Controlling kidney disease

The kidneys have many roles, from removing waste products and excess fluid to regulating salt content and producing hormones.[i] Without these organs, the body cannot function. However, chronic kidney disease (CKD) is on the rise; by 2040 it is forecast that it will be the fifth leading cause of premature death around the world.[ii]

Among the UK population, over 10% of people have some degree of CKD, with 3 million currently living with severe kidney disease.ⁱⁱ For dental practitioners, noting the rise in CKD is essential because of the complex relationship it has with oral diseases, particularly periodontitis.[iii] Identifying at-risk patients and supporting those diagnosed with CKD is of paramount importance.

Understanding CKD

CKD is a long-term condition where the kidneys struggle to function. Its aetiology is multi-factorial: health problems such as high blood pressure, diabetes and high cholesterol can place too much strain on the kidneys, while kidney infections, inherited conditions and long-term use of certain medicines can also increase the risk of developing CKD.[iv] Its prevalence increases with age and can affect anyone. However, it is more common in people of Afro-Caribbean or South Asian origin.^iv Socio-economic inequalities, and disparities in access to healthcare could be an explanation for this.[v]

CKD is often diagnosed late due to patients commonly experiencing a lack of symptoms in the early stages. However, those with CKD may experience fatigue, shortness of breath and nausea. Blood in the urine can also be a symptom.ⁱⁱ As obesity and cardiovascular disease are also risk factors, CKD patients may have a greater predisposition to heart attacks.ⁱⁱ With obesity, high blood pressure, and high cholesterol often overlapping with CKD, afflicted patients must be encouraged to alter their lifestyle choices, such as a poor diet or a lack of exercise, to reduce the risk of developing CKD. But one of the biggest concerns of CKD is how it weakens the immune system, making patients more vulnerable to infections, especially in the oral cavity.

Oral health and CKD

Research has shown that 77.8% of CKD patients had some alteration in their oral cavity.[vi] Oral health can be easily neglected when being treated for a systemic health condition, and the suppressed immunity of CKD makes oral diseases more likely to develop. For instance, CKD patients being treated with haemodialysis are more prone to severe periodontal disease[vii]; patients may be hospitalised for long periods without consistent oral healthcare.^vi

Besides the inflammation of the gingiva, renal failure has other oral manifestations, ranging from ulcers and viral infections to xerostomia and halitosis.[viii] The latter two are more prevalent. Xerostomia can develop from the medication that CKD patients may be taking for high blood pressure and cholesterol^iv meaning that, with less saliva to buffer harmful particles, this can magnify the risk of infection.ⁱⁱⁱ Halitosis can be caused when urea, usually removed by the kidneys, breaks down into the foul-smelling ammonia.^ix

Whilst CKD can increase the risk of periodontitis, periodontal disease can also affect renal dysfunction, increasing the risk of CKD.^vii Inflammatory biomarkers, such as interleukins found in the gingivae and associated with periodontitis, are also linked with those that increase the risk of developing CKD.^vii Furthermore, dental infections like periodontitis may delay kidney transplants, meaning patients have to endure kidney failure for longer.[ix]

A daily task

To help protect CKD patients and patients at risk of developing CKD from oral diseases, a consistent oral hygiene routine is essential. Maintaining regular dental visits and toothbrushing twice a day can minimise kidney disease as a factor for oral diseases.^vi

Incorporating interdental brushing into the daily routine can also reduce gingival inflammation, and therefore the risk of periodontitis.^vii The FLEXI range of interdental brushes from TANDEX is ideally suited for this, offering 11 different sizes for optimal access around the oral cavity. Between the malleable brushes and the flexible handle, the FLEXI provides a comfortable clean. It can also be paired with the PREVENT Gel, from TANDEX, for an anti-bacterial kick that strengthens enamel and protects the teeth. Reduce the risk of oral diseases with the TANDEX product range.

The association between CKD and periodontitis is common, and must be addressed. As CKD increases in prevalence, arming patients with the knowledge and equipment they need to protect their oral health is essential.

For more information on Tandex’s range of products,
visit https://tandex.dk/

Our products are also available from CTS Dental Supplies
https://www.cts-dental.com/

Author: Jacob Watwood

[i] National Kidney Foundation (2024). How Your Kidneys Work. [online] National Kidney Foundation. Available at: https://www.kidney.org/kidney-health/how-your-kidneys-work.

[ii] Kidney Research UK (2023). Kidney disease: A UK public health emergency The health economics of kidney disease to 2033. [online] Available at: https://www.kidneyresearchuk.org/wp-content/uploads/2023/06/Economics-of-Kidney-Disease-full-report_accessible.pdf.

[iii] www.sgkpa.org.uk. (n.d.). Dental Health in Kidney Disease Patients. [online] Available at: https://www.sgkpa.org.uk/main/dental-health-in-kidney-disease-patients.

[iv] NHS (2023). Chronic kidney disease. [online] NHS. Available at: https://www.nhs.uk/conditions/kidney-disease/.

[v] National Kidney Foundation. (2024). Race, Ethnicity, & Kidney Disease. [online] Available at: https://www.kidney.org/kidney-topics/race-ethnicity-kidney-disease.

[vi] Daniel Furtado Silva, Ramos, C., Sivanilson Assis Medeiros, Fernando Martins Baeder, Carolina, A. and de, E. (2024). Oral health challenges in patients with chronic kidney disease: A comprehensive clinical assessment. ˜The œSaudi dental journal, 36(2), pp.364–367. doi:https://doi.org/10.1016/j.sdentj.2023.11.026.

[vii] Chang, Y., Lee, J.S., Woo, H.G., Ryu, D.-R., Kim, J.-W. and Song, T.-J. (2021). Improved oral hygiene care and chronic kidney disease occurrence. Medicine, 100(47), p.e27845. doi:https://doi.org/10.1097/md.0000000000027845.

[viii] National Kidney Federation. (n.d.). Dental care. [online] Available at: https://www.kidney.org.uk/dental-care.

[ix] Cigna Healthcare Newsroom. (n.d.). Here Are 14 Medical Conditions with a Surprising Connection to Oral Health. [online] Available at: https://newsroom.cigna.com/medical-conditions-with-surprising-connection-oral-health.