Examining the multidimensional implications of oral health in chronic kidney disease: A systematic review

The authors of this systematic review aimed to synthesize the evidence on the multidimensional oral health outcomes associated with chronic kidney disease (CKD), including oral health status, oral manifestations, oral health-related quality of life, underlying biological mechanisms, and access to oral health care.

A total of 46 English-language studies published over the past decade were included, comprising randomized controlled trials, nonrandomized interventional studies, and observational designs (eg, cohort, case-control, and cross-sectional studies). Studies were selected according to predefined population, exposure, comparator, and outcomes criteria. Risk of bias and methodological quality were assessed independently, and findings were synthesized qualitatively due to heterogeneity. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

Patients with CKD exhibited poorer oral health outcomes than healthy controls across multiple domains. These included reduced oral health-related quality of life (standardized mean difference, 0.45), high prevalence of oral mucosal lesions (81.8%), higher salivary pH (standardized mean difference, 1.74), and substantial tooth loss (mean, 15 teeth). Proposed mechanisms include systemic inflammation, altered mineral metabolism, kidney osteodystrophy, salivary changes, and oral microbiome dysbiosis.

Routine use of the 14-item Oral Health Impact Profile can help clinicians identify oral health-related quality of life issues in patients with CKD, guide early detection and prevention of oral complications, and support integration of oral health care with overall medical management, including monitoring kidney function tests to identify patients at higher risk. In the future, researchers should focus on underrepresented groups, particularly patients with mild to moderate CKD, and use robust study designs to clarify longitudinal outcomes and the complex interactions between CKD and oral health. The protocol used in this systematic review was registered in the International Prospective Register of Systematic Reviews database (registration CRD42024618866).