![]() The overall prevalence of genetic kidney disease in children in Australia and New Zealand is 70.6 children per million in the age-representative population. Surveys in Australia, Europe, and Japan describe the prevalence of chronic kidney disease to be 6–16% of their respective populations ( El Nahas and Bello, 2005 Hallan et al., 2006). ![]() In North America, up to 11% of the population (19 million) may have chronic kidney disease ( Coresh et al., 2003). The estimated incidence of ESRF in childhood, either due to a congenital or acquired condition, is 10–12 cases per 1 million children, with a prevalence varying from 39 to 56 million children ( Trivedi and Pang, 2003). Because this disease is often asymptomatic in its early stages, it is both underdiagnosed and underreported ( Warady and Chadha, 2007). There is limited information on the epidemiology of CRD in the pediatric population. ![]() This manuscript provides an up-to-date review of the clinical and oral manifestations of CRD and the role of pediatric dentists in the treatment of patients with CRD. These complications can lead to excessive bleeding, anemia, increased susceptibility to infection, drug intolerance, renal osteodystrophy, adrenal crisis, and enamel defects in children. Renal disease may lead to the development of pale oral mucosa ( Al Nowaiser et al., 2003), dental calculus ( Davidovich et al., 2009 Martins et al., 2008), enamel hypoplasia ( Al Nowaiser et al., 2003 Martins et al., 2008), dry mouth ( Martins et al., 2008), low caries rate ( Al Nowaiser et al., 2003 Nakhjavani and Bayramy, 2007 Nunn et al., 2000), poor oral hygiene, and uremic stomatitis, and may cause changes in the salivary composition ( Guzeldemir et al., 2009) and flow rate ( Al Nowaiser et al., 2003 Guzeldemir et al., 2009 Martins et al., 2008). In children, renal disease can give rise to a wide spectrum of oral manifestations in the hard and soft tissues. ESRD is the stage when renal replacement therapy by dialysis or transplantation is required ( Greenberg and Glick, 2003). Nephrotic range proteinuria is defined as proteinuria exceeding 1000 mg/m 2/d or a spot urinary protein-to-creatinine ratio exceeding 2 mg/mg ( Bagga and Mantan, 2005). Nephrotic syndrome is a common chronic disorder that is characterized by alterations of permselectivity at the glomerular capillary wall, resulting in protein loss through the urine. CRF is accompanied by clinical and laboratory changes that are related to the inability of the kidney to excrete metabolites and perform endocrine functions, including secretion of active vitamin D and erythropoietin ( Fogo and Kon, 2004). Common renal disorders seen in children include congenital nephropathies, nephrotic syndrome, chronic renal failure (CRF), glomerulonephritis, hydronephrosis, and multicystic renal dysplasia, which ultimately lead to end-stage renal disease (ESRD) ( Bagga et al., 2009 Warady and Chadha, 2007).ĬRF is a progressive and irreversible decline in the total number of functioning nephrons, which causes a decline in the glomerular filtration rate. In particular, the prevalence of chronic renal disease (CRD) is increasing worldwide ( Olivas-Escárcega et al., 2008). With advances in medical treatment and improved survival rates for many disorders, dentists can be expected to treat an increasing number of patients with complex medical conditions. Various medical conditions can affect the oral health of patients. Hence, treatment plans should be formulated to restore the patient’s dentition and protect them from potentially severe infections of dental origin. ![]() Improving oral hygiene and performing necessary dental and oral treatment before hemodialysis or transplantation may prevent endocarditis and septicemia in these patients. Medical treatments in these patients may need to be postponed due to an unfavorable oral health status or potential risk of life-threatening infection after surgery. Dentists should consult with nephrologists regarding the specific precautions required for each patient. Dental management of patients with CRD requires that clinicians appreciate that multiple systems can be affected by the disease. Bleeding, altered drug metabolism, impaired immune function, and an increased risk of dentally induced bacterial endocarditis are some important features that require attention. ![]() In children, CRD can elicit a wide spectrum of oral manifestations in the hard and soft tissues. As the number of people suffering from CRD increases worldwide, dentists are expected to encounter more patients with CRD who need oral care. A PubMed literature search was performed and all relevant studies were assessed. This article reviews the current understanding of the oral and dental aspects of chronic renal disease (CRD). ![]()
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