Patient-reported receipt of oral cancer screenings and smoking cessation counseling from US oral health care providers: National Health and Nutrition Examination Survey, 2015-2016

BackgroundOral health care providers are encouraged to screen for oral cancer (OC) and oropharyngeal cancer (OP) and promote smoking cessation to their patients. In this study, the authors investigated the prevalence and correlates of receiving OC and OP screening and tobacco and OC and OP counseling from oral health care providers.MethodsThe authors analyzed self-reported survey data from the National Health and Nutrition Examination Survey 2015-2016 for participants who reported a dental visit. They created different samples for each subanalysis and categorized them according to smoking status. The authors calculated weighted proportions and adjusted odds for receiving tobacco counseling and screening for OC and OP in a dental office.ResultsOverall, 25.85% of US adults 30 years or older who had ever visited an oral health care professional received OC and OP screening. Odds of receiving an OC and OP screening were lower among current cigarette smokers than among never cigarette smokers (adjusted odds ratio [AOR], 0.47; 95% confidence interval [CI], 0.30 to 0.74) and among non-Hispanic blacks (AOR, 0.36; 95% CI, 0.22 to 0.59), Mexican Americans (AOR, 0.23; 95% CI, 0.10 to 0.53), non-Hispanic Asians (AOR, 0.21; 95% CI, 0.13 to 0.35), and those of other races (AOR, 0.39; 95% CI, 0.24 to 0.65), than among non-Hispanic whites. Participants with a high school education or more had higher odds of receiving an OC and OP screening (AOR, 1.88; 95% CI, 1.04 to 3.43) and counseling for screening (AOR, 1.64; 95% CI, 1.07 to 2.51) than did those with less than a high school education. Participants with family incomes of 400% or more of the federal poverty guideline had higher odds of receiving OC and OP screening (AOR, 5.17; 95% CI, 2.06 to 12.94) but lower odds of receiving tobacco counseling (AOR, 0.45; 95% CI, 0.24 to 0.82) than did participants with family incomes of less than 100% of the federal poverty guideline.ConclusionsOral health care providers underscreen for OC and OP among high-risk groups, including current cigarette smokers, minorities, and people of low socioeconomic status. The authors charge oral health care educators to include OC and OP screening and smoking cessation counseling in training and continuing education programs to increase the confidence of oral health care providers.Practical ImplicationsPotential to influence change on current pre-doctoral clinical training programs and to increase opportunities for continuing education courses that review the importance of, as well as, how to successfully complete smoking cessation counseling.     

Disparities in dental health issues and oral health care visits in US children with tobacco smoke exposure

BackgroundThe objective of the authors was to assess the relationships between tobacco smoke exposure (TSE) and dental health and dental care visits among US children.MethodsThe authors examined 2018-2019 National Survey of Children’s Health data on TSE, dental health, and oral health care visits. Children aged 1 through 11 years (N = 32,214) were categorized into TSE groups: no home TSE (did not live with a smoker), thirdhand smoke (THS) exposure (lived with a smoker who did not smoke inside the home), or secondhand smoke (SHS) and THS exposure (lived with a smoker who smoked inside the home). The authors conducted multivariable logistic regression analyses, adjusting for child age, sex, race or ethnicity, prematurity, caregiver education level, family structure, and federal poverty threshold.ResultsChildren with home SHS and THS exposure were at increased odds of having frequent or chronic difficulty with 1 or more oral health problem (adjusted odds ratio [AOR], 1.59; 95% CI, 1.07 to 2.35; P = .022) and carious teeth or caries (AOR, 1.74; 95% CI 1.14 to 2.65; P = .010) than those with no TSE. Compared with children aged 1 through 11 years with no TSE, children with SHS and THS exposure were 2.22 times (95% CI, 1.01 to 4.87; P = .048) more likely to have not received needed oral health care but at decreased odds of having had any kind of oral health care visit (AOR, 0.55; 95% CI, 0.32 to 0.95; P = .032), including a preventive oral health care visit (AOR, 0.60; 95% CI, 0.36 to 0.99; P = .047).ConclusionsTSE in children is associated with caries and inadequate oral health care visits.Practical ImplicationsThe pediatric dental visit is an opportune time to educate caregivers who smoke about dental health to improve their children’s teeth condition and increase oral health care visits.     

Digit Sucking,Age, Sex,and Socioeconomic Status as Determinants of Oral Hygiene Status and Gingival Health of Children in Suburban Nigeria

Background: This study determines prevalence of digit sucking and gingivitis, and association among age, sex, socioeconomic status, presence of digit‐sucking habits, oral hygiene status (OHS), and gingivitis among a group of Nigerian children. Methods: Data of 992 children aged 1 to 12 years recruited through a household survey conducted in Osun State, Nigeria were analyzed. Information on age, sex, socioeconomic status, and history of digit‐sucking habits were collected. Children were assessed for OHS and severity of gingivitis using the simplified oral hygiene index and the gingival index, respectively. Predictors of presence of gingivitis and poor oral hygiene were determined using multivariate logistic regression. Results: One (0.2%) and 454 (93.0%) children aged 1 to 5 years had poor oral hygiene and mild gingivitis, respectively. Twenty‐two (4.4%) and 361 (72.9%) children aged 6 to 12 years had poor oral hygiene and mild gingivitis, respectively. The odds of having poor oral hygiene (adjusted odds ratio [AOR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.35; P <0.001) and gingivitis (AOR: 0.21; 95% CI: 0.14 to 0.31; P <0.001) was significantly reduced for children aged 1 to 5 years. The odds of having gingivitis was increased in children with low socioeconomic status (AOR: 2.09; 95% CI: 1.32 to 3.31; P = 0.002). There was no significant relationship among sex, digit sucking, OHS, and presence of gingivitis. Conclusions: A digit‐sucking habit did not increase chances of having poor oral hygiene and gingivitis. Increasing age and low socioeconomic status were factors that significantly increased chances of having poor oral hygiene and gingivitis.     

Oral health and oral diseases in pregnancy: a multicentre survey of Italian postpartum women

Background

The aim of this study was to explore the oral hygiene practices and oral health status of Italian postpartum women.

Methods

A self‐administered questionnaire assessed socio‐demographic information, oral hygiene habits and frequency of dental visits. All women received a thorough oral examination within five days after delivery. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for exposures of interest and the presence of ‘severe’ periodontitis.

Results

Seven hundred and fifty women participated in the study; 99.1% brushed their teeth everyday and 59.9% visited the dentist annually. The mean frequency of sites with bleeding on probing was 16.1% and the median clinical attachment level was 2.1 mm. The mean caries experience score (DMFT) was 8. Severe periodontal disease was present in 21.9% of individuals. Patients who reported visiting a dentist only when in pain and women with three dental caries or more were significantly more likely to have periodontitis (OR: 1.6; 95% CI: 1.1–2.2; p < 0.05 and OR: 2.3; 95% CI: 1.5–3.5; p < 0.01, respectively).

Conclusions

Given the possible association between maternal and infant oral health, and between periodontal infection and general health, antenatal care providers should collaborate with dentists to encourage all pregnant women to comply with the oral health professionals' recommendations regarding appropriate dental brushing techniques and the importance of dental visits.     

Emergency department visits for infectious oral conditions in Massachusetts, 2014 through 2018

BackgroundThe authors aimed to measure population-based preventable emergency department (ED) visits related to infectious oral conditions (IOCs) in Massachusetts and to examine the associated sociodemographic factors to support prevention efforts.MethodsA statewide retrospective analysis of ED visits related to IOCs in Massachusetts from 2014 through 2018 was conducted using a Center for Health Information and Analysis database. The authors described patients' characteristics, dental diagnoses frequencies, emergency severity, lengths of stay, associated treatment, and costs. Multilevel logistic regression was used to assess factors associated with IOC visits.ResultsIOC visits in 2014 through 2018 were 1.2% (149,777) of the total ED visits, with an estimated cost of $159.7 million. There was an annual decline in the prevalence of IOC visits from 2014 through 2018. After adjusting for sociodemographic factors, odds of IOC were higher among males (adjusted odd ratio [AOR], 1.26; 95% CI, 1.24 to 1.27), non-Hispanic Blacks compared with non-Hispanic Whites (AOR, 1.03; 95% CI, 1.02 to 1.06), people residing in dental health care professional shortage areas (AOR, 1.06; 95% CI, 1.04 to 1.07), public insurance beneficiaries (AOR, 1.90; 95% CI, 1.87 to 1.93), or uninsured (AOR, 2.60; 95% CI, 2.54 to 2.66) compared with privately insured.ConclusionsThere was an annual decline in the prevalence of IOC visits from 2014 through 2018. Higher odds of IOC visits were associated with young adults, Black patients, uninsured people, public insurance beneficiaries, and people who reside in dental health care professional shortage areas.Practical ImplicationsThe authors provided statewide data to support proposed policies to improve oral health care in Massachusetts. IOCs are mostly preventable, but well-coordinated care between medicine and dentistry is integral for prevention.     

Discrimination of functional capacity for oral hygiene in elderly Spanish people by the Barthel General Index

OBJECTIVES: To explore, among the institutionalized elderly in Spain, the association between functional dependence in manipulating aids used in oral self-care (oral hygiene dependence) and general functional capacities, as measured by the Index of Activities of Daily Oral Hygiene (ADOH) and the Barthel Index (BI), respectively. METHODS: A cross-sectional study was performed in 2002 on 390 Spanish residents of a residential home for the elderly aged, 65-101 years. All study subjects underwent a oral examination and their ADOH and BI scores assessed. The association between the index scores was studied and the discriminant capacity of BI for oral hygiene dependence was calculated. RESULTS: The mean number of decayed, missing, or filled permanent teeth (+/-SD) was 26.6 +/- 7.3. The mean BI score was 68.31 (95% CI 64.35-72.27), and 172 individuals (44.1%; 95% CI 39.2-49.0%) were independent in all BI-measured functions. The mean ADOH score was 2.43 (95% CI 2.11-2.75), and 238 individuals (61.0%; 95% CI 56.2-65.9%) were independent for oral hygiene, 39 (10.0%; 95% CI 7.2-13.4%) required assistance (assistive devices), and 113 (29.0%; 95% CI 24.5-33.5%) were completely dependent. The BI scores were significantly correlated with the ADOH scores (r = -0.80, P < 0.001). The BI showed a high discriminant capacity to identify the individuals who were dependent for oral hygiene in this population (area under the ROC curve +/- SE = 0.929 +/- 0.013). Using the optimal cut-off point according to the Youden Index (<61), the sensitivity was 0.87 +/- 0.03 and specificity 0.87 +/- 0.02. CONCLUSION: There is a close association between BI and ADOH in this population, which could be useful to identify elderly individuals who are dependent for oral hygiene.     

Oral hygiene practices and periodontitis in health care professionals

BACKGROUND: One in 3 adults in the United States has periodontitis, yet there are few widely applied methods for its prevention. Few studies have assessed oral hygiene practices related to periodontitis. METHODS: There were 533 participants in this study (14.8% male dentists; 13.7% male non-dentist health care professionals; and 71.5% female nurses), all of whom are enrolled in ongoing cohort studies in the United States which have inquired about their oral hygiene practices and whether they have professionally diagnosed periodontitis. We studied the relationship between oral hygiene practices and periodontitis, controlling for potential confounders. RESULTS: The participants were 69 years old on average, 84.2% white, 12.4% current smokers, and 8.3% diabetic. Seventy percent of the dentists and nurses brushed at least twice a day compared to 56% of the other health professionals. Two-thirds of the nurses, 56.3% dentists, and 36.4% other health professionals flossed at least once daily. Persons brushing twice daily were as likely to have periodontitis as those brushing once or less daily (odds ratio [OR] = 1.16; 95% confidence interval [CI]: 0.64 to 2.10); persons flossing less than once a day were as likely to have periodontitis as those who flossed daily (OR = 1.16, 95% CI: 0.63 to 2.13) after controlling for profession, age, gender, smoking, diabetes, coronary heart disease, history of periodontal surgery, and number of teeth present. CONCLUSIONS: People who reported better oral hygiene practices did not report less periodontitis, after controlling for potential confounders. Oral hygiene practices were not associated with periodontitis in this population.     

Severe Preeclampsia and Maternal Self‐Report of Oral Health,Hygiene, and Dental Care

Background: Maternal periodontal disease diagnosed by a detailed oral health examination is associated with preeclampsia. Our objective was to measure the association between maternal self‐report of oral symptoms/problems, oral hygiene practices, and/or dental service use before or during pregnancy and severe preeclampsia. Methods: A written questionnaire was administered to pregnant females at the time of prenatal ultrasound and outcomes were ascertained by chart abstraction. The χ² test compared maternal oral symptoms/problems, hygiene practices, and dental service use between females with severe preeclampsia versus normotensive females. Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for severe preeclampsia. Results: A total of 48 (10%) of 470 females reported ≥2 oral symptoms/problems in the 6 months before pregnancy and 77 (16%) since pregnancy. Fifty‐one (11%) reported previous periodontal treatment. Twenty‐eight (6%) of 470 developed severe preeclampsia. Females with a history of periodontal treatment were more likely to develop severe preeclampsia (aOR = 3.71; 95% CI = 1.40 to 9.83) than females without a history of periodontal treatment. Self‐reported oral health symptoms/problems, oral hygiene practices, or dental service use before or during pregnancy were not associated with severe preeclampsia when considered in the context of other maternal risk factors. Conclusion: Maternal self‐report of previous periodontal treatment before pregnancy is associated with severe preeclampsia.     

Oral Health,Diabetes, and Inflammation: Effects of Oral Hygiene Behaviour

IntroductionThe aim of this research was to assess the association between inflammation and oral health and diabetes, as well as the mediating role of oral hygiene practice in this association.MethodsData were from the 2009–2010 National Health and Nutrition Examination Survey. The analytical sample consisted of 2,191 respondents aged 50 and older. Poor oral health was clinically defined by significant tooth loss (STL) and periodontal disease (PD). Diabetes mellitus (DM) was determined by glycemic levels. The outcome variable was serum C-reactive protein (CRP) level, dichotomised as ≥1 mg/dL (elevated CRP) vs <1 mg/dL (not elevated CRP). Two path models, one using STL and DM as the independent variable, the other using PD and DM as the independent variable, were estimated to assess the direct effects of having poor oral health and DM on elevated CRP and the mediating effects of dental flossing.ResultsIn path model 1, individuals having both STL and DM (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.30–2.82) or having STL alone (AOR, 2.30; 95% CI, 1.68–3.15) were more likely to have elevated CRP than those with neither STL nor DM; dental flossing (AOR, 0.92, 95% CI, 0.88–0.96) was associated with lower risk of elevated CRP. In path model 2, no significant association was found between having both PD and DM and elevated CRP; dental flossing (AOR, 0.91; 95% CI:, 0.86–0.94) was associated with lower risk of elevated CRP.ConclusionsFindings from this study highlight the importance of improving oral health and oral hygiene practice to mitigate inflammation. Further research is needed to assess the longer-term effects of reducing inflammation.Key words: Tooth loss, Periodontal disease, Diabetes, Inflammation     

The effectiveness of an individually tailored oral health educational programme on oral hygiene behaviour in patients with periodontal disease: a blinded randomized‐controlled clinical trial (one‐year follow‐up)

Aim: To evaluate the effectiveness of an individually tailored oral health educational programme for oral hygiene self‐care in patients with chronic periodontitis compared with the standard treatment. Material and Method: A randomized, evaluator‐blinded, controlled trial with two different active treatments were used with 113 subjects (60 females and 53 males) randomly allocated to an experimental or a control group. The individually tailored oral health educational programme was based on cognitive behavioural principles and the individual tailoring for each participant was based on participants' thoughts, intermediate, and long‐term goals, and oral health status. The effect of the programmes on gingivitis [gingival index (GI)], oral hygiene [plaque indices (PlI) and self‐report], and participants' global rating of treatment was evaluated 3 and 12months after oral health education and non‐surgical treatment. Results: Between baseline and the 12‐month follow‐up, the experimental group improved both GI and PlI more than the control group. The mean gain‐score difference was 0.27 for global GI [99.2% confidence interval (CI): 0.16–0.39, p<0.001] and 0.40 for proximal GI (99.2% CI: 0.27–0.53, p<0.001). The mean gain‐score difference was 0.16 for global PlI (99.2% CI: 0.03–0.30, p=0.001), and 0.26 for proximal PlI (99.2% CI: 0.10–0.43, p<0.001). The subjects in the experimental group reported a higher frequency of daily inter‐dental cleaning and were more certain that they could maintain the attained level of behaviour change. Conclusion: The individually tailored oral health educational programme was efficacious in improving long‐term adherence to oral hygiene in periodontal treatment. The largest difference was for interproximal surfaces.     

Self-care intervention to reduce oral candidiasis recurrences in HIV-seropositive persons: a pilot study

OBJECTIVES: This single-blind randomized controlled pilot study evaluated the efficacy of a behavioral intervention program, PRO-SELF: Candidiasis, to reduce time to recurrence of oral candidiasis over 6 months in susceptible HIV-seropositive persons. The intervention involved instruction by dentists on improving oral hygiene, minimizing sugar intake, and self-diagnosing candidiasis. METHODS: Participants were adults with oral candidiasis responsive to antifungals who presented to the UCSF Stomatology Clinic between 1997 and 2000. At 2-3 weeks of follow-up visits, a dentist "examiner", masked to group assignment, quizzed participants as to the presence of candidiasis, and assessed candidiasis status. A second, unmasked dentist "instructor" then delivered the program to intervention participants. Participants recorded dietary and oral hygiene practices in 24-h recall diaries: intervention participants at each visit and controls at initial and final visits. RESULTS: At randomization, CD4+ cell counts (cells/mm(3)) were 298 +/- 188 among 18 intervention participants and 396 +/- 228 among 17 controls. The candidiasis recurrence rates at 6 months were 78% among intervention compared with 88% among control participants (hazard ratio 0.72; 95% CI 0.35-1.50). Performing oral hygiene after meals/snacks showed the largest relative improvement: intervention-control difference in proportion of meals/snacks affected was 24% (95% CI -1 to 48%). Self-diagnoses of candidiasis were inaccurate, possibly because of mild episodes. CONCLUSIONS: The results weakly indicate that regular instruction from healthcare professionals helps patients delay candidiasis recurrence by improving oral hygiene. Among HIV-seropositive persons, those with poor oral hygiene, and high-sugar diets are most likely to benefit.     

The association between depression and anxiety and use of oral health services and tooth loss

Okoro CA, Strine TW, Eke PI, Dhingra SS, Balluz LS. The association between depression and anxiety and use of oral health services and tooth loss. Community Dent Oral Epidemiol 2012; 40: 134–144. © 2011 John Wiley & Sons A/S Abstract – Objective: The purpose of this study is to examine the associations among depression, anxiety, use of oral health services, and tooth loss. Methods: Data were analysed for 80 486 noninstitutionalized adults in 16 states who participated in the 2008 Behavioral Risk Factor Surveillance System. Binomial and multinomial logistic regression analyses were used to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI). Results: The unadjusted prevalence for use of oral health services in the past year was 73.1% [standard error (SE), 0.3%]. The unadjusted prevalence by level of tooth loss was 56.1% (SE, 0.4%) for no tooth loss, 29.6% (SE, 0.3%) for 1–5 missing teeth, 9.7% (SE, 0.2%) for 6–31 missing teeth and 4.6% (SE, 0.1%) for total tooth loss. Adults with current depression had a significantly higher prevalence of nonuse of oral health services in the past year than those without this disorder (P < 0.001), after adjustment for age, sex, race/ethnicity, education, marital status, employment status, adverse health behaviours, chronic conditions, body mass index, assistive technology use and perceived social support. In logistic regression analyses employing tooth loss as a dichotomous outcome (0 versus ≥1) and as a nominal outcome (0 versus 1–5, 6–31, or all), adults with depression and anxiety were more likely to have tooth loss. Adults with current depression, lifetime diagnosed depression and lifetime diagnosed anxiety were significantly more likely to have had at least one tooth removed than those without each of these disorders (P < 0.001 for all), after fully adjusting for evaluated confounders (including use of oral health services). The adjusted odds of being in the 1–5 teeth removed, 6–31 teeth removed, or all teeth removed categories versus 0 teeth removed category were increased for adults with current depression versus those without (AOR = 1.35; 95% CI = 1.14–1.59; AOR = 1.83; 95% CI = 1.51–2.22; and AOR = 1.44; 95% CI = 1.11–1.86, respectively). The adjusted odds of being in the 1–5 teeth removed and 6–31 teeth removed categories versus 0 teeth removed category were also increased for adults with lifetime diagnosed depression or anxiety versus those without each of these disorders. Conclusions: Use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders.     

Oral cancer screening practices of oral health professionals in Australia

Background

To evaluate oral cancer-related screening practices of Oral Health Professionals (OHPs - dentists, dental hygienists, dental therapists, and oral health therapists) practising in Victoria, Australia.

Methods

A 36-item survey was distributed to 3343 OHPs. Items included socio-demographic and work-related characteristics; self-assessed knowledge of oral cancer; perceived level of confidence in discussing oral health behaviors with patients; oral cancer screening practices; and self-evaluated need for additional training on screening procedures for oral cancer.

Results

A total of 380 OHPs responded this survey, achieving an overall response rate of 9.4%. Forty-five were excluded from further analysis. Of these 335 OHP, 72% were dentists; (n?=?241); either GDP or Dental Specialists; 13.7% (n?=?46) were dental hygienists; 12.2% (n?=?41) were oral health therapists, and the remaining 2.1% (n?=?7) were dental therapists. While the majority (95.2%) agreed that oral cancer screening should be routinely performed, in actual practice around half (51.4%) screened all their patients. Another 12.8% “Very rarely” conducted screening examinations. The probability of routinely conducting an oral cancer screening was explored utilising Logistic Regression Analysis. Four variables remained statistically significant (p?<?0.0001). Results indicate that the likelihood of conducting an oral cancer screening rose with increasing levels of OHPs’ confidence in oral cancer-related knowledge (OR?=?1.35; 95% CI: 1.09–1.67) and with higher levels of confidence in discussing oral hygiene practices with patients (OR?=?1.25; 95% CI: 1.03–1.52). Results also showed that dental specialists were less likely to perform oral cancer screening examinations compared with other OHPs (OR?=?0.18; 95% CI: 0.07–0.52) and the likelihood of performing an oral cancer screening decreased when the “patient complained of a problem” (OR?=?0.21; 95% CI: 0.10–0.44).

Conclusion

Only half the study sample performed oral cancer screening examinations for all of their patients. This study provides evidence of the need for further oral cancer-related education and screening training for OHPs, which is vital to enhance oral cancer prevention and early detection.

     

Oral care practices and A1c among youth with type 1 and type 2 diabetes

Background: Periodontal treatment is associated with lower hemoglobin A1c in individuals with diabetes, but the relationship between oral hygiene practices and A1c among youth with diabetes is understudied. Methods: This study evaluates the cross‐sectional relationships among oral health habits, reported oral conditions, and A1c and control of diabetes among a subset of youth with diabetes enrolled in the SEARCH for Diabetes in Youth study in South Carolina. Oral hygiene practices were determined by questionnaire, and periodontal bone loss was defined as alveolar bone loss ≥3 mm on ≥1 permanent tooth site on preexisting bitewing radiographs. A1c was considered controlled if individuals were aged ≤6 years with A1c <8.5%; aged 7 to 11 years with A1c <8.0%; aged 12 to 18 years with A1c <7.5%; and aged ≥19 years with A1c <7.0%. Results: Among 155 participants, 68% brushed their teeth no less than once daily, 84% flossed, and 70% rinsed, respectively, less than once a week. Diabetes control was associated with toothbrushing (≥1 time daily [odds ratio (OR) = 3.10; 95% confidence interval (CI) = 1.26 to 7.62] and using mouthrinse at least once weekly (OR = 3.33; 95% CI = 1.30 to 8.54) after multivariate adjustment. Periodontal bone loss was three times more common among those with dry mouth (OR = 3.05; 95% CI = 1.07 to 8.70). Conclusions: Clinicians should be aware that children with diabetes tend to have poor oral hygiene practices. Dry mouth may indicate periodontal bone loss in children with diabetes.     

Psychosocial factors and self‐reported transitions in oral and general health

Psychosocial factors may explain variance in health beyond conventional indicators, such as behaviours. This study aimed to examine changes in health associated with perceived stress, social support, and self‐efficacy, controlling for sociodemographic characteristics and health behaviour. A random sample of 45‐ to 54‐yr‐old subjects was surveyed in 2004–2005, with a follow‐up 2 yr later. The outcomes were self‐reported changes in oral and general health. Explanatory variables included stress, social support, and perceived health competence with covariates of income, gender, dentition status, toothbrushing, and smoking. Responses were collected from 986 persons (response = 44.4%). At the 2‐yr follow‐up, 25.6% reported worsening in oral health and 15.3% reported worsening in general health. Prevalence ratios (PR) from adjusted log‐binomial regression showed an association between worsening oral health and higher perceived health competence (PR = 0.75, 95% CI: 0.57–0.99), and worsening general health was associated with perceived health competence (PR = 0.82, 95% CI: 0.72–0.94) and stress (PR = 1.17, 95% CI: 1.03–1.32). Worsening oral and general health were seen for male subjects (PR = 1.33, 95% CI: 1.06–1.68 and PR = 1.14, 95% CI: 1.01–1.29) and low income (PR = 1.40, 95% CI: 1.04–1.89 and PR = 1.20, 95% CI: 1.03–1.40). Health‐related self‐efficacy representing psychosocial resilience was associated with oral and general health, while stress was associated with general health. Psychosocial factors were independent predictors of change in health after controlling for sociodemographic characteristics and health behaviours.     

Multivariate analysis of oral hygiene data from a representative sample

BACKGROUND: This analysis was based on an oral health survey with dental examination and interview by questionnaire. METHOD: The data set comprised a representative random sample of the over 14-year-old residents of the German Federal State of Saxony (n=714), in which a multivariate logistic regression analysis was conducted. The dependent variable was the debris index (DI) score of the oral hygiene index scoring system. The subjects were split into 2 groups by dividing DI scores into tertiles: those with acceptable oral hygiene (1st tertile, DI 0.00< or =1.20) and unacceptable oral hygiene (2nd and 3rd tertile, DI>1.20). The most important explanatory variable was the community periodontal index of treatment need (CPITN). RESULTS: The higher the CPITN score, the lower the probability of acceptable oral hygiene. In relation to the reference category score 0, higher CPITN scores were associated with acceptable oral hygiene, with an odds ratio 0.05 (95% confidence interval (CI)=0.01-0.23) for CPITN score 1, and an odds ratio 0.02 (95% CI: 0.01-0.08) for score 4. Further significant variables were: self-evaluation of tooth condition, gender, and the number of missing teeth.     

An examination of racial/ethnic disparities in children's oral health in the United States

Objective: To assess the extent factors other than race/ethnicity explain apparent racial/ethnic disparities in children's oral health and oral health care. Methods: Data were from the 2007 National Survey of Children's Health, for children 2‐17 years (n = 82,020). Outcomes included parental reports of child's oral health status, receiving preventive dental care, and delayed dental care/unmet need. Model‐based survey‐data‐analysis examined racial/ethnic disparities, controlling for child, family, and community/state (contextual) factors. Results: Unadjusted results show large racial/ethnic oral health disparities. Compared with non‐Hispanic White people, Hispanic and non‐Hispanic‐Black people were markedly more likely to be reported in only fair/poor oral health [odds ratios (ORs) (95% confidence intervals) 4.3 (4.0‐4.6), 2.2 (2.0‐2.4), respectively], lack preventive care [ORs 1.9 (1.8‐2.0), 1.4 (1.3‐1.5)], and experience delayed care/unmet need [ORs 1.5 (1.3‐1.7), 1.4 (1.3‐1.5)]. Adjusting for child, family, and community/state factors reduced racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non‐Hispanic Blacks attenuated for fair/poor oral health, to 1.6 (1.5‐1.8) and 1.2 (1.1‐1.4), respectively. Adjustment eliminated disparities for lacking preventive care [AORs 1.0 (0.9‐1.1), 1.1 (1.1‐1.2)] and in Hispanics for delayed care/unmet need (AOR 1.0). Among non‐Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need [AOR 0.6 (0.6‐0.7)]. Conclusions: Racial/ethnic disparities in children's oral health status and access were attributable largely to socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at social, economic, and other factors associated with minority racial/ethnic status and may have positive effects on all who share similar social, economic, and cultural characteristics.     

Trends in use of dental care provider types and services in the United States in 2000-2016: Rural-urban comparisons

BackgroundThe authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities.MethodsData were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix.ResultsA decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values < .001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37).ConclusionsAlthough preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents.Practical ImplicationsThese results of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients’ oral health needs.     

Social capital and self-rated oral health among young people

Furuta M, Ekuni D, Takao S, Suzuki E, Morita M, Kawachi I. Social capital and self‐rated oral health among young people. Community Dent Oral Epidemiol 2012; 40: 97–104. © 2011 John Wiley & Sons A/S Abstract – Objectives: A few studies have revealed the impact of neighborhood social capital on oral health among young people. We sought to examine the associations of social capital in three settings (families, neighborhoods, and schools) with self‐rated oral health among a sample of college students in Japan. Methods: Cross‐sectional survey of 967 students in Okayama University, aged 18 and 19 years, was carried out. Logistic regression was used to examine the associations of poor self‐rated oral health with perceptions of social capital, adjusting for self‐perceived household income category and oral health behaviors. Results: The prevalence of subjects with poor self‐rated oral health was 22%. Adjusted for gender, self‐perceived household income category, dental fear, toothbrush frequency, and dental floss use, poor self‐rated oral health was significantly associated with lower level of neighborhood trust [odds ratio (OR) 2.22; 95% confidence interval (CI): 1.40–3.54] and lower level of vertical trust in school (OR 1.71; 95% CI: 1.05–2.80). Low informal social control was unexpectedly associated with better oral health (OR 0.54; 95% CI: 0.34–0.85). Conclusions: The association of social capital with self‐rated oral health is not uniform. Higher trust is associated with better oral health, whereas higher informal control in the community is associated with worse oral health.     

Inconsistencies in recommendations on oral hygiene practices for children by professional dental and paediatric organisations in ten countries

International Journal of Paediatric Dentistry 2011; 21: 223–231 Background. Some of the basic dental health practices that are recommended to the public by professionals are not evidence based. Incorrect oral health messages may adversely affect children’s oral health behaviours. Aim. To identify and list the recommendations concerning children’s oral hygiene practices provided by dental and paediatric organisations, and to assess how these recommendations relate to the scientific evidence currently available. Design. Cross‐sectional. The authors contacted professional organisations in ten countries requesting items (brochures, leaflets or folders) containing messages on children’s oral hygiene practices. They then listed these recommendations and assessed how they related to scientific evidence obtained from systematic reviews available at PubMed and the Cochrane Library. Results. Fifty‐two of 59 (88%) organisations responded to our request and 24 dental health education materials were submitted to the authors. They mentioned recommendations on oral hygiene practices for children, such as toothbrushing frequency, supervision and technique; when to start and how long toothbrushing should last; toothbrush design and replacement; flossing; gums/teeth wiping; tongue cleaning; type and amount of toothpaste and advice on toothpaste ingestion. The search at PubMed and the Cochrane Library resulted in 11 systematic reviews addressing these topics. Conclusions. Several oral hygiene messages delivered by professional organisations showed inconsistencies and lacked scientific support.