Assessment of oral health in chronic kidney disease patients aged between 30-70 years in Mangalore, South India

Ancy R. J., Rekha P. Shenoy, Praveen S. Jodalli, Laxminarayan Sonde, Imran Pasha M.


Background: Chronic kidney disease (CKD) is an increasing health concern worldwide. In addition to systemic changes, kidney disease patients also present with oral complications. The objectives of the study were to assess and compare the oral health status in patients with CKD (with diabetes and without diabetes) undergoing dialysis and not undergoing dialysis aged between (30-70) years and controls in Mangalore, South India.

Methods: A descriptive cross-sectional study was conducted among 160 adults with various types of kidney disease and controls, attending a tertiary care hospital in Mangalore. Oral health status was assessed using WHO oral health assessment form for adults 2013. Oral hygiene was assessed by using simplified oral hygiene index and gingival status was assessed by using modified gingival index.

Results: Number of decayed teeth was more among controls, and number of missing teeth was more among CKD patients. Diabetic CKD patients who were not on dialysis had highest number of teeth with periodontal pocket and more sextants with loss of attachment. Non-diabetic CKD patients who were on dialysis had more gingival bleeding and gingival inflammation. Multinomial logistic regression analysis showed that CKD patients have more odds of having poor oral health than controls.

Conclusions: CKD patients had poor oral hygiene, gingival and periodontal status. In contrast, dental caries was significantly lower in CKD patients than the control group. Good oral health condition mitigates the risk of infection, contributing to a better quality of life among CKD patients.


Kidney disease, Oral health, Diabetes mellitus, Dialysis, Quality of life

Full Text:



World Health Organization. Oral health. 2018. Available at: news- room/fact-sheets/detail/oral-health. Accessed on 15 September 2019.

Links between oral health and general health - the case for action. Dental Health Services Victoria. 2011. Available at: assets/pdf_file /0013/2515 / links-between-oral-health-and-general-health-the-case-for-action.pdf. Accessed on 15 September 2019.

Kuravatti S, David PM. Oral manifestations of chronic kidney disease - an overview. Int J Contemp Med Res. 2016;3(4):1149-52.

Asha V, Latha S, Pai A, Srinivas K, Ganapathy K. Oral manifestations in diabetic and nondiabetic chronic renal failure patients on hemodialysis. J Indian Acad Oral Med Radiol. 2012;24:274-9.

World Health Organization; Global report on diabetes. Geneva: World Health Organization; 2016.

Vesterinen M, Ruokonen H, Furuholm J, Honkanen E, Meurman JH. Oral health in predialysis patients with emphasis on diabetic nephropathy. Clin Oral Invest. 2011;15:99-104.

Nylund KM, Meurman JH, Heikkinen AM, Furuholm JO, Ortiz F, Ruokonen HM. Oral health in patients with renal disease: a longitudinal study from predialysis to kidney transplantation. Clin Oral Invest. 2018;22:339-47.

Tawfig A, Alsaadoon A, Alasmari B, Aleid M, Balbhaith M, Aljabr S. Dental calculus formation among recurrent renal calculi formers. Int J Dent Oral Heal. 2017;3(1):7-12.

Strippoli GFM, Palmer SC, Ruospo M, Natale P, Saglimbene V, Craig JC, et al. Oral disease in adults treated with hemodialysis: prevalence, predictors, and association with mortality and adverse cardiovascular events: the rationale and design of the ORAL Diseases in hemodialysis (ORAL-D) study, a prospective, multinational, longitudinal, observational, cohort study. BMC Nephrol. 2013;14(90):1-10.

Yadav A, Deepak U, Misra N, Gc SK, Kaur A. Oral manifestations in renal failure patients undergoing dialysis. Int J Med Sci Public Health. 2015;4(7):1015-8.

Tadakamadla J, Kumar S, Mamatha GP. Comparative evaluation of oral health status of chronic kidney disease (CKD) patients in various stages and healthy controls. Spec Care Dent. 2014;34(3):122-6.

Seraj B, Ahmadi R, Ramezani N, Mashayekhi A, Ahmadi M. Oro-Dental Health Status and Salivary Characteristics in Children with Chronic Renal Failure. J Dent. 2011;8(3):146-51.

Wahid A, Chaudhry S, Ehsan A, Butt S, Khan AA. Bidirectional Relationship between Chronic Kidney Disease and Periodontal Disease. Pak J Med Sci. 2013;29(1):211-5.

Naugle K, Darby ML, Bauman DB, Lineberger LT, Powers R. The oral health status of individuals on renal dialysis. Ann Periodontol. 1998;3(1):197-205.

Gavalda C, Bagan J, Scully C, Silvestre F, Milian M, Jimenez Y. Renal hemodialysis patients: oral, salivary, dental and periodontal findings in 105 adult cases. Oral Dis. 1999;5(4):299-302.

Chuang SF, Sung JM, Kuo SC, Huang JJ, Lee SY. Oral and dental manifestations in diabetic and nondiabetic uremic patients receiving hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(6):689-95.

Garcez J, Posse LJ, Carmona IT, Feijoo JF, Dios DP. Oral health status of patients with a mild decrease in glomerular filtration rate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(2):224-8.

Thorman R, Neovius M, Hylander B. Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population. Scand J Urol Nephrol. 2009;43(2):154-9.

Parkar SM, Ajithkrishnan CG. Periodontal status in patients undergoing hemodialysis. Indian J Nephrol. 2012;22:246-50.

Tiwari V, Saxena V, Bhambhal A, Tiwari U, Singh A, Goud S. The oral health status of patients with renal disease in central India: a preliminary study. J Ren Care. 2013;39(4):208-13.

Kaushik A, Reddy SS, Umesh L, Devi B, Santana N, Rakesh N. Oral and salivary changes among renal patients undergoing hemodialysis: A cross sectional study. Indian J Nephrol. 2013;23(2):125‑9.

Naruishi K, Oishi K, Inagaki Y. Association between periodontal condition and kidney dysfunction in Japanese adults: A cross-sectional study. Clin Exp Dent Res. 2016;2(3):200-7.

Swapna LA, Koppolu P, Prince J. Oral health in diabetic and nondiabetic patients with chronic kidney disease. Saudi J Kidney Dis Transpl. 2017;28(5):1099-105.

World Health Organization. Oral health surveys: Basic methods. 5th Edition. Geneva: World Health Organization; 2013.

Greene JC, Vermillion JR. The Simplified Oral Hygiene Index. J Am Dent Assoc. 1964;68:7-13.

Rebelo MAB, Queiroz DAC. Gingival Indices: State of Art, Gingival Diseases - Their Aetiology, Prevention and Treatment.2011. Available at: http:// www. Intech open. com/ books/ gingival-diseases-their-aetiology-prevention-and treatment/ gingival- indices-state-of-art. Accessed on 15 September 2019.