Preventive Dental Strategies to Minimize Oral Health Complications After Renal Transplantation: A Systematic Review

Kidney transplantation dramatically improves survival and life quality in patients with end-stage renal disease, yet it imposes a substantial and often overlooked oral health burden. Immunosuppressive therapy, comorbidities, and residual renal dysfunction increase susceptibility to periodontal disease, oral candidiasis, mucosal lesions, and drug-induced gingival overgrowth, which may contribute to systemic complications and negatively affect patient well-being. This review synthesizes evidence on oral complications and evaluates preventive strategies.

A comprehensive systematic review with qualitative evidence synthesis was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, encompassing studies published over the last 20 years. Observational studies and randomized trials were analyzed, with risk-of-bias assessment using ROBINS-I and Cochrane RoB tools. Due to heterogeneity in study design, outcome definitions, and reporting methods, a quantitative meta-analysis was not feasible.

Oral complications arise from the interplay of immunosuppression, comorbidities, and insufficient oral care. Periodontal disease affects up to 87% of recipients, with xerostomia, candidiasis, and gingival overgrowth commonly reported. Preventive measures, including pretransplant dental clearance, individualized hygiene programs, antifungal prophylaxis, fluoride use, and structured post-transplant monitoring, are associated with reductions in oral infections and inflammatory complications reported across multiple studies. Evidence gaps persist, particularly in low-resource settings, standardized protocols, and patient-reported outcomes such as oral health-related quality of life (OHRQoL).

Oral health is an important component of kidney transplant care. Integrating structured, patient-centered dental protocols within transplant programs may help reduce oral morbidity and support overall patient health, although direct causal effects on graft outcomes remain incompletely established in current literature. Future research should focus on longitudinal outcomes and OHRQoL metrics to guide precision, holistic transplant care.