The Tribune

KEEPING YOUR MOUTH ALIVE

By Dr Andre Clarke

World Kidney Day was March 8th, 2012 and it was recognized internationally. It is a joint initiative of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF). The day is to increase awareness of the importance of the kidneys to the overall health (including the mouth). In addition, the day seeks to reduce the stigma attached to kidney disease.

Human kidneys come as a pair and are found in the back part of the abdominal cavity (belly area). They are bean shaped and are essential in forming and excreting urine; regulating fluid and electrolytes (inorganic compounds/ions); and excreting hormones directly into the blood.

Individuals with kidneys that are not functioning well for a long time, and are damaged beyond repair, are said to be in chronic renal failure. Chronic renal failure can be mild, moderate or severe, and in extreme cases, can advance to 'end stage renal disease'.

Long term dialysis is needed in chronic renal failure, and in suitable individuals with 'end stage kidney disease', a kidney transplant may be advised. Dialysis is the process by which uric acid and urea are removed, by a machine, from the circulating blood. In short, dialysis ensures the removal of the body's toxins.

Chronic renal disease affects the mouth in many ways. Some of the common effects include: dry mouth; bad breath; metallic taste; insidious (seeming unimportant) bleeding from the mouth; swollen salivary glands and increased tartar accumulation. In addition to insidious bleeding in the mouth, the mouth tissues often appear pale because of anemia or orange due to carotene-like deposits.

The bones of the jaws are also commonly affected with the occurrence of osteoporosis and weakened jaw segments. The temporomandibular joints (TMJ) (joints in the front of the ears), as a result of the jaw bone effects, are affected. It is also common for fluid in the mouth tissues to accumulate and cause a swollen tongue and a swollen roof of the mouth. Oftentimes, mouth ulcers occur and sometimes they are covered by false grey membranes. Of note, patients with large amounts of waste products in their bodies, because of failing kidneys, are known to have a degree of tingling of their tongues and lips.

Whenever the dental healthcare professional is managing a patient who has chronic renal failure, the main concerns are the tendencies to bleed and acquiring infections. Consideration must be given to the effect on dental management (of any underlying diseases), which may have caused the kidney damage (e.g. hypertension, diabetes and systemic lupus erythematosus).

To minimize bleeding during dental procedures, no dental procedure should be performed on the same day as dialysis. This is because the patient is usually heparinised (medication that causes bleeding) to allow the blood to flow in and out of the dialysis tubes without clotting. In order to minimize infections, antibiotic coverage for patients with polycystic kidneys; those receiving peritoneal dialysis; some on haemodialysis; and those with kidney transplants, should be considered.

All organs in the body are special, but the task of the kidneys to seamlessly cleanse the body deserves special note. It is known that people with chronic kidney disease are at risk for dental problems such as gum disease, tooth decay and tooth loss. When left untreated, these problems can cause infections, which can lead to overall health issues.

Please remember that gum disease and tooth decay are both treatable and preventable. If your kidneys are functioning well or not, follow your dentist's recommendations regarding brushing, flossing, exams twice a year and professional teeth cleanings. Keep your teeth and gums healthy. Always keep them healthy.

This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication. If you have questions, please send email to dr_andreclarke@hotmail.com.