Written By: IJCP Editorial Team

Published On: 26 Mar, 2025 11:48 AM | Updated On: 29 Mar, 2025 2:05 PM

A case report of Improving Oral Health in a Young Patient with Chronic Kidney Disease

Chronic kidney disease (CKD) involves a progressive decline in kidney function and is often associated with dental health problems. A 15-year-old girl diagnosed with stage 4 CKD and methylmalonic aciduria also had hyperparathyroidism, high blood pressure, and severe plaque-induced gingivitis. At her first dental visit, she was on several medications, including sodium citrate and growth hormone, and wore braces on both her upper and lower jaws. The orthodontist halted her treatment due to her poor adherence, despite the ongoing need for orthodontic care. The girl sought help for her aesthetic concerns and to improve her oral hygiene. 

To address her gingivitis, a series of targeted dental interventions were implemented to see if oral hygiene efforts alone could reduce her condition. The fixed braces were removed to facilitate oral care, as the orthodontist refused to continue treatment. Instead, removable appliances were provided to minimize the impact on her oral hygiene.

Over four weeks, she received weekly professional mechanical plaque removal (PMPR) along with oral hygiene education. Subgingival calculus was also removed under antibiotic protection. The study included analyzing the microbiome of her tongue before and after treatment. Initially, the tongue microbiome revealed common oral bacteria linked to gingivitis. Despite intensive preventive measures, there was little change in the microbiome. Initially, 26 sites in her mouth showed signs of gingivitis, but three months later, this was reduced by 80%, with signs present at only three sites. The plaque levels significantly decreased, indicating an almost plaque-free mouth.

However, at a follow-up appointment three months later, there was an increase in inflammation, with signs of gingivitis present at 34 sites, attributed to the girl's noncompliance with hygiene practices.

This case highlights the importance of a collaborative approach among dental and medical professionals to maintain oral health in young CKD patients. Effective dental care and patient motivation, combined with oversight from pediatric nephrologists, are essential for improving oral health outcomes in these individuals.

Source: Hoefer KC, Weber LT, Jazmati N, Noack MJ, Barbe AG, Graf I. Chronic Kidney Disease With Related Oral Health Problems and Alterations in the Tongue Microbiome Illustrated by a 15-Year-Old Girl: A Case Report. Case Rep Pediatr. 2025 Feb 18;2025:1018472. doi: 10.1155/crpe/1018472. PMID: 40007817; PMCID: PMC11858826.