Suetonia C Palmer1, Marinella Ruospo2, Germaine Wong3, Jonathan C Craig3, Massimo Petruzzi4, Michele De Benedittis4, Pauline Ford5, David W Johnson6, Marcello Tonelli7, Patrizia Natale8, Valeria Saglimbene8, Fabio Pellegrini9, Eduardo Celia8, Ruben Gelfman8, Miguel R Leal8, Marietta Torok8, Paul Stroumza8, Luc Frantzen8, Anna Bednarek-Skublewska10, Jan Dulawa11, Domingo Del Castillo8, Amparo G Bernat8, Jorgen Hegbrant8, Charlotta Wollheim8, Staffan Schon8, Letizia Gargano8, Casper P Bots12, Giovanni F M Strippoli13. 1. Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand. 2. Medical Scientific Office, Diaverum, Lund, Sweden Division of Nephrology and Transplantation, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy. 3. Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. 4. Department of Odontostomatology and Surgery, University of Bari, Bari, Italy. 5. School of Dentistry, University of Queensland, Brisbane, QLD, Australia. 6. Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, QLD, Australia Translational Research Institute, Brisbane, QLD, Australia. 7. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 8. Medical Scientific Office, Diaverum, Lund, Sweden. 9. Global Medical, Biogen Idec, Cambridge, MA, USA. 10. Medical Scientific Office, Diaverum, Lund, Sweden Medical University of Lublin, Lublin, Poland. 11. Medical Scientific Office, Diaverum, Lund, Sweden Medical University of Silesia, Katowice, Poland. 12. Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands. 13. 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.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: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. METHODS: 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. RESULTS: 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. CONCLUSIONS: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.