Social capital and self-rated oral health among young people

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

Factors associated with the use of emergency dental care facilities in a French public hospital

This study was undertaken to qualitatively analyze patients’ profiles and to identify the sociodemographic and oral health factors associated with emergency visits to the public dental service in Montpellier, France. A cross‐sectional survey was conducted in the dental care service at Montpellier Hospital. Socioeconomic and clinical variables were compared between the patients using the emergency dental care service and those utilizing the general dental services, which were by appointment. An evaluation of the results indicated that younger patients and people from lower socioeconomic groups used the emergency dental service more frequently. Unemployed people (OR = 1.60) and manual workers (OR = 1.86) were also more likely to use this service. The need for treatment of caries was significantly higher in the group that used the emergency service. It appeared that the two groups of patients had different attendance behavior and showed significantly different socioeconomic and oral health status.     

Diabetes and oral health promotion: a survey of disease prevention behaviors

BACKGROUND: Diabetes is a chronic metabolic disease known to affect oral disease progression. The authors surveyed health behaviors essential for preventing dental and periodontal diseases and maintaining oral health is a population of adult patients with type 1 (insulin-dependent) diabetes. The goals of this study were to assess these patients' oral health behaviors, access to dental care and need for improved health education. METHODS: As part of a dental and periodontal examination, 406 subjects with type 1 diabetes completed a questionnaire regarding their oral health attitudes, behaviors and knowledge. The authors also evaluated 203 age-matched nondiabetic control subjects. RESULTS: The authors found that diabetic subjects' tobacco use and oral hygiene behaviors were similar to those of the nondiabetic control subjects. Diabetic subjects, however, more frequently reported the cost of dental care as a reason for avoiding routine visits. Most of these subjects were unaware of the oral health complications of their disease and the need for proper preventive care. CONCLUSIONS: Patients with diabetes appear to lack important knowledge about the oral health complications of their disease. The results of this survey did not indicate improved prevention behaviors among the subjects with diabetes compared with nondiabetic control subjects. CLINICAL IMPLICATIONS: Dentists have an opportunity and the responsibility to promote good oral health behaviors such as regular dental examinations, proper oral hygiene and smoking cessation that may significantly affect the oral health of their diabetic patients.     

Socio-economic inequality in the self-reported number of natural teeth among Norwegian adults--an analytical study

Abstract – Objective: To assess inequality in dental status associated with educational level, gross personal and family income among Norwegian adults. Methods: Data were collected by Norway's Central Bureau of Statistics in November–December 2003. A two‐stage, proportional random sample comprising 2000 persons aged 16–79 years was drawn from the national population register. Information became available for 1309 subjects by interview. The present analyses pertain to 1092 subjects aged 25–79 years (response rate 66%, mean age 47.9 years). Results: Of the respondents, 3% were edentulous and 9% had fewer than 20 teeth. The mean number of teeth was 27.1 (SD 7.0). In multiple logistic regression analysis, low gross personal and adjusted family income were associated with increased likelihood of having fewer than 20 natural teeth (OR = 2.84, 95% CI 1.58, 5.10; OR = 3.63, 95% CI 1.99, 6.62, respectively). Educational level was significantly associated with dental status in bivariate but not in multivariate analyses, except once among males. The predictors of socio‐economic inequality in dental status accounted for a limited proportion of explained variance (Nagelkerke's R²) when controlling for age, place of residence, perceived oral health compared with others, perceived importance of oral health, dental attendance and smoking. Conclusion: Socio‐economic inequality in dental status persists among Norwegians aged 25–79 years but absolute differences have decreased during the last 30 years. The findings are encouraging but challenging as far as choice of strategy for further reduction of differences in tooth loss.     

Oral health status among low‐income people admitted to Osaka Socio‐Medical Center in Japan

Objective : To examine the dental condition, perceived oral symptoms, and frequency of dental visits among low‐income people admitted to Osaka Socio‐Medical Center (OMSC) and to compare with Japanese national survey respondents. Methods : Oral health examinations for inpatients admitted to OMSC were performed from August to November 2004. In total, 113 inpatients who were in the recovery period without acute symptoms, were selected. Results : 109 inpatients received dental examination. All participants were male. About half of the subjects (49%) did not have any medical insurance, and the percentage of subjects who had 20 or more teeth was smaller than in a national survey in all age groups. The subjects had a higher reported frequency of oral symptoms compared with respondents to the national survey. Accessibility to dental clinics among subjects was notably low. Conclusion : Dental condition and perceived oral symptoms among the subjects were poor compared to national survey respondents. Dental care to improve the oral health condition of this segment of the population is needed.     

Cost as a barrier to dental care among people with disabilities: a report from the Florida behavioral risk factor surveillance system

Many individuals who have disabilities or complex health conditions do not have adequate access to comprehensive oral health care. An examination of the literature indicates a variety of contributing factors. This study reports on cost of care as a barrier to oral health care. Data from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS) were used (n = 33,777). Respondents who reported activity limitation or the use of special equipment were considered to have a disability. Lack of access to dental care due to cost during the past year was assessed. More individuals with a disability reported not seeing a dentist due to cost versus people without disabilities (30% vs. 16%). After adjusting for confounding variables, Floridians with disabilities were 60% more likely to report cost as a barrier to dental care (OR = 1.60, 95% CI 1.32–1.94). Cost of dental care is an access to oral health barrier for Floridians with disabilities. Improving access to dental care for this population will require consideration of financial issues.     

The Influence of Dental Insurance on Institutionalized Older Adults in Ranking Their Oral Health Status

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel‐Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as “good,”“very good” or “excellent” by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting “good,”“very good” or “excellent” oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.     

Is dental care utilization associated with oral cavity cancer in a large sample of community‐based United States residents?

Abstract – Objectives: Cancer of the oral cavity and pharynx remains one of the 10 leading causes of cancer deaths in US. Besides smoking and alcohol consumption, there are no well‐established risk factors. While poor dental care had been implicated, it is unknown if lack of dental care, implying poor dental hygiene predisposes to oral cavity cancer. This study aimed to assess the relationship between dental care utilization during the past 12 months and the prevalence of oral cavity cancer. Methods: A cross‐sectional design of the National Health Interview Survey of Adult, noninstitutionalized US residents (n = 30 475) was used to assess the association between dental care utilization and self‐reported diagnosis of oral cavity cancer. Chi‐square statistic was used to examine the crude association between the explanatory variable, dental care utilization and other covariates, while unconditional logistic regression was used to assess the relationship between oral cavity cancer and dental care utilization. Results: There were statistically significant differences between those who utilized dental care during the past 12 months and those who did not with respect to education, income, age, marital status, and gender (P < 0.05), but not health insurance coverage (P = 0.53). In addition, those who utilized dental care relative to those who did not were 65% less likely to present with oral cavity cancer, prevalence odds ratio (POR), 0.35, 95% confidence interval (CI), 0.12–0.98. Further, higher income, advanced age, people of African heritage, and unmarried status were statistically significantly associated with oral cavity cancer (P < 0.05), but health insurance coverage, alcohol use, and smoking were not, P > 0.05. After simultaneously controlling for the relevant covariates, the association between dental care and oral cavity cancer did persist but imprecise. Thus, when compared with those who did not use dental care, those who did were 62% less likely to be diagnosed with oral cavity cancer, adjusted POR, 0.38, 95% CI, and 0.13–1.10. Conclusions: Among US adults residing in community settings, use of dental care during the past 12 months was marginally statistically significantly associated with oral cavity cancer, but clinically relevant in assessing oral cavity cancer prevalence in this sample. However, because of the nature of our data, which restricts temporal sequence, a large sample prospective study that may identify modifiable factors associated with oral cavity cancer development, namely poor dental care is needed.     

Relationship between dental care and oral health in institutionalized elderly people in Japan

This study examined the relationship between dental care and dental health status in institutionalized elderly people in Japan through a 6-year prospective cohort study. All the 719 subjects received both baseline and follow-up surveys. The uptake of dental care was examined at the follow-up survey. We examined the relationship between baseline variables and the provision of dental care, and the relationship between dental care and change of oral health status. About 47% of the subjects and about 60% of the baseline dentate subjects received some dental treatment during the 6-year follow-up period. The subjects who were in better systemic and dental health at baseline used dental services frequently. The number of teeth needing extraction decreased in the subjects who received dental treatment, and increased in the untreated subjects. Denture status was better in the treated subjects than in the untreated subjects. Dental care appears to be an important factor in maintaining a healthy oral status for the institutionalized elderly.     

Impact of disability diagnosis on dental care use for adults in the United States: Status matters

BackgroundApproximately 25% of adults in the United States have a disability that limits function and independence. Oral health care represents the most unmet health care need. This population has been found to have decreased oral health outcomes compared with the general population.MethodsThe authors used the 2018 adult National Health Interview Survey to assess the association between disability status and dental care use (dental visit within or > 2 years). Disability status was categorized as adults with an intellectual, acquired, or developmental disability (IADD) that limits function, other disability that limits function, or no disability, on the basis of diagnoses of birth defect, developmental diagnosis, intellectual disability, stroke, senility, depression, anxiety, or emotional problem, all causing problems with function.ResultsAdults with an IADD with functional and independence-limiting disabilities experienced higher crude odds of going 2 years or more without a dental visit than adults without disabilities (odds ratio [OR], 2.29; 95% CI, 1.96 to 2.67). This association was part of a significant interaction and was stronger among those with IADDs who could afford oral health care (OR, 1.73; 95% CI, 1.47 to 2.14) than among those who could not afford oral health care (OR, 1.21; 95% CI, 0.88 to 1.67; P value of interaction <.01).ConclusionsAdults with IADDs have decreased access to oral health care compared with adults with other disabilities or without disabilities. The inability to afford oral health care lessens the impact of disability status.Practical ImplicationsDentists can use this study to understand the implications of IADD diagnoses on dental care use and make efforts to facilitate care for these patients.     

Oral self-care among adults with diabetes in Finland

OBJECTIVES: The importance of maintenance and promotion of periodontal health is emphasized among people with diabetes because of their high risk for periodontal diseases. Our aim was to evaluate oral health behavior and its determinants among adults with diabetes in Finland. METHODS: The population of the questionnaire study consisted of 420 systematically selected adults with diabetes, who were members of a national diabetes register. The response rate was 80%. Questions focused on self-treatment, -prevention, and -diagnosis of oral diseases, utilization of dental services, and knowledge and attitudes toward oral health among adult people with diabetes. Oral self-care was evaluated in the framework of the New Century model of oral health promotion. RESULTS: The proportion of edentulous subjects was 23%, and these were excluded from further analysis. Self-reported twice-a-day brushing among dentate participants was significantly more common among women and the highly educated, but was less common compared with earlier studies among Finnish adults. A quarter of those surveyed reported never cleaning interdental surfaces, with the number of daily cleaners being nearly equal (27%). Age 40 years or over and recent treatment by a private dentist were significant predictors for daily interdental cleaning. The proportion of those who had attended a dental appointment within the last year was 63%, and the main reason for the last dental visit was an emergency among almost one-fifth of those surveyed. CONCLUSIONS: A need exists for further promotion of oral self-care among adults with diabetes. Support by dental and other health care professionals involved in diabetes care should be encouraged.     

Type 1 Diabetes Mellitus and Oral Health: Assessment of Tooth Loss and Edentulism

Objective : The oral health of an adult population previously diagnosed with juvenile onset insulin dependent-diabetes was comprehensively assessed. The goal of this exploratory cross-sectional evaluation was to describe the characteristics related to partial tooth loss and edentulism in subjects with Type 1 diabetes mellitus. Methods : An adult population of 406 Type 1 diabetes mellitus subjects, who had been monitored for 6–8 years as part of a University of Pittsburgh longitudinal study of medical complications associated with diabetes, received an oral health examination for missing teeth, edentulism, coronal and root caries, periodontal status, and oral health behaviors. Results : Of the 406 subjects evaluated, 204 had no missing teeth, 186 had partial tooth loss (1–27 missing teeth), and 16 were edentulous. Patients who had partial tooth loss or who were edentulous were generally older; had lower incomes and levels of education; and had higher rates of nephropathy, neuropathy, retinopathy, and peripheral vascular disease. A logistic regression model found partial tooth loss to be significantly associated with extensive periodontal disease in remaining teeth (OR=7.35), a duration of diabetes longer than 24 years (OR=5.32), not using dental floss (OR=2.37), diabetic neuropathy (OR=2.29), household income less than $20,000 (OR=2.21), multiple coronal caries and fillings (OR=1.98), and bleeding on probing (OR=1.82). Conclusion : Although the majority of these adult Type 1 diabetes patients had serious medical complications associated with their diabetes, the possible impact of diabetes mellitus on oral health should be included in their overall management.     

Parental perception of oral health status of children in mainstream and special education classrooms

The aim of this study was to compare parental perceptions of oral health status and access to dental services by children in 34 special education and 16 mainstream public elementary school classes in San Mateo County, California. A self-administered parental survey was utilized and included questions about demographics, oral health, and dental utilization. The overall response rate was 58.8%. After adjusting for age and gender of the child, compared to mainstream, parents of students in special education classes were significantly more likely to report their children to have worse oral health (OR = 2.4, 95% CI 1.54, 3.67), be lacking a past year dental visit (OR = 1.96, 95% CI 1.01, 3.84), and have missed school days due to dental reasons (OR = 2.5, 95% CI 1.55, 4.17). Both groups rated their children's oral health inferior to the overall health rating ( p < .001). The authors concluded that disparities exist between the two groups in parental perceptions of their children's oral health status and dental service utilization.     

Changes of general and oral health status of elderly patients receiving home-visit dental services

This study investigated the changes of general and oral health status of elderly patients who received home-visit dental services. The subjects were 51 patients (male: 19, female: 32, age: 83.0+/-9.1). The results of initial and re-examination (5.4 months later) by questionnaire survey, oral status and oral microbes were compared. The following results were obtained. 1. More than half of the subjects were bedridden and about 70% were affected by dementia. Three-quarters needed special care for daily activities. 2. The general health condition of the subjects became worse after 5.4 months. Moreover, 11 subjects died within 6 months after re-examination. However, oral health status, such as status of oral hygiene (p < 0.01), inflammation of gingiva (p < 0.01), tongue coating (p < 0.05) and oral malodor (p < 0.01) improved significantly. 3. There was a significant difference in the rate of people with dysphagic problems between the living and dead groups (p < 0.05). 4. The initial general and oral health status of the people with dysphagic problems was significantly worse than that of those without it. After receiving home-visit dental services, general condition became worse. However oral status, such as status of oral hygiene, inflammation of gingiva, oral malodor, and lactobacillus count significantly improved in both groups. These results suggest that dysphagic problems of elderly patients may affect their general health condition and might increase the risk of death. It is recommended to judge dysphagic problems accurately when performing certification of need for long-term care and to provide professional oral care periodically for the dependent elderly needing care.     

Healthy practices, social relationships and dental perceptions among US dentate adults

OBJECTIVE: This study explored and described the effects of healthy practices and social relationships on dental perceptions among U.S. dentate adults. METHODS: Guided by the Alameda County Study: Health and Ways of Living, weighted data from the Third National Health and Nutrition Examination Survey of 8,449 U.S. dentate adults aged 18-64 years were analyzed with SUDAAN 7.5.3. RESULTS: Healthy practices and social relationships showed protective effects against unfavorable dental perceptions after controlling for socio-demographic characteristics, dental access, and related clinical dental status. Besides healthy practices and social relationships, education, family income, having dental visit in the past 12 months, having dental decay, having defective tooth condition, and number of natural teeth helped explain unfavorable dental perceptions in the adjusted model. Compared with persons who had high social relationships and high healthy practices, those who had low social relationships with very low, low and medium healthy practices were about five, times (OR=5.07; 99% CI=3.24, 7.91), almost four times (OR=3.61; 99% CI=2.22, 5.87), and two times (OR=2.24; 99% CI=1.37, 3.67) more likely, respectively, to have unfavorable dental perceptions. In the adjusted model, these odds ratios decreased to three (OR=3.30; 99% CI=2.01, 5.41), two (OR=2.06; 99% CI=1.15, 3.69) and non-significant difference, consecutively. CONCLUSIONS: Influence of healthy practices and social relationships on dental health may encourage dental health professions to participate in general health behavior modifications and social actions to foster social relationships, in addition to preventive dental care.     

Receipt of dental care, dental status and workforce in U.S. nursing homes: 1997 National Nursing Home Survey

The goal of this paper was to report the prevalence of dental care — a Healthy People 2010 objective — for nursing home residents 65 years and older, and to assess the association between receipt of dental care with other oral status and workforce measures. Data from 7,363 residents aged 65 years and older with information in the 1997 National Nursing Home Survey (NNHS) were used.
Overall, 18.2% of elderly nursing home residents had received dental care in the last month. Multivariable modeling found residents were more likely to receive dental care in the past month if they lived in the Northeast (OR=3.32, 95% CI 2.51-4.39); were dentate (OR=1.46, 95% CI 1.26-1.69); had a length of stay 12 months or longer (OR=1.37, 95% CI 1.17-1.62); or resided in facilities with dental professional services (OR=2.05, 95% CI 1.60-2.62).
The results showed that disparities in receipt of dental care existed by region, length of stay, dentate status, and availability of dental services in nursing homes. Additionally, current oral health surveillance measures for nursing homes may have been inadequate.     

A survey of oral health in a population of adults with developmental disabilities: Comparison with a national oral health survey of the general population

During 1991, an oral health assessment of 101 adults with developmental disabilities aged from 21 to 53 years undertaken as part of a broader health survey which also included medical, psychological and nutritional assessments. The study group consisted of a random sample of adults chosen form the developmentally disabled population known to be living in the lower North Shore area of Sydney. This paper describes the results of the oral health assessment and compress them with an oral health survey of the Australian population done in 1987/88. Forty-six per cent of the study group were males (mean age 33.5 years) and 54 per cent were females (mean age 33.0 years). Compared with similar age subgroups in the Australian population, the following factors were more frequently reported in the developmentally disabled group: a dental visit in the last 12 months (65 per cent vs 50) per cent; Odds Ratio (OR) 1.9:95) per cent; Confidence Internal (CI); 1.3-2.8); use of public rather than private dental services (42 per cent vs 6 per cent; OR 11.3:95% CI7.5–16.9); oral mucosal pathology requiring treatment (15 percent vs 2 per cent; OR 8.5:95% CI 5.2–13.8); Severe periodontal disease (16 per cent vs 3 per cent; OR 6.9:95% CI 4.2–11.4); and moderate to severe malocclusion (26 percent vs 11 per cent; OR 2.1:95% CI 1.3-3.5). Fifty-eight per cent of subjects felt they needed no dental treatment but on examination of the oral mucosa, periodontal tissues and teeth, over 90 per cent were found to require some sort of dental treatment.     

Predictors of oral health quality of life in HIV-1 infected patients attending routine care in Australia

Objective: To examine predictors of oral health quality of life (OHQoL) in a human immunodeficiency virus (HIV)‐infected population undergoing routine HIV care in the era of antiretroviral therapy. Method: The study was an anonymous self‐administered survey of 273 patients. Subjects completed the Oral Health Impact Profile‐14 and questionnaires on sociodemographics, HIV, and dental issues. Multiple logistic regression analysis was conducted to determine the predictors of OHQoL. Results: The study found smoking [odds ratio (OR) = 2.44], time to last dental visit (OR = 2.63), denture use (OR = 2.83), and income level (OR = 0.27) were significantly associated with OHQoL. No HIV‐related variables predicted OHQoL. Conclusion: Smoking, not consulting a dentist in the last year, denture use, and low income were identified as significant predictors which could be targeted to improve quality of life among people living with HIV. Preventing dental diseases may also reduce the risk of activation of latent HIV by oral pathogens.     

Preference for dentist's home visits among older people

Komulainen K, Ylöstalo P, Syrjälä A‐M, Ruoppi P, Knuuttila M, Sulkava R, Hartikainen S. Preference for dentist’s home visits among older people. Community Dent Oral Epidemiol 2012; 40: 89–95. © 2011 John Wiley & Sons A/S Abstract – Objectives: To investigate factors associated with older people’s preference for a dentist’s home visit. Methods: This is a report on 321 home‐dwelling participants (mean age 81.6) in the population‐based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study, conducted in 2004–2005 in the city of Kuopio in eastern Finland. The information about sociodemographic and general health‐related factors and the use of social and health services was collected by two study nurses using a structured interview. Each study subject was given a clinical oral examination and an interview about oral health and the use of dental health care services by one of two dentists. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Of the study subjects, 25.9% preferred a dentist’s home visit. The preference for choosing a dentist’s home visit was associated with a low score (≤24) in the Mini‐Mental State Examination, OR 6.1 (CI: 2.9–13.6), and a low score (<8) on the scale of Instrumental Activities of Daily Living, OR 8.0 (CI: 3.6–18.6). It was also associated with living alone, OR 5.9 (CI: 2.7–13.0), and high use of home care services, OR 9.3 (CI: 4.6–19.0). Conclusions: The findings of this study emphasize the need to organize dentists’ home visits in order to increase equality in the use of dental health care services among the older people with disabilities.