The questions were kept very simple and specific to which the answers were either “yes” or “no” to achieve accurate data analysis and avoid any misinterpretation.

Data collected from the questionnaire were recorded, and a detailed analysis was done to derive the outcome.

For those parameters where simple questionnaire method was not feasible or not applicable, clinical examination of the oral cavity was done to look for specific signs and simultaneously questions were asked to rule out other conditions in which similar signs are present. A history of any previous lesion of similar type was also recorded.

The oral examination was done by clean sterilized diagnostic instruments which included a straight probe and a mouth mirror along with a torch for proper illumination.

The signs for which oral examination was done are mucosal pallor, petechiae, ecchymosis, uremic stomatitis, and periodontal status (plaque, calculus, gingival recession, etc). A thorough and careful examination was done so that no sign or lesion goes unnoticed.

All the data were collected and maintained till the statistics were applied, and the results were obtained.

Pro forma for the questionnaire was as follows:

  1. Age
  2. Gender – Symptoms present


    • Dry mouth – yes/no
    • Taste change – yes/no.


Signs for which oral examination was done were as follows:

  • Mucosal pallor
  • Petechiae
  • Ecchymosis
  • Uremic stomatitis
  • Periodontal changes (plaque, calculus, and gingival recession).


Ethical Approval

Ethical approval for this study (DMIMS(DU)/IEC/2018-19/7191) was provided by the Ethical Committee of Datta Meghe Institute of Medical Sciences (Deemed to be University) on 5/4/2018.


  Results Top


The signs and symptoms in decreasing order of their prevalence were as follows:

  1. Periodontal disease in 75% of patients
  2. Taste change in 68.75% of patients
  3. Mucosal pallor in 56.25% of patients
  4. Dry mouth in 50% of patients
  5. Petechiae and ecchymosis in 43.75% of patients
  6. Uremic stomatitis in 25% of patients[Table 1 and [Figure 1] and [Figure 2].
Figure 1: Schematic representation

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Figure 2: Graphic representation

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Table 1: The signs and symptoms

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  Discussion Top


Chronic kidney diseases are very common and prevalent worldwide, and as it is rightly said that “oral cavity is the mirror of our general health,” chronic kidney diseases have a significant impact on the oral cavity and give rise to a large spectrum of oral manifestations affecting both the hard and soft-tissue structures of the oral cavity. Dental management of such patients does require that the clinician understands the multiple systems that can be affected.[1]

The importance of CRD for the dental practitioner lies in the fact that an increasing number of patients with this disease will probably demand dental treatment, and that up to 90% of them will show oral signs and symptoms related to this systemic disease, for which dental management must be adapted to these patients at an early stage of disease.[3]

The following manifestations were observed through this study: uremic stomatitis, mucosal pallor, petechiae, ecchymosis, uremic stomatitis, and periodontal status (plaque, calculus, gingival recession, etc.). The pathophysiology of these manifestations is related to metabolic defects or hormonal insufficiency or reduced fluid intake.[2]

Mucosal pallor is a classical sign of chronic kidney disease and is present due to a reduced amount of erythropoietin, which results in less production of red blood cells, leading to anemia.[1]

Uremic stomatitis is a rare mucosal disorder associated with renal disorders; it presents due to markedly elevated levels of urea and other nitrogenous wastes which can be abrupt in onset. It can be of four types – ulcerative, hemorrhagic, erythemopultaceous, and hyperkeratotic.[1]

Dry mouth or xerostomia is a common complaint among patients undergoing dialysis. Uremic involvement of salivary glands, chemical inflammation, dehydration, mouth breathing, and restricted fluid intake are the main causative factors of xerostomia. Other reasons are metabolic disturbances and use of diuretics.[1]

Taste change: Patients often complain of reduced taste sensation or altered taste sensation, the cause of which is increased amount of urea in blood and their conversion into ammonia and carbon dioxide by bacterial urease.[3]

Petechiae and ecchymosis: They result from decrease in platelet dysfunction in platelet factor 3 and due to the effects of anticoagulants on CRD patients.[3]

While examination of patients, it was found that majority of these symptoms were found in all patients, which suggests that there is a strong correlation between the oral cavity and renal diseases.

To improve the general status and health of such patients, management of such manifestations becomes important, and dentists have a crucial role in such cases. It can be achieved along with physicians, dentists, and other health-care staff.[4],[5],[6],[7],[8],[9]


  Conclusions Top


From the obtained results, the following conclusions can be drawn:

  1. The most common manifestations are periodontal changes in the form of increased amount of plaque, calculus, and gingival recession; taste change; and mucosal pallor
  2. Uremic stomatitis and petechiae are comparatively less prevalent than periodontal changes and taste change
  3. CRDs have a significant impact on oral health, which needs intervention at an early stage of disease and its management to improve the general health status of patients.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kuravatti S, David MP. Oral manifestations of chronic kidney disease: An overview. Int J Contemp Res 2016;3:4.  Back to cited text no. 1
    
2.
Gupta M, Gupta M, Abhishek. Oral conditions in renal disorders and treatment considerations: A review for pediatric dentist. Saudi Dent J 2015;27:113-9.  Back to cited text no. 2
    
3.
Proctor R, Kumar N, Stein A, Moles D, Porter S. Oral and dental aspects of chronic renal failure. J Dent Res 2005;84:199-208.  Back to cited text no. 3
    
4.
Johnson CA, Levey AS, Coresh J, Levin A, Lau J, Eknoyan G. Clinical practice guidelines for chronic kidney disease in adults: Part I. Definition, disease stages, evaluation, treatment, and risk factors. Am Fam Physician 2004;70:869-7.  Back to cited text no. 4
    
5.
Hamid MJ, Dummer CD, Pinto LS. Systemic conditions, oral findings and dental management of chronic renal failure patients: General considerations and case report. Braz Dent J 2006;17:166-70.  Back to cited text no. 5
    
6.
Haider SR, Tanwir F, Momin IA. Oral Aspects of Chronic Renal Failure. Pak Oral Dent J 2003;1:87-90.  Back to cited text no. 6
    
7.
Prabahar MR, Chandrasekaran V, Soundararajan P. Epidemic of chronic kidney disease in India: What can be done? Saudi J Kidney Dis Transpl 2008;19:847-53.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Davidson SS. Diseases of kidney and urinary system. In: Haslett C, Chilvers ER, Hunter JAA, Boon NA, editors. Davidsons: Principles and Practice of Medicine. 18th ed. UK: Church Hill Livingstone; 1999. p. 417.  Back to cited text no. 8
    
9.
Patil S, Khaandelwal S, Doni B, Rahuman F, Kaswan S. Oral manifestations in chronic renal failure patients attending two hospitals in North Karnataka, India. Oral Health Dent Manag 2012;11:100-6.  Back to cited text no. 9
    


    Figures

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    Tables

  [Table 1]



 

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