Oral Manifestation of

Renal Disease &

Hypertension

Arny Erawaty Muryah, drg

PPDGS ILMU PENYAKIT MULUT
(April 10 2015)

Renal Disease

Meliputi gangguan keseimbangan asam-basa, kelainan elektrolit,

nefrolitiasis, hipertensi, penyakit ginjal akut, penyakit ginjal tahap akhir
(end-stage renal disease / ESRD) tipe diabetik dan non diabetik.

Gagal ginjal, dapat terjadi secara akut Acute renal failure ; ARF (setelah
pembedahan atau trauma parah), atau adanya obtruksi pembuluh darah
ginjal menyebabkan gagal ginjal kronis (chronic renal failure ; CRF).
Gagal ginjal akan menimbulkan retensi cairan, asidosis, akumulasi
metabolik dan bahan obat, kerusakan platelet ( memicu pendarahan),
hipertensi, anemia dan efek endokrin.
(Burket : 2008)

Major function of Renal

Type of Renal Failure

(Haider et al : 2013)

Burket : 2008

Burket : 2008

Oral Manifestations of Renal Diseases

Ghom : 2013, Haider 2011, Scully : 2010, Ongole :2013)

Oral Manifestations of Uremia

Oral mucosa pale mucosa

Salivary gland decreased salivary flow resulting in erostomia.
Odor & taste odor of urea on breath and metallic taste.
Candidiasis

candidal infection can occur on tongue.

Gingiva increase in calculus formation, gingival inflammation, bleeding.

Teeth

enamel hypoplasia, dark brown stain on crowns, dental malocclusion

Other

petechiae, ecchymosis, erosive mucous, burning and tenderness with

dryness of mucosa.

(Ghom et al : 2014)

Uremic Stomatitis

Tipe 1. Erytemopultakeus

Tipe 2. Ulseratif

more extensive area of erosion verlying a delicate atrophic

mucosa. The typical striae are seen anterior to the erosion.

Hiperplasia gingiva oleh karena drug induced pada CRF

(Sunil et al : 2012)

Hipoplasia email pada gagal ginjal (Sunil et al : 2012)

Oral candidiasis on dorsal of tongue

(Scully : 2010)

Hypertension

Hipertensi

. (Ongole et al : 2013)

Blood pressure determined

(Scully : 2010)

Types of Hypertension

(Ghom : 2010)

Blood Pressure Measurement

(Scully : 2010)

Klasifikasi tekanan darah. (Ongole et al : 2013)

Antihypertension Medicine

(Popescu et al : 2013)

Oral side effects

of antihypertension medicines

(Ongole : 2014)

Orofacial manifestations

None specific to hypertension, The development of facial palsy has been

described in the occasional patient with very severe hypertension.

Side-effects of anti-hypertensive medications include:

chronic cough (e.g., angiotensin converting enzyme inhibitors ACEIs);
taste changes (e.g., ACEIs, beta blockers, alpha-adrenergic blockers);
angioedema of lips, face, tongue (ACEIs, angiotensin II receptor blockers-ARBs);
upper respiratory tract infections (e.g., ARBs);
gingival hyperplasia (e.g., calcium channel blockers CCBs);
dry mouth (e.g., thiazide diuretics and alpha-adrenergic blockers);
lichenoid reactions (e.g., thiazide diuretics and beta blockers); and
lupus-like oral and skin lesions (e.g., direct vasodilators).
(Scully : 2010)

Xerostomia karena diuretik, calsium channel bloker

Lichenoid drug eruption oleh karena beta bloker

Hiperplasia oleh karena calsium channel bloker

Kandidiasis pada mukosa bukal

General Management
(Ongole et al : 2013)

Dental Consideration

- Interaksi anastesi lokal - non selective beta-blockers toksisitas

- Penurunan dosis epinefrin dan diperpanjang jarak pemberiannya
- Teknik injeksi dengan perlahan menghindari reaksi yg tidak diinginkan
- NSAIDs menurunkan efek diuretik antihipertensi parasetamol
- Kontrol kecemasan, stres dan rasa sakit antianxietas
- Xerostomia agen parasimpatomimetik (pilocarpine atau cevimeline)
- Disarankan cukup minum dan berkumur, mengunyah permen tanpa gula,
mengurangi konsumsi kafein, tidak menggunakan obat kumur yg
mengandung alkohol
- Karies aplikasi topikal fluorida.

(Popescu et al : 2013, Ongole et al : 2013)

Penutup

DAFTAR PUSTAKA

Ongole, Praveen : Textbook of Oral Medicine, Oral Diagnosis and Oral Radiology, second edition, Elsivier, 2013

Proctor R, Kumar N, Stein A, Moles D, Porter S : Oral and Dental Aspects of Chronic Renal Failure Journal of Dental
Research; Mar 2005; 84, 3; Health & Medical Complete page. 199

Scully C : Medical Problems in Dentistry, 6th Edition, Elsevier, 2010 page 111-115 and 296-303

Scully C, Almeida P.de Oslei, Bagan Jose,Dios PD, Taylor AM : Oral Medicine and Pathology at a Glance, edition first
published, Blackwell Publishing Ltd, 2010

Field, Anne; Longman, Lesley : Tyldesley's Oral Medicine, 5th Edition , Oxford University Press, 2003 Page : 254-259

Bailoor ND, Nagesh KS: Fundamentals of Oral Medicine and Radiology, Jaypee Brothers Medical Publishers (P) Ltd New
Delhi, 2005

Ghom A.Govindrao : Textbook of Oral Medicine, Jaypee, 2010

Haider S.Raza, Tanwir F, Momin I.Abdul : Oral aspects of chronic renal failure, Pakistan Oral & Dental Journal Vol 33, No.
1 April 2013

DAFTAR PUSTAKA

Mozaffari P. Mosannen, Amirchaghmaghi M, Mortazavi H : Oral Manifestations of Renal Patients Before and After
Transplantation: A Review of Literature DJH Vol.1, No.1 : 2009

DeLong, Leslie. : General and oral pathology for the dental hygienist. 2nd ed, 2013 Wolters Health, 2013

Scully, C. : Oral And Maxillofacial Medicine. 2nd ed. Edinburgh: Churchill Livingstone. 2008

Ghom AG, Lodam,: textbook of Oral Medicine, third edition, Jaypee, 2014

Greenberg SM, Glick M, Ship AJ : Burkets Oral Medicine, Hamilton, 2008

Hamid MJ, Dummer CD, Pinto LS : Systemic Conditions, Oral Findings and Dental Management of Chronic Renal Failure
Patients: General Considerations and Case Report, Brazilian Dental Journal : 17(2) 2006

Garca E. de la Rosa, Padilla AM, Romo SA, Ramirez MA : Oral Mucosa symptoms, signs and lesions, in end stage renal
disease and non-end stage renal disease diabetic patients, Oral Medicine and Pathology, Med Oral Patol Oral Cir
Bucal;11:E467-73. 2006

Patil S, Khandelwal S, Doni B, Rahman F, Kaswan S.: Oral Manifestations in Chronic Renal Failure Patients Attending Two
Hospitals in North Karnataka, India, OHDM - Vol. 11 - No. 3 - September, 2012

DAFTAR PUSTAKA

Sunil, Kumar, Sawheney, Gaur B, Rastogi T : Spectrum of orofacial manifestations in renal diseases, Journal of
orofacial research 2(4) oct-dec 2012 page 216-220

Popescu SM, Mercuu Veronica, Mihaelatuculina, Dascslu Ionela : Hypertensive Patients and Their Management
in Dentistry ; Review Article, ISRN Hypertension Volume 2013, Hindawi Publishing Corporation Article ID
410740,8pages

Vesterinen Maarit : Oral Health And Kidney Disease With Emphasis On Diabetic Nephropathy, Academic
Dissertationuniversity Of Helsinki, Unioninkatu 34, Helsinki, November , 2011

Pinto A, Roldan R, Sollecito, TP. : Hypertension in Children: An Overview Journal of Dental Education , Volume
70, Number 4, November 2005

Kessler CS, Joudeh Y, Evaluation and Treatment of Severe Asymptomatic Hypertension, University Of Illinois At
Chicago College Of Medicine, Chicago, Illinois, American Family Physician, Volume 81, Number 4, 2010
www.aafp.org/afp

Syukron...