title: Patterns of oral disease in adults with chronic kidney disease treated with hemodialysis.
abstract: Oral disease is a potentially treatable determinant of mortality and quality of life. No comprehensive multinational study to quantify oral disease burden and to identify candidate preventative strategies has been performed in the dialysis setting.
  
  
  
  The ORAL disease in hemoDialysis (ORALD) study was a prospective study in adults treated with hemodialysis in Europe (France, Hungary, Italy, Poland, Portugal and Spain) and Argentina. Oral disease was assessed using standardized WHO methods. Participants self-reported oral health practices and symptoms. Sociodemographic and clinical factors associated with oral diseases were determined and assessed within nation states.
  
  
  
  Of 4726 eligible adults, 4205 (88.9%) participated. Overall, 20.6% were edentulous [95% confidence interval (CI), 19.4-21.8]. Participants had on average 22 (95% CI 21.7-22.2) decayed, missing or filled teeth, while moderate to severe periodontitis affected 40.6% (95% CI 38.9-42.3). Oral disease patterns varied markedly across countries, independent of participant demographics, comorbidity and health practices. Participants in Spain, Poland, Italy and Hungary had the highest mean adjusted odds of edentulousness (2.31, 1.90, 1.90 and 1.54, respectively), while those in Poland, Hungary, Spain and Argentina had the highest odds of ≥14 decayed, missing or filled teeth (23.2, 12.5, 8.14 and 5.23, respectively). Compared with Argentina, adjusted odds ratios for periodontitis were 58.8, 58.3, 27.7, 12.1 and 6.30 for Portugal, Italy, Hungary, France and Poland, respectively. National levels of tobacco consumption, diabetes and child poverty were associated with edentulousness within countries.
  
  
  
  Oral disease in adults on hemodialysis is very common, frequently severe and highly variable among countries, with much of the variability unexplained by participant characteristics or healthcare. Given the national variation and high burden of disease, strategies to improve oral health in hemodialysis patients will require implementation at a country level rather than at the level of individuals.
authors.affiliation: Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden Division of Nephrology and Transplantation, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Department of Odontostomatology and Surgery, University of Bari, Bari, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Petruzzi
authors.affiliation: Department of Odontostomatology and Surgery, University of Bari, Bari, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Benedittis
authors.affiliation: School of Dentistry, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Pauline
authors.initials: P
authors.lastname: Ford
authors.affiliation: Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, QLD, Australia Translational Research Institute, Brisbane, QLD, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Natale
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Valeria
authors.initials: V
authors.lastname: Saglimbene
authors.affiliation: Global Medical, Biogen Idec, Cambridge, MA, USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Celia
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Ruben
authors.initials: R
authors.lastname: Gelfman
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Leal
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Marietta
authors.initials: M
authors.lastname: Torok
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Paul
authors.initials: P
authors.lastname: Stroumza
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Luc
authors.initials: L
authors.lastname: Frantzen
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden Medical University of Lublin, Lublin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Bednarek-Skublewska
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden Medical University of Silesia, Katowice, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Dulawa
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Domingo
authors.initials: D
authors.lastname: Del Castillo
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Amparo G
authors.initials: AG
authors.lastname: Bernat
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Hegbrant
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Wollheim
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Schon
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden.
authors.forename: Letizia
authors.initials: L
authors.lastname: Gargano
authors.affiliation: Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
authors.forename: Casper P
authors.initials: CP
authors.lastname: Bots
authors.affiliation: Medical Scientific Office, Diaverum, Lund, Sweden Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy Diaverum Academy, Bari, Italy.
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D009909:Oral Health / Q000639:trends*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: clinical outcomes; dental public health; epidemiology