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Aim: This study aims to assess the oral presentation in hemodialysis patients using Hospital Anxiety and Depression Scale (HADs). Material and method: Forty Iraqi patients were involved in this study aged 22 to 66 years. The selected patients were admitted to the hemodialysis center in Al-Karama teaching hospital. All patients were on dialysis for 3-4 hours/week for 5 years. HAD scale was applied with an oral examination for all patients. Results: Bordered line and abnormal cases for HAD scale shared the same oral manifestation, including caries, attrition, abrasion, gingivitis, and coated tongue, with a percentage prevalence of 55, 90, 35, 50, and 60%, respectively. Depression has more impact than anxiety on developing an oral disease in hemodialysis patients for all diagnosed oral diseases. Conclusions: Depression and anxiety are directly associated with developing caries, attrition, abrasion, gingivitis, and coated tongue. Moreover, depression was more effective in developing the disease. Clinical significance: HAD scale was a very effective evaluation tool for anxiety and depression. Hemodialysis patients should take into consideration anxiety and depression with oral changes.