ESPN 53rd Annual Meeting

ESPN 2021


 
Joining Forces: Optimising Oral Health for Children and Young People with Kidney Disease
CHRISTOPHER WALLACE 1 PALLAVI PRASAD 2 CATHERINE HORRIDGE 3 OLIVER SUMNER 3 CHRISTINE PATTINSON 4 JAYNE STRAKER 4 RICHARD BALMER 1 VIRGINIA HIND 3

1- LEEDS DENTAL INSTITUTE
2- ALDER HEY CHILDRENS HOSPITAL, LIVERPOOL
3- NEWCASTLE DENTAL HOSPITAL
4- GREAT NORTH CHILDRENS HOSPITAL, NEWCASTLE
 
Introduction:

Children and young people (CYP) with kidney diseases may face adverse impacts of chronic kidney disease (CKD) on their developing dentition, alongside increased risk of adverse side-effects from dental treatment. Those who are immunocompromised are at increased risk of severe orofacial infections which can lead to pain and poor quality of life.

 

Our objective: To highlight the main orofacial manifestations of kidney disease and provide guidance on improving dental care and maximising oral health outcomes in CYP with kidney disease. 

Material and methods:

A joint dental-kidney service for CYP with CKD was piloted at our centres. Patients with CKD (IV-V) and those undergoing renal replacement therapy (RRT) are offered specialist dental reviews as part of their regular kidney out-patient clinics, or during in-centre haemodialysis therapy.  

Results:

Enamel defects are prevalent in patients with CKD. They can result in poor aesthetics alongside pain, and breakdown of molar teeth.  Drug-induced gingival overgrowth is a side-effect of ciclosporin, tacrolimus and calcium-channel blockers. It can lead to disfiguration and increased risk of periodontal disease.  Other orofacial manifestations of kidney disease may include oral soft tissue changes, xerostomia, salivary stones, opportunistic infections, increased risk of malignancy and radiographic changes in those with renal osteodystrophy.  

 

This joint service ensures CYP receive dental care by dentists with appropriate experience within paediatric dentistry to manage these more complex conditions. Furthermore, it also minimises the personal and financial burden patients and families face from attending excessive health care appointments. 

Conclusions:

The Kidney MDT is in a pivotal position to advocate oral health and reinforce regular dental reviews. Equally, the dental team may require support from the kidney team regarding additional precautions such as antibiotic prophylaxis, steroid cover, altered prescribing, and haemostatic measures during dental treatment.  By working together, nephrology and dental teams can maximise oral health and quality of life for their patients.