Pediatric dental approaches in children with chronic kidney disease

Abstract

Chronic kidney disease (CKD) in childhood is a progressive and irreversible condition that affects multiple organ systems, including the oral and dental structures. This review article provides a comprehensive overview of the oral manifestations of CKD in pediatric patients and discusses appropriate dental management strategies. As the prevalence of CKD in children has increased in recent years, awareness of its oral implications has become increasingly important for pediatric dentists. Children with CKD commonly present with distinct oral findings resulting from metabolic disturbances, uremia, altered saliva composition, and long-term medical treatments. Although these patients often have inadequate oral hygiene and a carbohydrate-rich diet, several studies report a lower prevalence of dental caries compared to healthy peers. This paradox is mainly attributed to increased salivary urea levels, higher buffering capacity, and an alkaline oral environment, which inhibit acidogenic bacteria. However, the same salivary changes contribute to increased dental calculus formation. Additional oral findings include halitosis, gingival and periodontal alterations, oral mucosal pallor due to anemia, bleeding tendencies, and opportunistic infections, particularly in immunosuppressed or transplant patients. Renal osteodystrophy may affect the alveolar and supporting bone, increasing the risk of abnormal bone healing and jaw fractures following dental procedures. Moreover, medications commonly used in CKD management, such as cyclosporine and calcium channel blockers, may induce gingival overgrowth and xerostomia. Early identification of oral manifestations, regular dental follow-up, and preventive care are essential in children with CKD. A multidisciplinary approach involving pediatric dentists and pediatric nephrologists is crucial to ensure safe dental treatment and to improve both oral health outcomes and overall quality of life in this vulnerable population.