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Q)Someone at a conference I attended said kidney disease and bad teeth go hand in hand. Is this true? What does that mean for my patients?
“Bad teeth” can refer to periodontitis, a chronic inflammation of the tissue and structures around the teeth. The sixth most common disease in the world, periodontitis often leads to shrinkage of the gums, infection, and subsequent loosening or loss of teeth.3
Patients with chronic kidney disease (CKD) are predisposed to oral lesions and tooth decay related to dryness of the mouth; alterations in taste; malnutrition; and low albumin. Certain medications—such as ß-blockers, diuretics, anticholinergics, anticonvulsants, and serotonin reuptake inhibitors—can increase the risk for dry mouth and negatively affect oral structures.4
Compared with community-dwelling adults, those with CKD have higher rates of periodontitis, which increase with disease progression.5 A systematic review found that periodontitis increases the risk for CKD; evidence was inconclusive for the impact of periodontal treatment on estimated glomerular filtration rates (eGFR) but suggested positive improvements in eGFR.6
There is growing evidence of a multifaceted relationship between CKD, diabetes, periodontitis, and cardiovascular disease (CVD), the leading cause of mortality in patients with CKD.7 Studies have shown that periodontitis can contribute to systemic inflammation, inhibiting glycemic control and elevating the risk for conditions such as CVD.8-10
Diabetes, the most common cause of CKD, is associated with adverse dental outcomes and poor glycemic control. Vice versa, severe periodontitis increases risk for diabetes and worsening glucose control. Mechanical periodontal treatment has been shown to improve glycemic control.8
A recent study showed an increased risk for both CVD events and all-cause mortality in those with stage III to stage V CKD (eGFR < 60 mL/min/1.73 m2). The study also found that periodontitis increased 10-year all-cause mortality in this population (see Figure).11
Research is ongoing regarding the complex relationship between CKD and oral health. For patients with CKD at any stage, evidence promotes the benefits of good oral health habits. Encourage smoking cessation, daily flossing and tooth brushing, regular dental cleanings, and prompt evaluation and treatment of any oral issues.12—CS
Cynthia Smith, DNP, CNN-NP, FNP-BC, APRN
Renal Consultants PLLC, South Charleston, West Virginia
3. Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol. 2007;78(7):1387-1399.
4. Akar H, Akar GC, Carrero JJ, et al. Systemic consequences of poor oral health in chronic kidney disease patients. Clin J Am Soc Nephrol. 2011;6(1):218-226.
5. Borawski J, Wilczyn´ska-Borawska M, Stokowska W, Mys´liwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant. 2007;22(2):457-464.
6. Chambrone L, Foz AM, Guglielmetti MR, et al. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J Clin Periodontol. 2013;40(5):443-456.
7. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-1305.
8. Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014;93(11):1045-1053.
9. Chapple IL, Genco R; Working Group 2 of Joint EFP/AAP Workshop. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol. 2013; 40(14):S106-S112.
10. Menon V, Greene T, Wang X, et al. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int. 2005;68(2):766-772.
11. Sharma P, Dietrich T, Ferro CJ, et al. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol. 2016;43(2):104-113.
12. Ariyamuthu VK, Nolph KD, Ringdahl BE. Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review. Cardiorenal Med. 2013;3(1):71-78.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation’s Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month’s responses were authored by Sherry Mathes, NP-C, who practices at Georgia Nephrology LLC in Lawrenceville, Georgia, and Cynthia Smith, DNP, CNN-NP, FNP-BC, APRN, who practices with Renal Consultants PLLC in South Charleston, West Virginia.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation’s Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month’s responses were authored by Sherry Mathes, NP-C, who practices at Georgia Nephrology LLC in Lawrenceville, Georgia, and Cynthia Smith, DNP, CNN-NP, FNP-BC, APRN, who practices with Renal Consultants PLLC in South Charleston, West Virginia.
Clinician Reviews in partnership with
Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation’s Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month’s responses were authored by Sherry Mathes, NP-C, who practices at Georgia Nephrology LLC in Lawrenceville, Georgia, and Cynthia Smith, DNP, CNN-NP, FNP-BC, APRN, who practices with Renal Consultants PLLC in South Charleston, West Virginia.
Q)Someone at a conference I attended said kidney disease and bad teeth go hand in hand. Is this true? What does that mean for my patients?
“Bad teeth” can refer to periodontitis, a chronic inflammation of the tissue and structures around the teeth. The sixth most common disease in the world, periodontitis often leads to shrinkage of the gums, infection, and subsequent loosening or loss of teeth.3
Patients with chronic kidney disease (CKD) are predisposed to oral lesions and tooth decay related to dryness of the mouth; alterations in taste; malnutrition; and low albumin. Certain medications—such as ß-blockers, diuretics, anticholinergics, anticonvulsants, and serotonin reuptake inhibitors—can increase the risk for dry mouth and negatively affect oral structures.4
Compared with community-dwelling adults, those with CKD have higher rates of periodontitis, which increase with disease progression.5 A systematic review found that periodontitis increases the risk for CKD; evidence was inconclusive for the impact of periodontal treatment on estimated glomerular filtration rates (eGFR) but suggested positive improvements in eGFR.6
There is growing evidence of a multifaceted relationship between CKD, diabetes, periodontitis, and cardiovascular disease (CVD), the leading cause of mortality in patients with CKD.7 Studies have shown that periodontitis can contribute to systemic inflammation, inhibiting glycemic control and elevating the risk for conditions such as CVD.8-10
Diabetes, the most common cause of CKD, is associated with adverse dental outcomes and poor glycemic control. Vice versa, severe periodontitis increases risk for diabetes and worsening glucose control. Mechanical periodontal treatment has been shown to improve glycemic control.8
A recent study showed an increased risk for both CVD events and all-cause mortality in those with stage III to stage V CKD (eGFR < 60 mL/min/1.73 m2). The study also found that periodontitis increased 10-year all-cause mortality in this population (see Figure).11
Research is ongoing regarding the complex relationship between CKD and oral health. For patients with CKD at any stage, evidence promotes the benefits of good oral health habits. Encourage smoking cessation, daily flossing and tooth brushing, regular dental cleanings, and prompt evaluation and treatment of any oral issues.12—CS
Cynthia Smith, DNP, CNN-NP, FNP-BC, APRN
Renal Consultants PLLC, South Charleston, West Virginia
Q)Someone at a conference I attended said kidney disease and bad teeth go hand in hand. Is this true? What does that mean for my patients?
“Bad teeth” can refer to periodontitis, a chronic inflammation of the tissue and structures around the teeth. The sixth most common disease in the world, periodontitis often leads to shrinkage of the gums, infection, and subsequent loosening or loss of teeth.3
Patients with chronic kidney disease (CKD) are predisposed to oral lesions and tooth decay related to dryness of the mouth; alterations in taste; malnutrition; and low albumin. Certain medications—such as ß-blockers, diuretics, anticholinergics, anticonvulsants, and serotonin reuptake inhibitors—can increase the risk for dry mouth and negatively affect oral structures.4
Compared with community-dwelling adults, those with CKD have higher rates of periodontitis, which increase with disease progression.5 A systematic review found that periodontitis increases the risk for CKD; evidence was inconclusive for the impact of periodontal treatment on estimated glomerular filtration rates (eGFR) but suggested positive improvements in eGFR.6
There is growing evidence of a multifaceted relationship between CKD, diabetes, periodontitis, and cardiovascular disease (CVD), the leading cause of mortality in patients with CKD.7 Studies have shown that periodontitis can contribute to systemic inflammation, inhibiting glycemic control and elevating the risk for conditions such as CVD.8-10
Diabetes, the most common cause of CKD, is associated with adverse dental outcomes and poor glycemic control. Vice versa, severe periodontitis increases risk for diabetes and worsening glucose control. Mechanical periodontal treatment has been shown to improve glycemic control.8
A recent study showed an increased risk for both CVD events and all-cause mortality in those with stage III to stage V CKD (eGFR < 60 mL/min/1.73 m2). The study also found that periodontitis increased 10-year all-cause mortality in this population (see Figure).11
Research is ongoing regarding the complex relationship between CKD and oral health. For patients with CKD at any stage, evidence promotes the benefits of good oral health habits. Encourage smoking cessation, daily flossing and tooth brushing, regular dental cleanings, and prompt evaluation and treatment of any oral issues.12—CS
Cynthia Smith, DNP, CNN-NP, FNP-BC, APRN
Renal Consultants PLLC, South Charleston, West Virginia
3. Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol. 2007;78(7):1387-1399.
4. Akar H, Akar GC, Carrero JJ, et al. Systemic consequences of poor oral health in chronic kidney disease patients. Clin J Am Soc Nephrol. 2011;6(1):218-226.
5. Borawski J, Wilczyn´ska-Borawska M, Stokowska W, Mys´liwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant. 2007;22(2):457-464.
6. Chambrone L, Foz AM, Guglielmetti MR, et al. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J Clin Periodontol. 2013;40(5):443-456.
7. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-1305.
8. Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014;93(11):1045-1053.
9. Chapple IL, Genco R; Working Group 2 of Joint EFP/AAP Workshop. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol. 2013; 40(14):S106-S112.
10. Menon V, Greene T, Wang X, et al. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int. 2005;68(2):766-772.
11. Sharma P, Dietrich T, Ferro CJ, et al. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol. 2016;43(2):104-113.
12. Ariyamuthu VK, Nolph KD, Ringdahl BE. Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review. Cardiorenal Med. 2013;3(1):71-78.
3. Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol. 2007;78(7):1387-1399.
4. Akar H, Akar GC, Carrero JJ, et al. Systemic consequences of poor oral health in chronic kidney disease patients. Clin J Am Soc Nephrol. 2011;6(1):218-226.
5. Borawski J, Wilczyn´ska-Borawska M, Stokowska W, Mys´liwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant. 2007;22(2):457-464.
6. Chambrone L, Foz AM, Guglielmetti MR, et al. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J Clin Periodontol. 2013;40(5):443-456.
7. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-1305.
8. Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res. 2014;93(11):1045-1053.
9. Chapple IL, Genco R; Working Group 2 of Joint EFP/AAP Workshop. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol. 2013; 40(14):S106-S112.
10. Menon V, Greene T, Wang X, et al. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int. 2005;68(2):766-772.
11. Sharma P, Dietrich T, Ferro CJ, et al. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol. 2016;43(2):104-113.
12. Ariyamuthu VK, Nolph KD, Ringdahl BE. Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review. Cardiorenal Med. 2013;3(1):71-78.