Oral Health in Early and Advanced Stages (1-4) of Chronic Kidney Disease: A Systematic Review and Meta-Analysis

It is essential to identify oral health changes in the early stages of chronic kidney disease (CKD) to prevent oral degeneration. The effects of early-stage CKD on the periodontium and the manifestation of associated oral symptoms remain poorly understood. Periodontitis is well documented in late-stage CKD. These changes represent a considerable burden for patients, leading to consequences like tooth loss and stomatognathic disorders. This study evaluates oral health parameters in patients with early- and advanced-stage CKD (stages 1-4), to identify potential changes in oral health and provide important insights into CKD-specific dental treatment. We performed a comprehensive literature search of the databases 'Pubmed', 'Web of Science', 'ClinicalTrials.gov', and 'Cochrane' up to June 2025. Of 1,584 search results, 24 studies met the inclusion criteria. The meta-analysis revealed that patients with early- and advanced-stage CKD exhibited significantly higher levels of plaque and calculus accumulation compared to healthy patients. These patients experienced pronounced gingival inflammation, elevated gingival index scores, and increased 'bleeding on probing' levels. They demonstrated significantly higher salivary pH levels and reduced salivary flow rates. There is a strong relationship between early and advanced-stage CKD and increased oral inflammation, plaque accumulation, and reduced saliva flow rate. To prevent the dental health of these patients from deteriorating, it is crucial to refer them to a dentist rapidly during the progression of the disease. Based on their understanding of the impact of CKD on oral health, the dentist will then determine a patient-specific recall interval.