Utilization of dental services among the elderly in Brazil]

OBJECTIVE: To investigate the pattern of dental services use and its determinants among the elderly in Brazil. METHODS: The study included the elderly participating in the Ministry of Health of Brazil's oral health survey carried out in 2002 and 2003 who had used dental services at least once in their lifetime. Dentulous and edentulous individuals were compared and analyzed separately using multiple logistic regression. RESULTS: Of 5,009 participants, 46.0% were dentulous and 54.0% edentulous. The prevalence of dental services use in the year right before the survey was 26.6% and 10.4%, respectively. Among dentulous participants, the utilization rate was higher in those with more years of schooling, those who perceived their chewing as poor/very poor, and those who reported feeling oral pain; and lower in those who did not have information on oral health, who perceived their oral health as poor/very poor, those with lower per capita income, those who required prostheses and used them, and who required prostheses and did not use them, those with periodontal problems, and with a higher number of extracted teeth. Among edentulous participants, the utilization rate was higher in those with more years of schooling and those reporting oral pain; and lower in non-whites and in those who did not have information on oral health. CONCLUSIONS: The oral health of the elderly in Brazil is deficient and the use of dental services was lower among those who needed them most. The factors associated with dental services utilization differ for dentulous and edentulous individuals. The only similarities are schooling, having information on oral health, and having experienced pain in the teeth and gums in the previous three months. Public investment in oral health is needed to turn around this scenario.     

Routine use of dental services by the elderly in Brazil: the SB Brazil Project

The routine use of dental services by elderly participants in a representative survey of Brazilians (the SB Brazil Project) was investigated. 2,305 were dentate and 2,704 edentulous. Prevalence of use was 20% and 17%, respectively. Poisson regression showed that for dentate individuals, use was lower among residents who: lived in rural areas; had not received preventive oral health information; had lower incomes; needed a dental prosthesis; had periodontal problems; perceived their chewing as fair, bad, or terrible; felt that oral health affected their social interaction; and reported tooth pain. Among edentulous individuals, use was higher among those who paid out-of-pocket for dental services and was lower among those who: lived in rural areas; had used dental services more than a year previously; self-identified as non-white; had not received preventive oral health information; had less schooling; needed a dental prosthesis; and felt that oral health affected their social interaction. Inequalities, economic barriers, and lack of information jeopardized the routine use of dental services. Targeted public policies are required to correct these problems.     

Factors associated to self perceived need of dental care among Brazilian elderly

OBJECTIVE: To analyze factors associated with the self-perceived need for dental treatment among elderly people. METHODS: A total of 5,326 individuals who were included in a sample of Brazilian elderly people aged 65-74 years in a home survey on oral health conducted by the Brazilian Ministry of Health in 2002/2003 were investigated. The analysis was based on the model of Gift, Atchison & Drury, and Poisson regression for analysis of surveys with complex samples was used. RESULTS: Out of the whole sample, 2,928 (55%) of the elderly people said they needed dental treatment. This need was perceived less frequently among those aged 70 years or over (PR=0.94; 95% CI: 0.89;0.99), those who had not received information on how to avoid oral problems (PR=0.89; 95% CI: 0.83;0.95) and those who were edentate (PR=0.68; 95% CI: 0.62;0.74). The perceived need was greater among those who self;rated their oral health as regular (PR=1.31; 95% CI: 1.21;1.41) or poor/very poor (PR=1.29; 95% CI: 1.19;1.41), their appearance as regular (PR=1.23; 95% CI: 1.15;1.32) or poor/very poor (PR=1.28; 95% CI: 1.18;1.39) and their chewing as regular (PR=1.08; 95% CI: 1.01;1.15) or poor/very poor (PR=1.13; 95% CI: 1.05;1.21). It was also greater among those who reported pain in their teeth or gums over the six months prior to the survey (PR=1.27; 95% CI: 1.18;1.36) and among those who needed a prosthesis in one arch (PR=1.29; 95% CI: 1.19;1.39) or both (PR=1.27; 95% CI: 1.16;1.40). CONCLUSIONS: Information, oral health conditions and subjective questions were associated with self-perceived need for dental treatment. The results reinforce the need to capacitate individuals to carry out oral self-examination and identify non-painful signs and symptoms of mucosal lesions, caries and periodontal disease at an early stage.     

Oral disease burden and dental services utilization by Latino and African-American seniors in Northern Manhattan

Although oral diseases are among the most common chronic conditions affecting older adults, utilization of dental services by the elderly, especially minority elderly is low. This pilot study determined whether there are racial/ethnic differences in oral disease burden, perceived oral health-related quality of life, perceived need for dental services and dental services utilization between African-American and Latino seniors in Northern Manhattan. Subjects received an oral examination and a face-to-face survey to assess oral health status, perceived need, perceived oral health-related quality of life, and utilization of dental services. The data suggest that in both populations, oral disease burden is high and utilization of dental services is problematic—34.0% of the subjects were edentulous and average time since last dental visit was 40.1 months. The average DMFT was 23.8; 81.6% of the dental caries experience was accounted for by Missing Teeth, and there were significant differences in total caries experience, and Missing and Filled Teeth between African-American and Latino seniors. Although there were no racial/ethnic differences in the utilization of dental services, dentate individuals were more likely to have had a more recent dental visit (31.0 months) than edentulous individuals (57.7 months). The high proportion of Missing Teeth suggests that interventions aimed at improving the oral health of this population must target individuals at a younger age.     

Tooth loss and chewing capacity among older adults in Adelaide

Abstract: This study aimed to identify sociodemographic factors associated with edentulism (loss of all teeth) and the average number of teeth lost, and to investigate relationships between tooth loss and chewing capacity. Data were obtained in 1991–92 from a cross-sectional oral epidemiological survey of Adelaide residents aged 60+ years. Interviews with 1160 participants provided information on edentulism while oral examinations among 560 dentate participants and 313 edentulous participants provided information on the number of missing teeth. People were asked if they could chew or bite six common foods. Some 41.1 per cent of persons were edentulous, and nearly half the natural teeth (mean 15.2) were missing among dentate people. Multivariate analyses revealed higher rates of edentulism ( P ≤ 0.05) for people who were older, female, Australian-born, or holders of pensioner health benefit cards, and for people who left school at an early age, or who did not own their residence. Among dentate people there were more ( P ≤ 0.05) missing teeth among those who were older, Australian-born, health benefit card holders, and who left school at an early age. Some 37.9 per cent of people reported difficulty chewing at least one food, although 57 per cent of dentate people and virtually all edentulous people wore dentures. Difficulty chewing was associated with tooth loss: 6.1 per cent of people with fewer than nine missing teeth reported difficulty compared with S8.6 per cent of edentulous people ( P < 0.01). The findings show substantially compromised oral health among older adults, particularly the oldest-old and disadvantaged groups.     

Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis

ABSTRACT: BACKGROUND: Oral health is an important component of general well-being for the elderly. Oral health-related problems include loss of teeth, nonfunctional removable dental prostheses, lesions of the oral mucosa, periodontitis, and root caries. They affect food selection, speaking ability, mastication, social relations, and quality of life. Frailty is a geriatric syndrome that confers vulnerability to negative health-related outcomes. The association between oral health and frailty has not been explored thoroughly. This study sought to identify associations between the presence of some oral health conditions, and frailty status among Mexican community-dwelling elderly. METHODS: Analysis of baseline data of the Mexican Study of Nutritional and Psychosocial Markers of Frailty, a cohort study carried out in a representative sample of people aged 70 and older residing in one district of Mexico City. Frailty was defined as the presence of three or more of the following five components: weight loss, exhaustion, slowness, weakness, and low physical activity. Oral health variables included self-perception of oral health compared with others of the same age; utilization of dental services during the last year, number of teeth, dental condition (edentate, partially edentate, or completely dentate), utilization and functionality of removable partial or complete dentures, severe periodontitis, self-reported chewing problems and xerostomia. Covariates included were gender, age, years of education, cognitive performance, smoking status, recent falls, hospitalization, number of drugs, and comorbidity. The association between frailty and dental variables was determined performing a multivariate logistic regression analysis. Final models were adjusted by socio-demographic and health factors RESULTS: Of the 838 participants examined, 699 had the information needed to establish the criteria for diagnosis of frailty. Groups who had a higher probability of being frail included women (OR = 1.9), those who reported myocardial infarction (OR = 3.8), urinary incontinence (OR = 2.7), those who rated their oral health worse than others (OR = 3.2), and those who did not use dental services (OR = 2.1). For each additional year of age and each additional drug consumed, the probability of being frail increased 10% and 30%, respectively. CONCLUSIONS: Utilization of dental services and self-perception of oral health were associated with a higher probability of being frail.     

Oral health of Brazilian elderly: a systematic review of epidemiologic status and dental care access

Population aging and declining birth rate have significantly altered the Brazilian age structure pyramid. In parallel with demographic transition, epidemiological transition is altering morbidity-mortality profiles, without adequate health support for the elderly population group. By searching databases, the objective of this study was a systemic literature review from 1986 to 2004 concerning the most prevalent oral problems experienced by elderly Brazilians, aimed at revealing the main obstacles for accessing health services. Mean DMFT index values in this study ranged from 25 to 31. Most articles reported a high percentage of edentulism. The main barriers for access to dental services were poor education, low income, and scarcity of public oral health services. Brazilian elderly oral health is thus precarious, with high edentulism rates, periodontal problems, decayed teeth, and great need for prostheses, reflecting the historical inefficacy of public dental services, limited to serial extractions and emergency services, based on the curative model.     

Demographic and socio-economic factors associated with dental health among older people in NSW

OBJECTIVE: To investigate the association between oral health status and social, economic and demographic factors in community-dwelling older people in New South Wales (NSW). METHODS: Binary and multinomial logistic regression analyses were used to examine the associations between measures of oral health status (edentulous/dentate, and the frequency of toothache or mouth or denture problems in the previous 12 months) and demographic and socio-economic factors using data from the NSW Older People's Health Survey 1999. RESULTS: After adjusting for other factors, being edentulous was associated with being older, having no private dental insurance, being female, leaving school at less than 15 years of age, not being financially comfortable, not being a homeowner, living in a rural area, and being unable to travel alone. Among both dentate and edentulous people, increasing age and being able to travel independently were associated with decreased reporting of toothache, mouth or denture problems; while not being financially comfortable was associated with increased reporting of toothache or mouth or denture problems. The frequency of mouth or denture problems was not found to be independently associated with having private dental insurance nor with holding a health concession card. CONCLUSIONS: Among older people in NSW, oral health is associated with a range of demographic and socio-economic factors. The results suggest that better oral health among older people is associated with a capacity to pay out-of-pocket dental expenses rather than with private dental insurance or having access to public-funded dental care.     

Self-rated oral health among Brazilian adults and older adults in Southeast Brazil: results from the SB-Brasil Project, 2003

The aim of this study was to determine which characteristics (predisposing and enabling, oral health, perceived need for dental treatment, and behavior) are independently associated with self-rated oral health among adults and older adults in Southeast Brazil. The study was based on 3,240 participants in the SB-Brasil Project/ Southeast. The characteristics of those who rated their oral health as good/very good were compared to those who rated it as fair, poor, or very poor. The following characteristics were significantly and independently associated with better self-rated oral health among adults: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, place of residence in cities with > 50,000 inhabitants, and visit to the dentist > 3 years previously. Among older adults the factors were: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, and 1-19 permanent teeth. Our results confirm those observed in other countries, showing associations between self-rated oral health and predisposing and enabling factors, oral health, perceived need for dental treatment, and behavior.     

Dental care access and use among HIV-infected women.

OBJECTIVES: This study sought to identify predictors of dental care use in HIV-infected women. METHODS: In a cross-sectional survey of HIV-infected women enrolled in the northern California site of the Women's Interagency HIV Study, dental care use and unmet need were assessed in relation to selected variables. RESULTS: Among 213 respondents, who were predominantly Black and younger than 45 years, 43% had not seen a dentist and 53% (among dentate women) reported no dental cleaning in more than a year (although 67% had dental insurance coverage, mainly state Medicaid). Nine percent were edentulous. Among nonusers of dental care, 78% reported that they wanted care but failed to get it. Barriers included fear of and discomfort with dentists, not getting around to making an appointment, and not knowing which dentist to visit. Multivariate analysis showed that lack of past-year dental care was associated mainly with unemployment, a perception of poor oral health, and edentulism. CONCLUSIONS: HIV-positive women appear to be underusing dental care services. Fear and lack of information regarding available resources, in addition to unemployment and perception of poor oral health, may be important barriers.     

Epidemiological aspects of oral health among the elderly in Brazil

All indexed articles in BBO, LILACS, and MEDLINE databases from January 1998 to July 2001 were searched to analyze information on oral health among the elderly in Brazil. The year 1998 was used as a starting point, since this was the year the National Epidemiological Survey was published. Twenty-nine articles were found, of which 7 were analyzed in detail regarding key methodological aspects (age, sampling, data presentation) and the results were presented (DMFT index, proportion of missing teeth, edentulousness rate, and use and need of dental prostheses). DMFT ranged from 26.8 to 31.0, with approximately 84% of teeth missing. Prevalence of edentulousness was 68%. Few elderly did not need or use any kind of prosthesis. Denture use was more frequent in the upper than in the lower jaw. Lack of standardized data hampered an understanding of some key aspects of data analysis. Both data presentation and methodology must be improved in future research in this area. Despite all these caveats, the literature review confirmed the poor oral health of the Brazilian elderly population.     

Oral health promotion among Finnish adolescents between 1977 and 1989

In Finland a national, comprehensive preventive oriented oralhealth programme was implemented in 1972. Oral health habitsand services as well as their development were followed in theJuvenile Health Habit Study programme between 1977 and 1989.Postal questionnaires were sent to 12–18 year old Finnsevery second year from 1977. The response rates of the nationallyrepresentative samples were 79–88%. The most recent questionnairewas answered by 3220 adolescents (80%). Use of oral health services increased continuously from 1977to 1985. In 1985 there was a slight decrease in the use among16 and 18 year olds. Sex and socioeconomic differences in theuse of these services disappeared in 1985. In 1989 half of theadolescents had received instruction about oral hygiene butonly 20% about use of sugar during their last dental visit. Oral hygiene habits (toothbrushing and use of dental floss)improved slowly but continuously during the whole period Dailyuse of dental floss was still rare and one-third of the Finnishboys did not brush their teeth daily in 1989. The most common sugar-containing products used daily were hotsweet drinks (sugar-sweetened coffee, tea and hot chocolate).Use of sugar-sweetened coffee and cakes decreased but that ofsweets, soft drinks, sugar-sweetened tea and hot chocolate remainedunchanged. Use of sweetened yogurt increased slightly. The positive trend in the use of oral health services and oralhealth behaviour can be explained by the national oral healthpromotion programme. Extensive toothbrush and toothpaste advertisementsand changes in teenagers' life-style associated with urbanizationof the society may also have contributed to the improvements.     

Dental state and needs for episodic care of institutionalized elderly in an Asian community.

This study examined the dental state of institutionalized elderly and their need for care. An oral examination was carried out on 479 elderly persons living in long-term care facilities with a mean age of 74.9 years. Results showed an overall DMF score of 27.0 and the average number of teeth in dentate subjects was 7.5. A large proportion of teeth (76.6%) was lost through dental caries and the loss increased significantly with age. Consequently, 56.1% of subjects were edentulous, of whom 78.8% were without dentures. Among the conditions that required urgent dental care, majority of subjects needed extractions of residual roots and loose teeth. A lesser proportion required treatment for gross caries (4.8%), periodontal disease (5.0%), suspected tumor (0.2%), as well as alleviation of pain and infection arising from mucosal lesions (4.8%), abscesses (3.3%) and TMJ problems (2.8%). The treatment needs for dentures and episodic care are high among institutionalized elderly and need to be addressed.     

Strategies to improve the quality of oral health care for frail and dependent older people.

The dental profile of the population of most industrialised countries is changing. For the first time in at least a century most elderly people in the United Kingdom will soon have some of their own natural teeth. This could be beneficial for the frail and dependent elderly, as natural teeth are associated with greater dietary freedom of choice and good nutrition. There may also be problems including high levels of dental disease associated with poor hygiene and diet. New data from a national oral health survey in Great Britain is presented. The few dentate elderly people in institutions at the moment have poor hygiene and high levels of dental decay. If these problems persist as dentate younger generations get older, the burden of care will be substantial. Many dental problems in elderly people are preventable or would benefit from early intervention. Strategies to approach these problems are presented.     

Oral health need and access to dental services: evidence from the National Survey of Children's Health, 2007

This study examines associations between parents' report of their children's oral health and receipt of a dental visit for preventive care. We conducted a cross-sectional analysis of oral health status and receipt of a preventive dental visit among US children and youth, ages 1-17 years, using data from the 2007 National Survey of Children's Health (n = 86,764). Survey-weighted logistic regression was used to estimate associations between perceived oral health status and receipt of a preventive dental health visit in the prior 12 months. Overall, 78 % of children and youth received at least one preventive dental health visit in the prior year. Among the youngest children, lower oral health status was associated with higher odds of receiving a preventive dental visit; among older children, lower oral health status was associated with lower odds of receiving a dental visit for preventive care. Use of preventive dental health care is below national target goals. Younger children in worse oral health are more likely, and older youth less likely, to receive preventive dental care. Public health efforts to educate parents to seek early and ongoing preventive oral health care, rather than services in response to problems, may yield oral health benefits later in childhood and over the life course.     

Oral Health Need and Access to Dental Services: Evidence from the National Survey of Children’s Health, 2007

This study examines associations between parents’ report of their children’s oral health and receipt of a dental visit for preventive care. We conducted a cross-sectional analysis of oral health status and receipt of a preventive dental visit among US children and youth, ages 1–17 years, using data from the 2007 National Survey of Children’s Health (n = 86,764). Survey-weighted logistic regression was used to estimate associations between perceived oral health status and receipt of a preventive dental health visit in the prior 12 months. Overall, 78 % of children and youth received at least one preventive dental health visit in the prior year. Among the youngest children, lower oral health status was associated with higher odds of receiving a preventive dental visit; among older children, lower oral health status was associated with lower odds of receiving a dental visit for preventive care. Use of preventive dental health care is below national target goals. Younger children in worse oral health are more likely, and older youth less likely, to receive preventive dental care. Public health efforts to educate parents to seek early and ongoing preventive oral health care, rather than services in response to problems, may yield oral health benefits later in childhood and over the life course.     

Impact of dental caries and dental fluorosis on 12-year-old schoolchildren's self-perception of appearance and chewing

It has been suggested that psychosocial dimensions be used to assess the impact of oral health on people's quality of life. The purpose of this study was to measure the impact of dental caries and dental fluorosis on children's self-perception of appearance and mastication. A dental caries and dental fluorosis cross-sectional study was conducted with twelve-year-old schoolchildren (n = 695) in Chapec , Santa Catarina, Southern Brazil. A questionnaire to assess dental care and dental habits was applied. Risk factors were identified using unconditional multiple logistic regression analysis. None of the variables investigated was associated with dissatisfaction in relation to self-perceived appearance. Independent risk factors for dissatisfaction with self-perceived mastication included enrollment in a public school, caries in an anterior tooth and at least two posterior teeth, and female gender. By way of conclusion, dental fluorosis had no impact on children's self-perception of appearance. Increased severity of dental caries was associated with greater self-perception of impact on chewing. This impact was greater in public schoolchildren, suggesting that there are different values and perceptions between socially different groups.     

Self-perception and oral health conditions in an elderly population

This study assessed oral health conditions through clinical examination and self-perception. The sample consisted of 112 subjects 60 years of age or older in Rio Claro, S?o Paulo, Brazil, divided into two groups: G1, with dental insurance (n = 55) and G2, without dental insurance (n = 57). Clinical examinations were conducted according to WHO guidelines. Data on self-perceived oral health were collected using the GOHAI (Geriatric Oral Health Assessment Index). DMFT was 29.13, higher in G1 (p = 0.0091). Mean number of teeth currently present in both groups was 7.63, higher in G2 (p = 0.0131). Periodontal conditions showed a high percentage of null sextants (70.3%), where CPI revealed higher prevalence for calculus and PIP for pockets up to 3mm. The percentage of edentulous subjects was 45.5%, higher in G1 (p = 0.0142). Among edentulous subjects, 69.6% wore complete upper dentures and 42.9% complete lower dentures. Mean GOHAI was 33.61, qualifying self-perceived oral health status as positive, and the only difference was in the physical dimension, where G2 showed higher values (p = 0.0154). Self-perceived oral health was considered satisfactory, but this was not confirmed by clinical data from the two groups.     

Oral health studies in the 1982 Pelotas (Brazil) birth cohort: methodology and principal results at 15 and 24 years of age

The aim of this study was to describe the methodology and results of oral health studies nested in a birth cohort in Pelotas, Southern Brazil. For the oral health studies a sub-sample (n = 900) was selected from the cohort and dental examinations and interviews were performed at ages 15 (n = 888) and 24 years (n = 720; 81.1%). Data collection included dental outcomes, dental care, oral health behaviors, and use of dental services. Mean DMF-T varied from 5.1 (SD = 3.8) to 5.6 (SD = 4.1) in the study period. The proportion of individuals with at least one filled tooth increased from 51.9% to more than 70%. Individuals who had always been poor used dental services less and had fewer healthy teeth on average than those who had never been poor. Individuals with decreasing or increasing family income trajectories showed intermediate values. An increase was seen in the number of healthy teeth from age 15 to 24 only among those who had never been poor. A history of at least one experience with poverty had a negative impact on oral health in adulthood.     

Disparities in edentulism and tooth loss between Māori and non-Māori New Zealand women

Objectives: Tooth loss and edentulism are important negative health outcomes; however, there is little current information about the prevalence of these conditions among adults in New Zealand (NZ). This study describes the dentate status of Maori and non-Maori NZ women with regard to tooth loss, edentulism and denture-wearing, and investigates ethnic and sociodemographic disparities within the sample. Associations between dentate status, socio-demographic and health-related factors are described.
Methods: Participants were 1,817 women who were screened for participation in a randomised controlled trial.
Results: 9.0% of women were edentulous and 30.3% wore a denture (partial or complete). The mean number of teeth present was 24.2, and older women had fewer teeth on average. Socio-demographic and ethnic disparities in tooth loss and edentulism were observed. Maori ethnicity was strongly associated with edentulism and tooth loss, with Maori women five times more likely than NZ European women to be edentulous. These associations held after controlling for age, education, smoking, diabetes, cardiovascular disease history, and BMI.
Conclusions: Marked ethnic disparities in edentulism and tooth loss exist in New Zealand. Effective targeted programmes are needed to reduce the public health impact of poor oral health among Maori.