Algorithm of dental procedures in patients qualified for kidney transplant – case report

Background: Renal failure is associated with many abnormalities of oral and
dental health status. The aim of this study was to describe the procedures for dental treatment necessary to qualify the patient on the waiting list for kidney transplantation.
Material/Methods: 46-year old patients with ESRD due to reflux nephropathy,
dialyzed peritoneally for 8 years. She received a cadaveric kidney transplant in 2003. Her immunosuppression consisted of prograf, MMF and steroids; creatinine after Tx was 1.58 mg/dl to 2 mg/dl 6 months later. Transplant biopsy was performed in 2005 (chronic thrombotic microangiopathy, creatinine=3.5 mg/dl). 4 years after Tx she entered PD programme due to graft failure. She reported to a dental clinic in order to eliminate the odontogenic foci of infection. The pantomography and digital radiography has shown the presence of three teeth classified as potential centres of inflammation. The methods of treatment of choice were: 1) surgical extraction, connected with filling of the bone defect with BioOss bone substitute material and application of Bio-Gide collagen membrane; 2) extirpation of inflamed pulp in anaesthesia; 3) antiseptic endodontic treatment.
Results: Clinical and radiological examination has shown normal bone healing process and condition of periapical tissues.
Conclusions: The elimination of odontogenic centres of inflammation in patients before kidney transplant must be preceded by precisely planned multispecialist treatment. Central is the application of principles of odontogenic inflammation prophylaxis as soon as in the pre-dialysis period, since periodontal diseases are signifi cant cause of generalized inflammation accelerating the progression of atherosclerosis and its complications.

Keywords: Kidney Transplantation