When it comes to dental treatment for patients with severe renal impairment, cooperation between the dentist and the nephrologist is essential. Special considerations must be taken into account for people with kidney disease. During dialysis, the patient receives heparin to prevent blood clotting outside the body. Additionally, dental infection is a potential threat to both organ transplant candidates and recipients, as dental disease is a common condition and is likely to be more serious and untreated in the transplanted population. Therefore, prophylactic antibiotics should be administered in consultation with the patient's physician for those who have undergone kidney transplant operations.
In Wisconsin, investigative journalists found that patients with special needs in the area were left on waiting lists for years for dental care that required “crucial sedation at home or in a hospital.” The COVID-19 pandemic has changed the expectations of patients in dentistry, as remote work, digital communication and home delivery have become commonplace. Over the past two decades, there has been an increased awareness of the importance of oral health in patients with ESRD and in transplant candidates among the scientific community. This poses a threat of serious complications if dental interventions are performed on these patients. In 1906, Alfred Fones, a Connecticut dentist, trained his cousin to help him clean his patients' teeth and perform preventive treatments. Patients are at greater risk of suffering from endarteritis and endocarditis due to vascular access, which occurs in approximately 2.7% of patients during hemodialysis and 9% of those with vascular access infection. Ulcerations affected 8.6% of patients in stage 5D and 1.3% of transplant recipients, while candidiasis affected 22.2% of patients in stages 1 to 5, 19% of adults with CKD in stage 5D and 13.3% of patients with kidney transplants.
In 1917, Alfred Fones' cousin, Mary Newman, became the first president of the Connecticut Association of Dental Hygienists after receiving the world's first license as a dental hygienist in Connecticut.