Bidirectional link between oral, kidney health calls for patient education, access

Despite growing awareness of the connection between oral health and chronic health conditions, patient awareness and access to dental care remain limited, according to University of Cincinnati experts who recently spoke with Healio | Nephrology News & Issues.

Emerging research suggests a bidirectional relationship between oral health and several chronic conditions, including diabetes, heart disease, kidney disease, oral cancer, and Alzheimer’s disease. According to a 2024 review in the Journal of the National Medical Association, an estimated 90% of patients with chronic kidney disease will experience oral complications linked to poor oral hygiene, kidney disease treatment or the disease itself.

In another study published in BMC Nephrology in 2026, Priyanka Gudsoorkar, a College of Medicine assistant professor-educator in the Department of Environmental and Public Health Sciences; Prakash Gudsoorkar, MD, an associate professor in the Division of Nephrology in the Department of Internal Medicine; and colleagues reviewed more than 150 published studies, meta-analyses and trials evaluating links between kidney health and oral health. Across these publications, the researchers found evidence that kidney and oral health are connected through systemic inflammation, endothelial dysfunction and immune dysregulation.

“There’s definitely a bidirectional link between the two, but it’s mostly siloed off and unrecognized in the nephrology care sector,” Priyanka Gudsoorkar told Healio | Nephrology News & Issues.

The relationship between kidney disease and oral health appears to be driven by chronic systemic pathways, according to Priyanka Gudsoorkar. Periodontitis — or gum disease — triggers the release of cytokines. These small proteins contribute to narrowing of the blood vessels, kidney injury and an imbalance in the oral microbiome, or dysbiosis.

“Oral dysbiosis leads to xerostomia [or dry mouth], taste alterations, ulcerations in the oral cavity, bleeding on probing and then, as these cases advance, bone destruction,” she said.

Oral complications have been observed across the kidney disease spectrum. Mild dry mouth symptoms may appear in the early stages of CKD, but more severe conditions, such as uremic stomatitis, a rare, painful inflammation of the oral mucosa that occurs in patients with severe acute or chronic kidney failure, can worsen as kidney disease progresses, according to Prakash Gudsoorkar. He said it is caused “when high concentrations of urea in the blood and saliva are broken down into ammonia by the enzyme urease, leading to chemical irritation of the mouth.”

“Typically, we start seeing symptoms like uremic stomatitis or dysbiosis at CKD stage 3 or 4 and subsequent stages,” he told Healio | Nephrology News & Issues. “Bone health also gets compromised in patients with advanced CKD or on dialysis, primarily driven by kidney disease itself, which can have negative impacts on the jaw structure or teeth.”

Patients on dialysis may face greater risks of uremic stomatitis and oral dysbiosis than those with CKD who are not on dialysis, but scheduling dental appointments can be challenging, according to Priyanka Gudsoorkar. Dentists must consider how the kidneys filter oral medications and whether patients can make it to a dental appointment on nondialysis days, she said.

Furthermore, some medications used to treat patients with CKD may contribute to dry mouth. 

Kidney transplant candidates face a distinct set of oral health challenges: They must obtain dental clearance to receive a kidney transplant. Delays in seeing a dentist may affect a candidate’s transplant timeline, according to Prakash Gudsoorkar.

“It seems that there is an awful delay between the referral to a dentist and the patient actually being seen by a dentist, because it’s not just a one-time consult,” he said. “There might be additional procedures we need to follow, such as cleaning, scaling or a root canal.”

Posttransplant complications, such as gingival overgrowth, candidiasis and mucosal neoplasia, could also emerge, according to Priyanka Gudsoorkar.

Read the full Healio | Nephrology News & Issues article.

Featured image at top: iStock.