Dialysis and Dental Health: What You Need to Know

Keeping a healthy smile when you have kidney failure can take some extra effort. The type of treatment you choose can affect the health of your teeth and gums. In turn, your oral health can have an impact on the rest of your body.

If you were a shark, you could grow a new set of teeth every two weeks! Since we humans can't do that handy trick, we need to take good care of the 32 permanent teeth we have.

Meet Your Teeth

Tooth diagram Teeth contain four types of tissue (See Figure 1):

The role of saliva

Would you believe that healthy people make a liter and a half of saliva a day? Mainly water, saliva has enzymes that help digest starch. It helps wash bits of food away from your teeth. It makes your mouth more alkaline, so your teeth are less likely to decay from acid that forms when food breaks down.

Minerals in saliva make tiny repairs to enamel. Saliva moistens food so it's easier to swallow and less likely to scratch your throat. And, it lubricates and protects your tongue and the delicate tissues in your mouth. For all of these reasons, saliva is vital for healthy teeth and gums.

Dialysis and dry mouth

Tooth decay If you have a strict fluid limit, you may make less saliva. With less saliva to bathe them, your teeth are more prone to decay. Less saliva can also lead to bad breath, gum disease, and tooth loss (see Figure 2). In one study, the average number of teeth in people on dialysis was just 20—a loss of 12. Most transplant programs will require you to have healthy teeth and gums.

A dry mouth and gum disease can make it harder to eat, too. A study found that people on dialysis who had severe gum disease also had low blood albumin (protein) levels. 1 Not getting enough protein can lead to malnutrition—which is a strong risk factor for death in people on dialysis. 2

Will more dialysis help your mouth? Three studies suggest that it might. In a 2-year study, people who had kidney transplants made more saliva and had less dry mouth than those on standard in-center hemodialysis (HD). 3 In the second study, much more gum disease was found in people on standard HD than in a group on peritoneal dialysis (PD) or a group who did not yet need dialysis. 4 In the third study, people on standard HD had more gum bleeding than those on PD—but both those on PD and HD had more tooth plaque than healthy people. 5 The results suggest that the closer a treatment can bring you to normal kidney function, the healthier your mouth may be, too.

Antibiotics at the dentist

Dentist When you have your teeth cleaned, bacteria in pockets under the gum line may get into your bloodstream. These germs may stick to a dialysis fistula or graft and cause an infection. Some nephrologists prescribe antibiotics before a dental visit to help prevent a problem.

There are no controlled studies of whether this practice really does prevent access infections. This doesn't mean it won't work—just that we don't know for sure. Follow your doctor's advice about whether or not to take antibiotics before you have dental work.

For more than 50 years, the American Heart Association (AHA) has had guidelines for use of antibiotics at the dentist. They believed that bacteria from gum disease could reach the heart and lead to heart disease.

African-American couple Now, the AHA believes only a very small number of people need antibiotics for this reason. 6 They are those who:

What you can do about dry mouth

If dry mouth is a problem for you, the Mayo Clinic suggests some things you can do: 7

Changing to a longer or more frequent type of dialysis, or getting a transplant, may also help relieve dry mouth.

Preventing and treating tooth decay

Man smiling Brushing, flossing, and seeing a dentist for cleanings is key to keeping your teeth healthy. Getting small cavities filled can keep little problems from growing into bigger, costly ones.

Are you afraid of the dentist? Many people don't like to go to the dentist, but if fear keeps you from going at all, this can be treated. The Dental Fear Central website has information and even a dental fear support forum.

As with health insurance, many Americans don't have dental coverage. If you need dental work and can't afford it, talk to your social worker about local options:


Having a healthy mouth can help you maintain your overall health, and even aid your chance for a transplant. Fight dry mouth and take good care of your teeth and gums to keep on smiling.


  1. Kshirsagar AV, Craig RG, Beck JD, Moss K, Offenbacher S, Kotanko P, Yoshino M, Levin NW, Yip YK, Almas K, Lupovici E, Falk RJ. Severe periodontitis is associated with low serum albumin among patients on maintenance hemodialysis therapy. Clin J Am Soc Nephrol. 2007 Mar; 2(2):239-44.
  2. Leon JB, Albert JM, Gilchrist G, Kushner I, Lerner E, Mach S, Majerle A, Porter D, Ricanati E, Sperry L, Sullivan C, Zimmerer J, Sehgal AR. Improving albumin levels among hemodialysis patients: a community-based randomized controlled trial. Am J Kidney Dis. 2006 Jul; 48(1):28-36.
  3. Bots CP, Brand HS, Poorterman JH, van Amerongen BM, Valentijn-Benz M, Veerman EC, ter Wee PM, Nieuw Amerongen. Oral and salivary changes in patients with end-stage renal disease (ESRD): a two-year follo-up study. Br Dent J. 2007 Jan 27; 202(2):E3.
  4. Borawski J, Wilczynska-Borawska M, Stokowska W, Mysliwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant. 2007 Feb; 22(2):457-64.
  5. Bayraktar G, Kurtulus I, Kazancioglu R, Bayramgurler I, Cintan S, Bural C, Bozfakioglu S, Besler M, Trablus S, Issever H, Yildiz A. Evaluation of periodontal parameters in patients undergoing peritoneal dialysis or hemodialysis. Oral Dis. 2008 Mar; 14(2):185-9.
  6. AHA Guideline: Prevention of Infective Endocarditis
  7. Mayo Clinic: Dry mouth
  8. Quench Gum - Nutrition Facts
  9. Biotene Dry Mouth Products