Oral health among white, black, and Mexican-American elders: an examination of edentulism and dental caries

Objectives: To examine racial/ethnic disparities in oral health among older Americans. Methods: Differences in frequency of edentulism and number of decayed, missing, and filled teeth were assessed in 2,679 non‐Hispanic white, 742 non‐Hispanic black, and 934 Mexican‐American individuals aged 60 and older from the National Health and Nutrition Examination Survey (1999‐2004). Results: Controlling for potential confounding variables, blacks and Mexican‐Americans had significantly higher numbers of decayed teeth but fewer numbers of filled teeth than whites. Although blacks had a lower likelihood of being edentulous than whites, dentate blacks had a higher number of missing teeth. Compared with whites, Mexican‐Americans were less likely to be edentulous, and dentate Mexican‐Americans had fewer missing teeth. Our study also showed that blacks and Mexican‐Americans had less frequent dental checkups than whites. Conclusions: Oral health disparities are persistent across racial/ethnic groups for older Americans despite the fact that the differences between groups typically diminish when socioeconomic, health‐related, and behavioral factors are considered in the models. Our study suggests that reducing racial/ethnic oral health disparities requires multiple clinical approaches.     

Prevalence of oral health problems in U.S. adults,NHANES 1999–2004: exploring differences by age,education, and race/ethnicity

Using the National Health and Nutrition Examination Surveys (NHANES) 1999–2004, the authors examined age patterns in oral health indicators by race/ethnicity and socioeconomic status related to edentulism, presence of root caries, and periodontal disease. Our analysis included subjects who were non‐Hispanic White, Mexican American, and African American over the age of 20, and who participated in the NHANES oral health examination. African Americans experienced more oral health problems at younger ages; as age increased, so did racial disparities in oral health problems. Lower educational attainment was strongly associated with more oral health problems at all ages. These results may indicate a faster progression of oral health problems with age among African Americans, thus suggesting that the “earlier aging” of members of racial/ethnic minorities which has been reported in prior research may also be found in oral health.     

Determinants for preventive oral health care need among community‐dwelling older people: a population‐based study

The aim was to study the determinants of preventive oral health care need among community‐dwelling old people. The study population consisted of 165 participants, a subpopulation in the Geriatric Multidisciplinary Strategy for Good Care of Elderly People (GeMS) study. Fifty‐five percent of the edentate participants with full dentures and 82% of the dentate had a need for preventive oral health care. In the total study population, the need for preventive care was associated with co‐morbidity (measured by means of the Modified Functional Co‐morbidity Index) odds ratios (OR) 1.2 (confidence intervals [CI] 1.0–1.5), being pre‐frail or frail, OR 2.5 (CI 1.2–5.1), presence of natural teeth, OR 4.8 (CI 2.2–10.4), and among dentate participants, the use of a removable partial denture, OR 12.8 (CI 1.4–114.4). Primary care clinicians should be aware of the high need for preventive care and the importance of nonoral conditions as determinants of preventive oral health care need.     

Factors associated with preventive dental care-seeking behavior among people living with HIV

Objectives: This study examined factors associated with preventive dental care‐seeking behavior among HIV‐positive adults who participated in a federally funded demonstration project to expand access to oral health care. Methods: Two thousand one hundred eighty‐seven adults living with human immunodeficiency virus (HIV) in the United States were enrolled in free dental care and were interviewed about their reasons for seeking care, their oral health, and overall health status. Multivariate analysis using Generalized Estimating Equations to control for clustering by site was conducted to identify factors associated with preventive care‐seeking behavior. Results: Forty‐one percent of participants reported the only reason they sought dental care was for preventive care, to receive a checkup or cleaning. Factors associated with preventive care‐seeking behavior in multivariate analysis included no unmet need for dental care since testing HIV positive, no dental insurance, taking HIV medications and better overall oral health. Conclusions: Many HIV‐positive adults may seek preventive care when it is offered at no cost. Interventions that address unmet needs and target individuals who are not taking HIV medications or have poorer oral health may improve preventive practices.     

Oral health disparities in New York State

New York State population is diverse, with a large proportion of racial and ethnic minorities. The poverty rate is two- to three-times higher among minorities. Oral diseases are higher among low-income and/or less-educated groups and in racial and ethnic minorities. The use of dental services is also lower. Eliminating disparities in oral health will require enhanced efforts at preventing disease, promoting health and delivering appropriate care. It will also require a thorough understanding of the lower use of already available effective preventive and treatment services, and additional interventions to address the identified causes. Many initiatives have been undertaken in New York State to address these disparities.     

Knowledge and beliefs regarding oral health among pregnant women

BackgroundRacial or ethnic and economic disparities exist in terms of oral diseases among pregnant women and children. The authors hypothesized that women of a racial or ethnic minority have less oral health knowledge than do women not of a racial or ethnic minority. Therefore, the authors conducted a study to assess and compare maternal oral health knowledge and beliefs and to determine if maternal race and ethnicity or other maternal factors contributed to women’s knowledge or beliefs.MethodsThe authors administered a written oral health questionnaire to pregnant women. The authors calculated the participants’ knowledge and belief scores on the basis of correct answers or answers supporting positive oral health behaviors. They conducted multivariable analysis of variance to assess associations between oral health knowledge and belief scores and characteristics.ResultsThe authors enrolled 615 women in the study, and 599 (97.4 percent) completed the questionnaire. Of 599 participants, 573 (95.7 percent) knew that sugar intake is associated with caries. Almost one-half (295 participants [49.2 percent]) did not know that caries and periodontal disease are oral infections. Median (interquartile range) knowledge and belief scores were 6.0 (5.5–7.0) and 6.0 (5.0–7.0), respectively. Hispanic women had median (interquartile range) knowledge and belief scores significantly lower than those of white or African American women (6.0 [4.0–7.0] versus 7.0 [6.0–7.0] versus 7.0 [6.0–7.0], respectively [P < .001]; and 5.0 [4.0–6.0] versus 6.0 [5.0–7.0] versus 6.0 [5.0–7.0], respectively [P < .001]). Multivariable analysis of variance results showed that being of Hispanic ethnicity was associated significantly with a lower knowledge score, and that an education level of eighth grade or less was associated significantly with a lower belief score.ConclusionsPregnant women have some oral health knowledge. Knowledge varied according to maternal race or ethnicity, and beliefs varied according to maternal education. Including oral health education as a part of prenatal care may improve knowledge regarding the importance of oral health among vulnerable pregnant women, thereby improving their oral health and that of their children.Clinical ImplicationsIncluding oral health education as a part of prenatal care should be considered.     

A typology of models for expanding access to oral health care for people living with HIV/AIDS

Objectives: This article describes a typology of program models for expanding access to dental services for people living with HIV/AIDS (PLWHA). These programs serve communities with limited access and high unmet need for oral health care, such as rural areas, low‐income and racial/ethnic minorities. Methods: Interviews and site visits with dental and program directors were conducted at participating sites, including AIDS service organizations, community health centers, and university‐affiliated medical centers or hospitals. Results: Despite the differences across organizational structure, similar models and approaches were developed to engage and retain PLWHA in dental care. These approaches included: using mobile dental units; expanding the type and availability of previous dental services provided; providing training opportunities for dental residents and hygienists; establishing linkages with medical providers; providing transportation and other ancillary services; using dental case managers and peer navigators to coordinate care; and patient education. Conclusions: This typology can assist program planners, medical and dental care providers with service delivery strategies for addressing the unmet need for oral health care in their area.     

Racial disparities in being recommended to surgery for oral and oropharyngeal cancer in the United States

Weng Y, Korte JE. Racial disparities in being recommended to surgery for oral and oropharyngeal cancer in the United States. Community Dent Oral Epidemiol 2012; 40: 80–88. © 2011 John Wiley & Sons A/S Abstract – Objectives: To investigate the impact of race on the likelihood of patients being recommended for surgery after a diagnosis of oral and oropharyngeal cancer. Methods: A total of 68 445 cases of oral and oropharyngeal cancer were extracted from the 1988 to 2005 Surveillance, Epidemiology, and End Results (SEER) database. County‐level rurality data and income data were merged using the US Department of Agriculture Rural‐Urban Continuum Codes dataset and US Census Bureau Small Area Income & Poverty Estimates dataset. We used logistic regression analyses to investigate the impact of race on being recommended to surgery for oral and oropharyngeal cancer, adjusting for demographic, socioeconomic, and clinical factors. Stratified analyses were further conducted by tumor site and rural/urban status. Results: Recommendation to surgery varied significantly by race, with black patients less likely than white patients to be recommended to surgery for their oral and oropharyngeal cancer. The racial difference in recommendation to surgery varied significantly by age, geography, and tumor subsite. Racial disparities are most evident in lip and buccal cancer from rural areas (OR, 4.4; 95% CI, 2.6–7.5); and least evident in oropharyngeal cancer from urban areas (OR, 1.2; 95% CI, 1.1–1.3). The magnitude of the racial disparity is attenuated with increasing age. Conclusions: We observed substantial racial disparities in surgery recommendation for oral and oropharyngeal cancer in the United States. Our results suggest the need to improve accessibility to better health care in racial minority groups, particularly in rural areas, and call for individual and institutional efforts to avoid physician bias related to the patient’s sociodemographic characteristics in healthcare service.     

Cultural factors and children's oral health care: a qualitative study of carers of young children

Objective: This qualitative study sought to identify cultural beliefs, practices and experiences that influence access to preventive oral health care for young children from different racial and ethnic groups. Methods: Four to six focus groups in each of the African–American, Chinese, Latino and Filipino communities in San Francisco, California were included in the study. Participants were carers of children aged 1–5 years. The 22 groups (n = 177 participants) were stratified by carer's age and, except in the African–American community, by whether US or non‐US born. Sessions were conducted in different languages as needed. Results: Lack of knowledge and beliefs about primary teeth created barriers to early preventive care in all groups. In Chinese groups more than others, health beliefs regarding disease causation and prevention influenced access to preventive dental care. In all groups, multiple family carers, especially elders, influenced access to preventive care. Dental fear, whether derived from prevailing community beliefs or personal negative dental experiences, greatly influenced attitudes regarding accessing preventive care. Conclusion: There are both similarities and differences between racial/ethnic groups in how cultural beliefs and experiences influence young children's access to dental care and how it might be improved.     

Linking mother access to dental care and child oral health

Abstract – Objectives: The authors examined whether low‐income mothers, who have a regular source of dental care (RSDC), rate the dental health of their young children higher than mothers without an RSDC. Methods: From a population of 108 151 children enrolled in Medicaid aged 3 to 6 years and their low‐income mothers in Washington state, a disproportionate stratified random sample of 11 305 children aged 3 to 6 years was selected from enrollment records in four racial/ethnic groups: 3791 Black; 2806 Hispanic; 1902 White; and 2806 other racial/ethnic groups. A mixed‐mode survey was conducted to measure mother RSDC and mother ratings of child’s dental health and pain. The unadjusted response rate was 44%, yielding the following eligible mothers: 816 Black, 1309 Hispanic, 1379 White, 237 Asian, and 133 American‐Indian. Separate regression models for Black, Hispanic, and White mothers estimated associations between the mothers having an RSDC and ratings of child dental health. Results: Across racial/ethnic groups, mothers with an RSDC consistently rated their children’s dental health 0.15 higher on a 1‐to‐5 scale (where ‘1’ means ‘poor’ and ‘5’ means ‘excellent’) than mothers without an RSDC, controlling for child and mother characteristics and the mothers’ propensity to have an RSDC. This difference can be interpreted as a net movement of one level up the scale by 15% of the population. Conclusions: Across racial/ethnic groups, low‐income mothers who have a regular source of dental care rate the dental health of their young children higher than mothers without an RSDC.     

Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature

Background

The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino) were chosen as exemplar populations.

Methods

The dental literature published in English for the period 1980–2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied.

Results

Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base.

Conclusion

The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.     

Disparities in children's oral health and access to care

The oral health of Americans has improved in recent years, yet considerable gaps in the provision of dental care remain according to the U.S. Surgeon General's Report in 2000. This paper provides an overview of oral health disparities experienced by racial and ethnic minority children based upon the socioeconomic status. Many Americans, particularly children, continue to suffer disproportionately from oral pain and disease, including minority, low-income, and/or special care populations.     

Racial and ethnic disparity in oral cancer awareness and examination: 2003 New york state BRFSS

OBJECTIVES: This study documents the level of oral cancer awareness and examination among New York State adults and evaluates the determinants of disparities in oral cancer detection. METHODS: The 2003 New York State Behavioral Risk Factor Surveillance System gathered information on current awareness of oral cancer and receipt of oral cancer examination from 5,544 adults. To assess whether the racial/ethnic factor remains important for the awareness, receipt, and source of oral cancer examination after controlling for other socioeconomic and health care access variables, bivariate and multiple logistic regression analyses were conducted using SAS and SUDAAN. RESULTS: Even though a majority of State adults (80.4 percent) had heard about oral cancer, about three-quarters of these adults (74.3 percent) had never heard about an oral cancer test or examination. Only 35 percent of the adults reportedly received an oral cancer examination in their lifetime. Adults with Hispanic origin were less likely to have heard about and received an oral cancer examination. Regarding the source of the examination, some 72 percent of the examinations were conducted by a dental professional; the remaining 28 percent were performed by a physician, nurse, or nurse practitioner. Non-Hispanic Blacks were more likely to have received an oral cancer examination from health care providers other than a dentist or dental hygienist. CONCLUSIONS: These data suggest the need to improve the oral cancer awareness and examination rate in New York State. Routine examination of the mouth by primary care providers as part of a physical examination would provide the best opportunity for improving the low oral cancer examination rates in minority populations.     

Racial and ethnic disparities in children's oral health: the National Survey of Children's Health

BackgroundThe authors evaluated racial/ethnic differences and their socioeconomic determinants in the oral health status of U.S. children, as reported by parents.MethodsThe authors used interview data from the 2003 National Survey of Children's Health, a large representative survey of U.S. children. They calculated weighted, nationally representative prevalence estimates for non-Hispanic whites, non-Hispanic blacks and Hispanics, and they used logistic regression to explore the association between parents' reports of fair or poor oral health and various socioeconomic determinants of oral health.ResultsThe results showed significant racial/ethnic differences in parental reports of fair or poor oral health, with prevalences of 6.5 percent for non-Hispanic whites, 12.0 percent for non-Hispanic blacks and 23.4 percent for Hispanics. Although adjustments for family socioeconomic status (poverty level and education) partially explained these racial/ethnic disparities, Hispanics still were twice as likely as non-Hispanic whites to report their children's oral health as fair or poor, independent of socioeconomic status. The authors did find differences in preventive-care attitudes among groups. However, in multivariate models, such differences did not explain the disparities.ConclusionsSignificant racial/ethnic disparities exist in parental reports of their children's oral health, with Hispanics being the most disadvantaged group. Disparities appear to exist independent of preventive-care attitudes and socioeconomic status.     

Edentulism trends among middle-aged and older adults in the United States: comparison of five racial/ethnic groups

Wu B, Liang J, Plassman BL, Remle C, Luo X. Edentulism trends among middle‐aged and older adults in the United States: comparison of five racial/ethnic groups. Community Dent Oral Epidemiol 2012; 40: 145–153. © 2011 John Wiley & Sons A/S Abstract – Objectives: This study examined edentulism trends among adults aged 50 and above in five ethnic groups in the United States: Asians, African Americans, Hispanics, Native Americans, and non‐Hispanic Caucasians. Methods: Data came from the National Health Interview Surveys between 1999 and 2008. Respondents included 616 Native Americans, 2,666 Asians, 15,295 African Americans, 13,068 Hispanics, and 86,755 Caucasians. Results: In 2008, Native Americans had the highest predicated rate of edentulism (23.98%), followed by African Americans (19.39%), Caucasians (16.90%), Asians (14.22%), and Hispanics (14.18%). Overall, there was a significant downward trend in edentulism rates between 1999 and 2008 (OR = 0.97, 95% CI: 0.96, 0.98). However, compared with Caucasians, Native Americans showed a significantly less decline of edentulism during this period (OR = 1.10, 95% CI: 1.02, 1.19). Conclusions: While there was a downward trend in edentulism between 1999 and 2008, significant variations existed across racial/ethnic groups. Innovative public health programs and services are essential to prevent oral health diseases and conditions for minority populations who lack access to adequate dental care. Additionally, given the increasing numbers of adults retaining their natural teeth, interventions designed to assist individuals in maintaining healthy teeth becomes more critical.     

Workforce diversity in dentistry – current status and future challenges

The racial and ethnic diversity of the US oral health care workforce remains insufficient to meet the needs of an increasingly diverse population and to address persistent health disparities. The findings from a recent national survey of underrepresented minority dentists are reviewed and recommendations are made for enhancing diversity in the dental profession.     

The impact of dental benefits on the utilization of dental services by low-income children in western Pennsylvania

PURPOSE: This study examines the impact of dental coverage provided through a health insurance program for low-income children on the use of dental services in Western Pennsylvania. METHODS: A before-after design with a control group was used. Telephone interviews were conducted with the families of newly enrolled children at the time of enrollment, at 6 months and at 12 months after enrollment. Both structured and open-ended questions were asked about the use of health care services, unmet need/delayed care and causes and consequences of unmet need/delayed care. A second group of families were interviewed 12 months after the study group was initially interviewed to form a comparison sample. The study population consisted of 750 children who were continuously enrolled in the program for 12 months and 460 comparison children. RESULTS: After enrollment, the proportion of children with a regular source of dental care increased 42%, while the proportion of those who had a preventive dental visit increased 50%. The proportion of children reporting unmet need/delayed care for dental services fell from 43% to 10%. The program had a larger impact on the use of dental services than on the use of medical services. CONCLUSIONS: The extension of dental benefits to SCHIP-eligible children in Western Pennsylvania had a positive impact on children by increasing their access to dental care and to preventive dental services.     

Understanding health behavior and perceptions

Oral health and general health status depend on a dynamic interplay of many factors, including the individual's personal characteristics, behaviors, and perceptions. There are differences and disparities among different racial and ethnic groups in terms of oral health status, and in the physical, socioeconomic, cultural, and political environment. Furthermore, response to the environment may vary among individuals and populations. Access to care and patient-provider interactions are key issues to consider. This article presents a conceptual model of the variable influences on behaviors and perceptions that determine oral health status in minority and other populations.     

Income gradients in oral health according to child age

This study aimed to confirm whether the well‐known income disparities in oral health seen over the life course are indeed absent in 9‐ to 11‐yr‐old children, and to explore the role of access to dental care in explaining the age‐profile of the income gradient in child oral health. We used data from the 2007 United States National Survey of Children's Health. Income gradients in parental reports of children's decayed teeth or cavities, toothache, broken teeth, bleeding gums, and fair/poor condition of teeth were assessed in stratified analyses according to age of child (1–5, 6–8, 9–11, 12–14, and 15–17 yr), using survey logistic regression to control for family‐, parental‐, and child‐level covariates. Health insurance status and use of preventive dental care were the indicators for children's access to dental care. The adjusted ORs for the effect of family income on having decayed teeth or cavities, toothache, and fair/poor condition of teeth were not significant in 9‐ to 11‐yr‐old children. Different age‐patterns were found for broken teeth and bleeding gums. The attenuation of the income gradients in having decayed teeth or cavities, toothache, and fair/poor condition of teeth, previously seen in 9‐ to 11‐yr‐old children, was also seen in 15‐ to 17‐, 12‐ to 14‐, and 6‐ to 8‐yr‐old children, respectively, after controlling for children's access to dental care. This study supports the attenuation of income inequalities in oral health in 9‐ to 11‐yr‐old children. Access to dental care could attenuate income gradients in oral health in other age groups.