Dental Management of Urinary Disorders

Dental Management of Patients with Urinary Disorders

• Renal Disorders: Conditions affecting the kidneys include hydrogen ion concentration and electrolyte issues, glomerular diseases, acute renal failure, chronic renal failure, end-stage renal failure (uremic syndrome), and renal transplants.

Oral Manifestations of Impaired Renal Function

• Oral Manifestations: Patients with impaired renal function may display symptoms like an ammonia-like taste and smell, uremic stomatitis, gingivitis, xerostomia, and parotis. Petechiae and ecchymosis of the oral mucosa, oral mucosa pigmentation, and enamel hypoplasia can also occur.

Oral Manifestations of Impaired Renal Function

• Candidiasis: Oral yeast infection

• Osteodystrophy (radiolucent jaw lesion): Bone disease affecting the jaw

Glomerular Diseases

• Glomerular Diseases: An inflammation of the glomerular capillaries leading to complications like acute nephritic syndrome, chronic glomerulonephritis, and nephrotic syndrome

Acute Renal Failure

• Acute Renal Failure: A rapid and temporary loss of kidney function, often caused by acute and reversible deterioration, resulting in uremia.

Chronic Renal Failure

• Chronic Renal Failure: The irreversible decline of kidney function from a diminished mass/loss of excretory, metabolic, and endocrine functions in the kidney, leading to uremia.

Dental Management

• Consult with physician: Important when treating patients.

• Avoid unstable disease conditions: Avoid treatment if renal disease is unstable.

• Monitor blood pressure: Critical monitoring of blood pressure

• Meticulous surgical Technique: Employing meticulous techniques

• Avoid nephrotoxic drugs: Avoid drugs that damage the kidneys

• Adjust drug dosages: Adjusting drug dosages metabolized by the kidneys

• Infection control: Maintaining good infection control

• Maintainable teeth: Only treating easily maintainable teeth

• Oral Hygiene: Encouraging good oral hygiene

• Hospital-setting care: Advanced cases might necessitate hospital settings for care following a consultation.

Dental Management (Bleeding Problems)

• Bleeding Problems: Pretreatment screening for bleeding time and platelet count, and a hematocrit/hemoglobin count to assess for anemia.

Nephrotoxic Drugs

• Tetracyclines
• Streptomycin
• Vancomycin
• Gentamycin
• Acyclovir
• Acetaminophen
• Phenacetine
• NSAIDs
• Aspirin
• Antihistamines
• Phenobarbitones

Decrease Dosage

• Cephalosporins
• Penicillins
• Ampicillin
• Metronidazole
• Acyclovir
• Paracetamol
• Benzodiazepines

Normal Dose

• Cloxacillin
• Erythromycin
• Minocycline
• Codeine
• Diazepam
• Lidocaine

Patient Receiving Dialysis

• Arteriovenous shunt: Avoid pressure cuffs and IV medications in the shunt arm

• Infective endocarditis: Consulting with the physician about possible risks

• Avoid treatment: Avoid dental care on the day of dialysis treatment, and best practice is to wait until the day after.

• Antimicrobial prophylaxis: Considering antimicrobial prophylaxis

Renal Transplant Patient

• Infection Risk: Infection is a significant threat to renal transplant patients.

• Maintainable teeth: Determining only maintainable teeth for treatment before transplantation

• Extraction considerations: Extracting teeth with furcation involvement, periodontal abscesses, or extensive surgical needs.

Dental Management (Post-Transplant)

• Emergency Treatment: Emergency treatment only for the first 6 months post-transplant.

• Antibiotics: Prophylactic antibiotics according to AHA guidelines.

• Erythromycin Contraindication: Erythromycin is contraindicated for patients on cyclosporine.

• Gingival overgrowth: Cyclosporine can cause gingival overgrowth.

• Corticosteroids: Supplemental corticosteroids for immunosuppressed patients.