Relationships Among Renal Function, Bone Turnover and Periodontal Disease

a. Gingival enlargement Gingival enlargement secondary to drug therapy is the most commonly reported oral manifestation of renal disease. It can be induced by cyclosporine and/or calcium channel blockers (Somacarrera et al., 1994; Kennedy and Linden 2000). b. Oral hygiene and periodontal disease The oral hygiene of individuals receiving hemodialysis can be poor. Deposits of calculus may be increased (Epstein et al., 1980; Gavalda et al., 1999). There is no good evidence of an increased risk of periodontitis (Brown et al., 1989; Thorstensson et al., 1996; Naugle et al., 1998), although premature bone loss has been reported (Locsey et al., 1986). Localized suppurative osteomyelitis, secondary to periodontitis, was observed in individuals receiving hemodialysis (Tomaselli et al., 1993). c. Xerostomia Symptoms of xerostomia can arise in many individuals receiving hemodialysis (Kho et al., 1999; Klassen and Krasko, 2002). Possible causes include restricted fluid intake, sideeffects of drug therapy and/or mouth breathing (Porter et al., 2004). d. Oral malodor/bad taste/halitosis Uremic patients may have an ammonia-like oral odor (Kho et al., 1999), which also occurs in about one third of individuals receiving hemodialysis. CRF can give rise to altered taste sensation, and some patients complain of an unpleasant and/or metallic taste or a sensation of an enlarged tongue (Kho et al., 1999).