Risk of Surgical Site Infections after Tooth Extraction in Chronic Kidney Disease

A recent study conducted in Japan was performed to look at the the risk of surgical site Infections after the extraction of a tooth for those suffering with chronic kidney disease.

Infectious disease prevention and management are essential for maintaining and improving life quality, as well as reducing healthcare costs, morbidity, and mortality in individuals with chronic kidney disease(CKD). Patients with CKD often experience xerostomia, which is defined as the sensation of oral dryness in which patients usually report mouth dryness, oral burning, swallowing difficulty, and decreased or altered taste This could lead to a deterioration of oral health and necessitate tooth extraction. However, tooth extraction poses risks of both regional and systemic infections.

Patients with advanced CKD face higher risks for hospital-acquired infections following major surgeries. Although tooth extraction is considered more of a minor surgery, it is invasive and affects gingival tissue and bone. Nevertheless, infectious events risk post-tooth extraction in CKD patients have not been sufficiently assessed. This study was aimed at assessing the incidence of surgical site infections (SSI) post-tooth extraction, stratified by CKD severity.

The study identified 190,762 procedures from 157,994 individuals, with a mean age of 70 (±13.3)years; 49% were female. Individuals with more severe CKD were likely to be older (exception for those on hemodialysis (HD), and use fewer antimicrobial agents. Except for HD patients, the risk of SSI was higher from CKD with more advanced staged or kidney failure. Adjusted SSI incidence was not significantly higher in mild and moderate CKD groups compared to that in the non-CKD group. However, a significantly higher SSI incidence was observed in the severe CKD groups.

Overall the study found that severe CKD patients had a higher infection risk, which was consistent with previous studies. Meanwhile, mild-to-moderate CKD did not show increased infection risk, which is inconsistent with previous reports. Two potential explanations for this discrepancy are the cohort’s in this study had an overall older age (mean age: 78 years, moderate CKD; 80 years, severe CKD), and less potent associations of low kidney function with outpatient infections compared with inpatient infections.

Severe CKD-related immune dysfunction increases the risk of complications following major surgeries. Although tooth extraction is minor, it is invasive and affects gingival tissue and bone. Furthermore, poor oral health is associated with low salivary flow and altered salivary components. These factors may contribute to increased SSI risk in severe CKD patients following tooth extraction.

In advanced CKD patients, managing infections effectively is crucial, given the potential for

fatal outcomes. Improving oral health to avoid tooth extraction is key to reducing

post-extraction infections in high-risk individuals. Although many CKD patients experience

poor oral health, efforts to improve it may be insufficient. Collaboration between

nephrologists and dentists is essential to maintain good oral health in CKD patients and

manage infections effectively.

It is believed that this is the first study to describe SSI risks post-tooth extraction relevant tothe CKD stage and HD in real-world settings. The conclusion of the study was that they found that severe CKD patients, with or without HD, had significantly higher SSI risks after tooth extraction.

Ishimaru, Miho1,a; Ono, Sachiko2; Iwagami, Masao3,4; Miyamoto, Yoshihisa5; Mikami, Risako6; Aida, Jun7. Risk of Surgical Site Infections after Tooth Extraction in Chronic Kidney Disease: A Retrospective Real-World Study in Japan. Clinical Journal of the American Society of Nephrology ():10.2215/CJN.0000000599, October 23, 2024. | DOI: 10.2215/CJN.0000000599