AtlasSystemicOral Manifestations of CKD

Systemic Diseases

Oral Manifestations of CKD

aka Uraemic Stomatitis

Chronic renal failure produces a distinctive constellation of oral findings — uraemic fetor, mucosal pallor, renal osteodystrophy of the jaws and bleeding tendency.

Fetor
Ammoniacal
Bone
Lamina dura loss
Rx timing
Day after dialysis

§ figuresFigures (1)

Fig. 1Uremic frost present on the forehead and scalp of a young Afro-Caribbean male with a history of hypertension who presented with chronic progressive anorexia and fatigue with blood urea nitrogen and serum creatinine level

“Uremic frost on forehead and scalp of young Afro-Caribbean male” · Fythrion · CC BY-SA 3.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Manifestations of CKD figures pending faculty review.

§ overviewOverview

Oral changes associated with chronic kidney disease and end-stage renal disease, secondary to uraemia, mineral-bone disorder and medications.

§ epidemiologyEpidemiology

Up to 90% of dialysis patients show oral changes.

§ pathogenesisPathogenesis

Uraemia → urea in saliva hydrolysed to ammonia by bacterial urease; secondary hyperparathyroidism → bone resorption; platelet dysfunction → bleeding; immunosuppression (post-transplant) → drug-induced gingival overgrowth.

§ clinicalClinical Features

  • 01Uraemic fetor (ammoniacal breath)
  • 02Metallic taste
  • 03Mucosal pallor from anaemia
  • 04Xerostomia and enlarged salivary glands
  • 05Uraemic stomatitis: white plaques/pseudomembranes
  • 06Gingival bleeding, petechiae
  • 07Delayed eruption, enamel hypoplasia in children
  • 08Cyclosporine/nifedipine-induced gingival overgrowth in transplant recipients

§ radiographicRadiographic Features

  • 01Renal osteodystrophy: loss of lamina dura, ground-glass trabeculae
  • 02Brown tumours (secondary hyperparathyroidism)
  • 03Widened diploe, 'salt-and-pepper' skull

§ investigationsInvestigations

  • 01FBC, urea, creatinine, eGFR
  • 02Calcium, phosphate, PTH, vitamin D
  • 03Coagulation profile before invasive dental treatment

§ treatmentTreatment

  • 01Coordinate care with nephrologist; treat on non-dialysis day, morning after dialysis
  • 02Avoid nephrotoxic drugs (NSAIDs, tetracycline, aminoglycosides)
  • 03Adjust doses (amoxicillin, aciclovir) per eGFR
  • 04Use LA with epinephrine cautiously if hypertensive
  • 05Manage bleeding with local haemostatics; consider DDAVP
  • 06Endocarditis prophylaxis if indicated (AV fistula not itself an indication)

§ complicationsComplications

  • 01Bleeding after extraction
  • 02Infection
  • 03Impaired healing
  • 04Cardiovascular events during treatment

§ prognosisPrognosis

Depends on underlying renal function; oral changes improve with dialysis/transplantation.

§ examKey Examination Points

  • 01Check dialysis schedule and access site
  • 02Assess bleeding risk
  • 03Screen for gingival overgrowth in transplant patients

§ revisionQuick Revision Summary

  • 01Uraemic fetor · lamina dura loss · treat morning after dialysis · avoid NSAIDs

§ vivaBDS Viva Questions

  • 01Why treat the day after dialysis?
  • 02How does CKD cause bone changes in the jaw?
  • 03Which analgesics are safe?

§ mcqsMCQs — Assessment (3)

Question 1

Best day to schedule dental treatment for haemodialysis patient:

Question 2

Radiographic hallmark of renal osteodystrophy:

Question 3

Analgesic to AVOID:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

  • L1 · Classification — 1
  • L6 · Textbook — 3

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified
WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

DOI: Identifier not availablePMID: Identifier not available
View source

Histopathology References

Reference #4L6 · TextbookHistopathology References Unverified
Surgical Pathology of the Head and Neck3rd Edition

Barnes L. CRC Press · 2008

Detailed histopathological reference for head and neck diagnostic criteria.

DOI: Identifier not availablePMID: Identifier not available

Textbook References

Reference #2L6 · TextbookTextbooksRecent Verified
Oral and Maxillofacial Pathology5th Edition

Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024

Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.

DOI: Identifier not availablePMID: Identifier not available
View source
Reference #3L6 · TextbookTextbooks Unverified
Shafer's Textbook of Oral Pathology9th Edition

Rajendran R, Sivapathasundharam B. Elsevier · 2020

Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.

DOI: Identifier not availablePMID: Identifier not available

Additional sources cited on this page

  1. Proctor R. J Dent Res 2005

Browse the full evidence library →

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.