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

§ 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:

References

  1. Proctor R. J Dent Res 2005

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