Dental clearance for kidney transplantation: median wait of one day

Preparation that does not consume days of waiting for an organ

Nephrologists regularly send candidates for kidney transplantation to the dentist for written clearance before the procedure, although there is neither a standardised protocol nor evidence to support that step. The team led by Ivan Mikić therefore extracted from the records of one tertiary care institution what is usually only assumed about this work-up: how much work it involves, how long it takes and how often it goes wrong. The records of patients referred between 2019 and 2024 were reviewed.

The series comprises 74 patients with a median age of 41 years, and the condition of their teeth on arrival betrayed a long caries history: the median DMFT index was 13.5, with individual values from zero to 28. In half of the patients, then, fourteen or more teeth were carious, filled or already extracted.

The extent of treatment nevertheless remained modest. Supragingival instrumentation was required by 39.2% of patients, in 27% of them at least one tooth was extracted — 62 teeth in the whole series — and 9.5% of patients required endodontic treatment. There were two complications (2.7%), both postoperative and both managed conservatively.

The figure that says the most concerns time. For two thirds of the patients (67.6%) a single visit was enough for clearance, so the median for the whole process came out at one day; in a minority it stretched to as much as 45 days. The authors conclude that clearance is obtained safely and that dental preparation in this series did not measurably slow the patient's path to transplantation.

Limitations

A retrospective review of records in a single institution, without a control group: the findings describe how the work-up proceeds in that setting, but do not prove the advantage of one protocol over another. The caveat of a single-centre and retrospective design is stated by the authors themselves.

For your practice

• Plan a candidate referred by a nephrologist as if the first appointment were also the only one — in two thirds of cases that was all it took.
• Reserve time at that appointment for a complete triage of foci, both clinical and radiographic: the range extending to 45 days shows that some patients do need more visits.
• Two complications in 74 patients (2.7%), both resolved conservatively, are a figure with which you can answer the patient and the nephrologist when they ask about the risk of dental treatment before transplantation.