Patients' perception of the financial impact of head and neck cancer and the relationship to health related quality of life

The aim of this cross-sectional survey was to ask patients about the financial burden of having head and neck cancer, and to explore its relation with health-related quality of life (HRQoL). In the Mersey region 447/752 eligible patients (59%) responded to the questionnaire. There was no obvious response bias. The most notable financial costs of head and neck cancer that were a moderate or large burden to patients were petrol (25%, 112), home heating (24%, 108), change in the type of food (21%, 95), and loss of earnings (20%, 88). During the previous week 15% (63/423) had lost a moderate or large amount of income because of their medical condition. In terms of taking care of their financial needs, 10% (40) were moderately dissatisfied and 15% (61) very dissatisfied. Patients with worse physical and social emotional functioning experienced more notable financial burden, more difficult life circumstances in the past month and greater financial difficulty and loss in income due to their condition in the previous week, more dissatisfaction with how well they took care of their own financial needs and were more likely to have sought statutory benefits. Cancer of the head and neck has a serious impact on financial aspects of patients' lives and seems to be associated with a poor HRQoL. Multidisciplinary teams can do much more to address the cost of having treatment by recognising need earlier, and giving advice and access to appropriate benefits.     

Reentry: manpower issues related to nonpracticing dental hygienists

At the present time there is concern about the current and projected dental hygiene manpower situation. As applicant pools diminish and dental hygiene schools close, the need to investigate retention and reentry issues for hygienists increases. The purpose of this study was to determine (1) the number of unemployed dental hygienists who could be enticed to reenter the workforce, (2) the reasons why these dental hygienists left their profession, and (3) the factors that could facilitate their reentry into dental hygiene. A random sample of 10,249 licensed dental hygienists in 27 states was surveyed. Only nonpracticing dental hygienists completed the questionnaire; practicing dental hygienists returned the questionnaire unanswered. A 65% response rate was established. Of those dental hygienists returning questionnaires, 79% (N = 4,665) were currently practicing and 21% (N = 1,227) were not practicing. Of those hygienists who were not practicing, 63% (N = 773) stated intentions of returning to the work force if circumstances change. Within the unemployed sample, a subsample was created consisting of nonpracticing hygienists who have been out of the work force for less than eight years but intend to return to dental hygiene. Data were analyzed using frequency distribution, chi-square analyses, and factor analyses. Results showed five major reasons cited for leaving dental hygiene: (1) family responsibilities, (2) boredom, (3) fear of infectious disease, (4) lack of benefits, and (5) lack of adequate salary.(ABSTRACT TRUNCATED AT 250 WORDS)     

Components of socioeconomic risk associated with head and neck cancer: A population-based case–control study in Scotland

The complex associations between socioeconomic circumstances and risk for head and neck cancer are under-explored. We investigated components of social class and their relative influence on the risk of head and neck cancers by studying 103 patients (age range 24–80 years) who had been diagnosed with cancer of the head and neck between April 2002 and December 2004, and 91 controls who were randomly selected from general practitioners’ lists. Information about occupation, education, smoking, and alcohol consumption was collected at personal interview. Socioeconomic circumstances were measured at an individual level (education, occupational social class, unemployment), and by area-based measures of deprivation. Odds ratios (OR) and 95% confidence intervals (CI) were computed using unconditional logistic regression and multivariate analyses. People living in the most deprived areas (OR = 4.66, 95% CI 1.79–12.18); and those who were unemployed (OR = 2.27, 95% CI 1.21–4.26) had a significantly higher risk of cancer than those with high levels of educational attainment (OR = 0.17, 95% CI 0.05–0.58). Significance was lost for all measures of social class when adjustments were made for smoking and consumption of alcohol. Smoking was the only significant risk factor (OR = 15.53, 95% CI 5.36–44.99) in the multivariate analysis. A high risk of head and neck cancer was consistently associated with poor socioeconomic circumstances, and there were strong links for specific components however smoking dominated the overall profile of risk. We propose a framework for future socioeconomic analyses.     

Conservative management of temporomandibular disorders: a posttreatment comparison between patients from a university clinic and from private practice

Long-term (1 to 7.5 years) follow-up evaluations of 110 adult patients who were seen for diagnosis and treatment of symptoms related to myofascial problems (MP), internal derangement (ID), or both were conducted by means of telephone interview. One half of the patients were seen at the Northwestern University Dental School TMJ Clinic, while the other half were seen in the private office of one author (H. T. P.). The purpose of this study was to evaluate patient response to conservative therapy combined with advice about self-management, as compared with the response to advice only. Further, we desired to compare treatment outcomes among (1) diagnostic categories ID, MP, and ID plus MP, (2) clinic patients and private patients, and (3) patients with acute disease and those with chronic disease. Chronic disease was identified as that in which pretreatment symptoms had persisted for more than 4 months. The ridit analysis was used to assess differences in outcomes for patients in the three diagnostic categories and for clinic patients compared with private patients. The results revealed no significant differences. There was a trend for patients with acute conditions to improve more than those with chronic problems; however, further research is needed to determine whether a correlation exists between symptom duration and treatment outcome. At the time of the follow-up evaluation, 88% of all patients reported substantial or total improvement in their symptoms of pain and dysfunction. Therefore, conservative therapy, including advice about self-management, was found to be both adequate and appropriate for most of these patients.     

Models to Evaluate the Role of Stress in Periodontal Disease

We evaluated the association of stress, distress, and coping behaviors with periodontal disease in 1,426 subjects, aged 25 to 74, in Erie County, NY. Demographic characteristics, medical and dental history, and tobacco and alcohol consumption, as well as clinical assessments of supragingival plaque, subgingival flora, gingival bleeding, calculus, probing depth, clinical attachment level (CAL), and radiographic alveolar bone loss (ABL) were obtained for each subject. Subjects also completed a set of 5 psychosocial instruments that measured life events, daily strains, hassles and uplifts, distress, and coping behaviors. Internal consistencies of all subscales on the instruments were high, with Cronbach's alpha ranging from 0.88 to 0.99. Logistic regression indicated that financial strain was significantly associated with greater attachment and alveolar bone loss (OR 1.70; 95% CI, 1.09–2.65; and 1.68; 95% CI, 1.20–2.37, respectively) after adjusting for age, gender, and smoking. When those with financial strain were stratified with respect to coping behaviors, it was found that those who exhibited high emotion-focused coping (inadequate coping) had an even higher risk of having more severe attachment loss (OR 2.24; 95% CI, 1.15–4.38) and alveolar bone loss (OR 1.91; 95% CI, 1.15–3.17) than those with low levels of financial strain within the same coping group, after adjustment for age, gender, and cigarette smoking. After further adjusting for number of visits to the dentist, those with financial strain who were high emotion-focused copers still had higher levels of periodontal disease based on CAL (OR 2.12; 95% CI, 1.07–4.18). In contrast, subjects with high levels of financial strain who reported high levels of problem-based coping (good coping) had no more periodontal disease than those with low levels of financial strain. Salivary cortisol levels were higher in a test group exhibiting severe periodontitis, a high level of financial strain, and high emotion-focused coping, as compared to a control group consisting of those with little or no periodontal disease, low financial strain, and low levels of emotion-focused coping (11.04 ± 4.4 vs. 8.6 ± 4.1 nmol/L salivary cortisol, respectively). These findings suggest that psychosocial measures of stress associated with financial strain are significant risk indicators for periodontal disease in adults. Further prospective studies are needed to help establish the time course of stress, distress, and inadequate coping on the onset and progression of periodontal disease, as well as to evaluate the mechanisms by which stress exerts its effects on periodontal infections. Ann Periodontol 1998;3:288–302.     

Description of persons with symptoms presumed to be caused by electricity or visual display units—oral aspects

A questionnaire containing 20 questions was sent to 127 members of the Association for Those Injured by Electricity and Visual Display Units in northern Sweden, of whom 103 (81%) answered. The questionnaire consisted of questions about age, sex, and place of work. Furthermore, the members were asked to state: 1) their general and oral symptoms; 2) whether they thought that dental amalgam and other types of dental filling materials had affected their symptoms; 3) whether they were replacing or had replaced their amalgam fillings and, if so, what effect it had had on their symptoms; 4) whether they had been medically examined; and 5) whether they were or had been sick-listed for their complaints. Of those who answered the questionnaire, 79% were women (mean age 45 yr) and 21% men (mean age 42 yr). Sixty percent worked in offices. In 82%, the symptoms had started at work. The mean duration of the symptoms was 5.2 yr. The symptoms were aggravated mostly in "electric environment in general" and in "office with computers". Skin complaints, fatigue, and eye symptoms were the most common general symptoms. Sixty-five percent mentioned that they had oral symptoms. Gustatory disturbances, burning mouth, and temporomandibular joint (TMJ) dysfunction were the most common oral symptoms. Fifty-six percent considered that dental amalgam and 24% that other dental materials affected the symptoms. Twenty-one percent were in the process of replacing the amalgam fillings; 40% had already done so. After replacement, 37% had noticed a decrease of symptoms. Most had been medically examined for their complaints, and 81% had been sick-listed. Forty-two percent had received "alternative care". Finally, a treatment protocol for the examination and treatment of patients with symptoms caused by electricity or visual display units (VDUs) is recommended.     

Knowledge of oral cancer and screening practices of primary care providers at Federally Qualified Health Centers

OBJECTIVES: Primary care providers (PCPs) who worked in Federally-Qualified Health Centers (FQHC) in Michigan were surveyed to assess their knowledge level and practices related to screening and preventing oral cancer. METHODS: A questionnaire was developed with the assistance of dental and medical experts, and revised through focus groups. The questionnaire included one case scenario describing a suspicious oral lesion in a 55-year old female patient, followed by questions assessing PCPs' knowledge level, attitude, opinion, and screening practices for oral cancer. This mail survey was conducted in 2003. RESULTS: Survey response rate was 56.4%. Over 70% of the respondents reported that they screen patients for oral cancer during a routine physical examination. Forty-four percent of PCPs had high knowledge level, based on the scenario questions. Those who had high knowledge level were more likely to be physicians, males, and more likely to perform screening for oral cancer than those with low knowledge level. There was no difference in age and race/ethnicity between high and low knowledge groups. Perceived barriers included (1) lack of education; (2) lack of specialists to refer patients; and (3) lack of reimbursement. CONCLUSIONS: The majority of PCPs in this survey had positive attitudes about performing screening for oral cancer. To involve PCPs in screening for oral cancer, oral health programs should focus on providing up-to-date education, setting up a referral system, and providing proper reimbursement.     

老年人失牙的相关因素研究

目的:探讨老年人失牙与各种相关因素的关系,对老年人的口腔预防保健工作提供依据。方法:对808位76～92岁离退休老年人进行口腔健康状况检查以及口腔健康行为认知和全身性疾病的问卷调查,通过单因素分析引起老年人失牙的相关因素。结果:老年人失牙率为90.83%,失牙数随年龄增长而增加。老年人口腔健康行为认知度较低,在"人老掉牙是必然的"、"正确的刷牙方法"和"是否定期做口腔检查"3个问题中,认知正确组与不正确组失牙数之间有统计学差异(P<0.05)。患有糖尿病、冠心病、高血压组失牙数显著高于正常组(P<0.05)。结论:老年人失牙率高并且口腔健康知晓率普遍偏低。口腔健康知识薄弱、患有糖尿病、高血压、冠心病的老年人是口腔健康的重点防治人群,应加强这一特殊群体的口腔健康服务。     

Dental students' smoking behavior and their attitude towards smoking

This study investigated dental students' smoking behavior and their attitudes, in order to provide programs to patients for giving up smoking. A questionnaire survey was conducted on dental students from November 2003 to February 2004. The subjects were 69 third-grade and 80 fifth-grade students of Tokyo Medical and Dental University. The following results were obtained. (1) The smoking rate of dental students was 19.4% (Male: 31.3%, Female: 5.8%). (2) About forty-three percent of the students had started smoking before entering the university. However, most of the students who smoked had started after entering the university. The smoking rate and number of cigarettes smoked of fifth-grade students were significantly higher than those of third-grade students. (3) Dental students recognized the health risks of smoking more than the general public, especially concerning periodontal disease. (4) Only 5.4% of students answered that they would actively provide advice and instructions about the health hazards of tobacco to patients who smoked. (5) The rate of students who answered that they had enough knowledge to conduct smoking cessation programs for patients was 21.5%. (6) Students who smoked showed positive attitudes towards dentists' smoking behaviors and had passive attitudes towards smoking cessation programs conducted by dentists. These results show it is necessary to conduct smoking cessation programs soon after entering university and to provide more lectures on tobacco and health issues as well as practical training programs about giving up smoking in the dental education curriculum.     

Attitudes to oral health, preventive practices and dental services in a Thai population

1500 subjects aged 15-18 and 35-44 years, providers of oral health care and village headmen from 6 north Thailand districts with different dental services were interviewed about their knowledge of and attitudes to oral health, preventive practices and oral health services. Current oral symptoms mentioned by the 1500 subjects included pain (20.7 per cent), holes in teeth (10.5 per cent), ulcer, lump or swelling (5.9 per cent), loose teeth (5.2 per cent), calculus (2.9 per cent) and bleeding gums (1.3 per cent). Those complaining of holes in teeth had a significantly higher mean number of DMFT (2.05) than those who had no current problem (0.60). There was a general lack of appreciation of periodontal disease as a clinical problem. 57.5 per cent of those with a current problem did nothing about it because of lack of time or because they did not know where to go. 98 per cent said they used a toothbrush and 75.1 per cent used it two or more times a day. 58 per cent said that oral disease was preventable. Virtually all methods mentioned referred to dental caries which was a minor problem in this age group. A significant number had received advice on oral health from primary health care workers. In two districts primary oral health care workers trained at the Intercountry Centre for Oral Health for two weeks to do superficial tooth scaling provided care for 110 subjects, 85-88 per cent of whom were satisfied with the care received. Village headmen were sceptical about preventing oral disease and wanted more frequent visits from mobile dental units. The dentist and dental nurses were unable to cope with the range of work required and wanted additional training. Sub-district health workers and primary oral health workers were frustrated by the limitations of their work and wanted additional training to do fillings and extractions.     

Incidence of attachment loss over 3 years in older adults – new and progressing lesions

Abstract Researchers attempting to identify and quantify risk factors have not paid adequate attention to whether or not they actually are identifying risk factors (exposures related to the onset of disease) and prognostic factors (characteristics related to the progression of established disease). The purpose of this paper is to present the incidence of attachment loss in people who have attachment loss in sites previously without disease and people who experience further progression of sites with disease, and to compare and contrast the characteristics of people with the two types of attachment loss. The subjects used for this study are a random sample of community-dwelling older adults residing in five contiguous North Carolina counties who were followed for 3 yr. The subjects were categorized into four groups according to the type of clinical attachment loss (change of 3 or more mm) experienced, those who only had attachment loss in previously undiseased sites, those with progression of attachment loss in previously diseased sites, those who experienced both types of attachment loss, and those who had no new sites of attachment loss. A bivariate logistic model was developed to identify the characteristics associated with “new” disease onset as compared to “progression of disease”. Just over 40% of the people had no change in their baseline attachment level, 27.5% of the people experienced only new lesions. 11.1% of the people only experienced clinical attachment loss in sites that had clinical attachment loss at baseline, and 20.1% experienced both kinds of clinical attachment loss. Low income, taking medications associated with soft tissue reactions, smokeless tobacco users and those who experience a history of oral pain were at greater risk for new lesions. People at higher risk for disease progression were low income, taking medications that may result in soft tissue reactions, cigarette smokers, BANA positive, P. gingivalis positive, and had worsening financial problems. The model indicates that the characteristics are different enough that periodontitis may be like other diseases in which risk factors and prognostic factors are not the same.     

Patterns and factors affecting dental utilisation among adolescents in Sri Lanka.

AIM: To determine the patterns and factors affecting dental utilisation by adolescents in Sri Lanka. DESIGN: The information was collected by means of a self-administered questionnaire. SETTING: Ten randomly selected secondary schools. PARTICIPANTS: A total of 492 Year 11 students of which 257 were from urban and 235 were from rural schools. RESULTS: Sixty one per cent of the rural and 54% of the urban students had used dental services. There was a significant difference in the care providers and the types of treatment received at the previous visit between the urban and the rural students. A majority of students in both groups utilised dental services for symptomatic reasons. According to logistic regression analysis, those students who had received advice about oral health were 1.9 times more likely to have used dental services than those who had not received advice. Also, female students were 1.5 times more likely to have used dental services than males. CONCLUSIONS: Utilisation of dental services was low in adolescents and was mainly related to symptomatic reasons. Gender, perceived need and whether the adolescents had received information about oral health were significant predictors of utilisation of dental services by adolescents in Sri Lanka.     

Outpatient follow-up appointments for patients having curative treatment for cancer of the head and neck: are the current arrangements in need of change?

Although there are recommendations, there is little evidence about the rationale for the frequency and duration of review appointments for patients with cancer of the head and neck. We have recorded the pattern of follow-up in a tertiary cancer centre and its association with survival and recurrent disease. We used clinical letters and a prospectively maintained database to obtain details on 297 patients who were treated curatively for squamous cell carcinoma (SCC) of the oral cavity between 2005 and 2008. Mean (SD) age was 63 (12) years and 58% (n = 171) were male. Most patients were seen about 6 times in year one, 3 times in year 2, twice in year 3, twice in year 4, once or twice in year 5, and once yearly beyond year 5. Fewer clinics were scheduled for and attended by patients over 75 years of age, those with overall clinical grades 0-1, and those treated by operation alone in contrast to those who also had adjuvant radiotherapy. Patients were usually seen about 15 times over the 5 years. Taking into account the stage of the tumour and overall mortality, the number and timing of follow-up visits is adequate for the needs of patients with stage II-IV disease. Those with stage I disease may be considered for discharge after the third year if they are told about the risk factors, and signs and symptoms of recurrent disease, and surveillance in primary care.     

Prevalence of caries and developmental defects of enamel in 9-10 year old children living in areas in Brazil with differing water fluoride histories

AIMS: To assess the prevalences of caries, of developmental defects of enamel and their interrelationship in Brazilian 9-10-year-olds from areas of contrasting fluoridation histories. METHODS: Systematic random sampling procedures were used to select children from an area where water had been fluoridated in 1963 and from a second area where water had been fluoridated since 1998. Clinical examinations for caries were carried out using the DMFT index and WHO diagnostic criteria. Developmental defects of enamel on upper incisors were diagnosed using the DDE index. RESULTS: A difference of 40% in DMFT was observed, with a lower prevalence of disease in the area fluoridated since 1963. Diffuse opacities affected 14.3% of the children from the area fluoridated since 1963 compared with only 2.4% in the area fluoridated in 1998. Children living in the area fluoridated in 1963 who had diffuse defects had twice the chance of being free from caries compared with those living in the same area who had no defects or who had only demarcated or hypoplastic defects. CONCLUSIONS: This study confirms previous ones in showing the benefits of water fluoridation. Diffuse opacities of upper incisors affected relatively few subjects in either of the two areas.     

Evaluation of the serum level of immunosuppressive substance in oral cancer patients

The serum level of immunosuppressive substance (IS) was studied in 40 patients with primary oral cancer and in 79 patients without cancer. Its usefulness was evaluated as a parameter for monitoring therapy as well as recurrence of the tumors. Mean values for serum IS in patients with cancer and patients without were 687 +/- 284 micrograms/mL and 464 +/- 153 micrograms/mL, respectively. Normal healthy controls had a mean value of 431 +/- 105 micrograms/mL, with the cutoff value set at 641 micrograms/mL (mean +2 SD). Patients without cancer who had a severe infectious disease showed conspicuously high serum IS levels, and these values were closely correlated with their C-reactive protein values. The positive rate of IS increased in all patients with oral cancer was 58%. The mean level of serum IS in cancer patients was significantly higher than that of the controls (P less than .01), and the level was found to be more elevated as the stage of the disease advanced (stage I to III, 48%; stage IV, 68%). Histologic analysis of the tumor cells in patients with squamous cell carcinoma (SCC) showed that the mean serum IS level of those who had poorly differentiated SCC was much higher (937 +/- 181 micrograms/mL) than that of patients with well-differentiated SCC (616 +/- 159 micrograms/mL). Patients who had recurrent or metastatic cancer, or those who died from the cancer exhibited marked elevation of the serum IS levels, whereas patients who remained free of cancer in the follow-up period showed significantly lower serum IS levels. The rise and fall of the serum IS level was closely correlated with the disease progression and/or remission. These data strongly suggest that serum IS is a useful parameter for monitoring the disease stage as well as the effect of therapy on patients with oral cancer.     

Retrospective analysis of implant survival and the influence of periodontal disease and immediate placement on long-term results

PURPOSE: The purpose of this study was to investigate the cumulative survival rates of dental implants placed in a private periodontal practice and the effects of periodontal disease and immediate placement on implant survival. MATERIALS AND METHODS: A retrospective chart review was conducted on 149 consecutive patients. Each patient had a single implant placed. For the purpose of analysis, patients were divided into 2 groups: those who were periodontally healthy and those who had periodontal disease. Implants were placed into available bone either immediately or after a healing period. All failed implants were removed and recorded. The effects of periodontal status and placement time on implant survival were evaluated using Cox proportional hazards regression and log-rank tests. RESULTS: Of the 149 implants in the study, 22 failed during the observation period. The 127 censored cases (i.e., implants that had not failed at the end of the observational period) were observed for a mean of 943 days (SD 932, range 35 to 4,030). Failed implants were observed for a mean of 722 days (SD 1,026, range 18 to 3,548). The presence of periodontal disease appeared to be associated with a greater failure rate, but there was no observed effect associated with time of placement. The percentages of censored immediate placement cases and delayed placement cases were nearly identical. Among the 77 implants associated with periodontal disease, placement time was not strongly associated with percentage censored. Forty-three of the 55 immediately placed implants (78.18%) and 18 of the 22 implants (81.18%) whose placement was delayed were censored. Both Cox proportional hazards regression and log-rank tests established that survival was adversely affected by periodontal disease (P < .05) but unaffected by time of placement (P > .50). The lower 1-sided 95% confidence limit for median survival time was 3,548 days for patients without periodontal disease and 1,799 days for patients with disease. DISCUSSION AND CONCLUSION: Implant survival was compromised by a history of periodontitis but not affected by immediate or delayed placement.     

Oral cancer, smoking and alcohol: the patients' perspective

Although the roles of smoking and drinking alcohol in the aetiology of oral cancer are common knowledge among the medical community, those who have the disease are often less well informed. To quantify this potential lack of knowledge, 152 patients being reviewed after treatment for oral cancer were questioned about their smoking habits, alcohol consumption, and their understanding of the part these factors play in the development of malignancy. At least six months after the diagnosis of their malignancy, 72 (47%) still smoked and 55 (36%) drank alcohol to excess. Only one-third were aware that these habits were important in the development of oral cancer. These results indicate widespread ignorance and suggest that education about the causes of oral cancer is required in the population as a whole and particularly among those with the disease.     

Reasons for delayed presentation in oral and oropharyngeal cancer: the patients perspective

Patients with oral and oropharyngeal cancer (OOC) often delay presenting to their doctor or dentist. The aims of this study were to ask a consecutive cohort following treatment for OOC about their initial symptoms and the time spent before presentation to the healthcare profession. Also to discover their views on how to reduce delays in presentation. From a 2-year cohort treated within 2 years, 71 completed a short survey and 44 were subsequently interviewed by telephone. A non-healing ulcer or sore was the commonest symptom patients first related to having cancer. Around half interpreted their symptoms as something minor, staying much the same initially, and something that probably would get better by itself. Most would have sought advice earlier if they had been more aware of oral cancer. Although many patients talked about their symptoms to spouse, partner, family or friends, over one-third said they spoke to nobody about it. Our sample did not find that access to a doctor or a dentist was a barrier to seeking advice. This study highlights that from the patients perception they generally thought their symptoms were trivial, would get better by themselves and gave little thought as to whether it might be cancer. Patients commented they knew nothing more about the disease. In their views the best way to get patients to self refer earlier was through improved awareness of the disease, as many felt there was a gross lack of knowledge in this field of cancers compared to other cancers.     

Dental health status,use, and insurance coverage among adults with chronic conditions: Implications for medical-dental integration in the United States

BackgroundThe authors examined potential benefits and difficulties in integrating oral health care and medical care for adults with chronic conditions (CCs).MethodsThe authors used National Health and Nutrition Examination Survey 2009-2016 data to estimate crude (age- and sex-standardized) and model-adjusted estimates to examine the association between dental disease (severe tooth loss, untreated caries) and chronic disease (≥ 3 CCs, fair or poor health) and Medical Expenditure Panel Survey 2014-2016 data to estimate crude estimates of past-year medical and dental use and financial access according to CC status. Reported differences are significant at P < .05.ResultsNational prevalences of reporting fair or poor health and 3 or more CCs were both approximately 15%. Standardized prevalence of dental disease was notably higher among adults reporting CCs than those not reporting. After controlling for covariates, the magnitude of the association was substantially lower, although the association remained significant. Adults with CCs were approximately 50% more likely to report having a past-year medical visit and no dental visit than those not reporting CCs. Among adults reporting CCs, prevalence of having no private dental insurance and low income was approximately 20% and 60% higher, respectively, than that among adults not reporting CCs.ConclusionsAdults with CCs had higher prevalence of dental disease, past-year medical visit and no dental visit, and limited financial access.Practical ImplicationsMedical visits may be the only opportunity to provide dental education and referrals to adults with CCs. Improved medical-dental integration could improve oral health care access and oral health among these adults who are at higher risk of dental disease.     

Relationship of stress, distress and inadequate coping behaviors to periodontal disease.

BACKGROUND: The association of stress, distress, and coping behaviors with periodontal disease was assessed. METHODS: A cross-sectional study of 1,426 subjects between the ages of 25 and 74 years in Erie County, New York, was carried out to assess these relationships. Subjects were asked to complete a set of 5 psychosocial questionnaires which measure psychological traits and attitudes including discrete life events and their impact; chronic stress or daily strains; distress; coping styles and strategies; and hassles and uplifts. Clinical assessment of supragingival plaque, gingival bleeding, subgingival calculus, probing depth, clinical attachment level (CAL) and radiographic alveolar crestal height (ACH) was performed, and 8 putative bacterial pathogens from the subgingival flora measured. RESULTS: Reliability of subjects' responses and internal consistencies of all the subscales on the instruments used were high, with Cronbach's alpha ranging from 0.88 for financial strain to 0.99 for job strain, uplifts, and hassles. Logistic regression analysis indicated that, of all the daily strains investigated, only financial strain was significantly associated with greater attachment and alveolar bone loss (odds ratio, OR = 1.70, 95% CI = 1.09 to 2.65 and OR = 1.68, 95% CI = 1.20 to 2.37, respectively) after adjusting for age, gender, and cigarette smoking. When coping behaviors were evaluated, it was found that those with more financial strain who were high emotion-focused copers (a form of inadequate coping) had a higher risk of having more severe attachment loss (OR = 2.24, 95% CI = 1.15 to 4.38) and alveolar bone loss (OR = 1.91, 95% CI = 1.15 to 3.17) than those with low levels of financial strain within the same coping group, after adjustment for age, gender, and cigarette smoking. Similar results were found among the low problem-focused copers for AL (OR = 2.21, 95% CI = 1.11 to 4.38) and ACH (OR = 2.12, 95% CI = 1.28 to 3.51). However, subjects with high levels of financial strain who reported high levels of problem-based coping (considered adequate or good coping) had no more periodontal disease than those with low levels of financial strain, suggesting that the effects of stress on periodontal disease can be moderated by adequate coping behaviors. CONCLUSIONS: We find that psychosocial measures of stress associated with financial strain and distress manifest as depression, are significant risk indicators for more severe periodontal disease in adults in an age-adjusted model in which gender (male), smoking, diabetes mellitus, B. forsythus, and P. gingivalis are also significant risk indicators. Of considerable interest is the fact that adequate coping behaviors as evidenced by high levels of problem-based coping, may reduce the stress-associated risk. Further studies also are needed to help establish the time course of stress, distress, and inadequate coping with respect to the onset and progression of periodontal disease, and the mechanisms that explain this association.