Kentucky's oral health indicators and progress towards Healthy People 2010 objectives

OBJECTIVES

National and Kentucky (KY) state-specific oral health indicators were compared to Healthy People (HP) 2010 oral health objectives to assess the progress of the state.

METHODS

Oral health surveillance system--derived estimates from national and KY surveys for various oral health indicators (1999-2004) were examined and compared with national estimates and the HP 2010 objectives. The null hypothesis that differences between national and KY indicators did not differ significantly was statistically evaluated using a "z" statistic-based test.

RESULTS

About 99.7% of KY had water fluoridation, ranking 2nd highest in the US. KY ranked 24th in the US for adult dental visits (69.8% people with a dental visit compared to national average of 69%). Some 38% of the elderly population was edentulous (national, 20.5%). Compared to other states, KY ranked high for teeth cleaning and dental sealants, but had greater caries experience and untreated caries among children. These patterns remained even in socio-demographic factor subgroup analysis. Most of these indicators improved from 1998 to 2004.

CONCLUSIONS

KY oral health indicators as documented by state/regional oral health surveys are not encouraging, and the progress towards the HP 2010 objectives is quite limited. Despite major national emphasis on oral health improvement and better than national average annual dental visit for some segments of the population, KY has a very high prevalence of edentulism compared to the rest of the country. Educated policy making and additional resources for program planning and implementation are required to improve the oral health status of KY residents.

[Oral health conditions and systemic diseases prevalence in long term institutionalizated elderly. A cross sectional study in Parma province]

People aging 74 years and more are in Parma province about 11,5% of residents. Disability conditions and familiar ties loss frequently let the elderly to recovery in long term home care where quality of care became synonymous of quality of life. To best evaluate oral health conditions in institutionalized elderly and their needs of care, we conducted, between August 2002 and July 2003 a cross-sectional study with clinical oral examinations in 200 long-term patients. Number of teeth, tooth remnants, mucosal findings, edentulousness, level of dental hygiene, needs for operative treatment and prevalence of systemic disease associated were evaluated. Subjects' mean age was 84,4 years (interval 57 _ 105); 59% were edentulous. As reported by several authors, a correlation between edentulousness and cardiovascular disease was found even after controlling for confounding variables (age, sex, smoking habit and Alzheimer disease).

Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population

OBJECTIVE

To test for an association of periodontitis and tooth loss with rheumatoid arthritis (RA).

METHODS

The third National Health and Nutrition Examination Survey (NHANES III) is a nationally representative cross-sectional survey of noninstitutionalized civilians. We included participants aged > or = 60 years who had undergone both musculoskeletal and dental examinations. RA was defined based on American College of Rheumatology criteria. Dental examinations quantified decayed and filled surfaces, missing teeth, and periodontitis. Periodontitis was defined as at least 1 site exhibiting both attachment loss and a probing depth of > or = 4 mm. We classified dental health status as (1) no periodontitis, (2) periodontitis, or (3) edentulous (i.e., complete tooth loss). We performed multivariate multinomial logistic regression models with dental health status as the dependent and RA as the independent variables.

RESULTS

The sample consisted of 4461 participants, of whom 103 were classified as having RA. Participants with RA had more missing teeth (20 vs 16 teeth; p < 0.001), but less decay (2% vs 4%; p < 0.001) than participants without RA. After adjusting for age, sex, race/ethnicity, and smoking, subjects with RA were more likely to be edentulous [odds ratio (OR) 2.27, 95% confidence interval (CI) 1.56 3.31] and have periodontitis (OR 1.82, 95% CI 1.04 3.20) compared with non-RA subjects. In participants with seropositive RA there was a stronger association with dental health status, in particular with edentulism (OR 4.5, 95% CI 1.2 17).

CONCLUSION

RA may be associated with tooth loss and periodontitis.

Oral health in the adult population of Västerbotten, Sweden--a comparison between an epidemiological survey and data obtained from digital dental records

The objective of this study was to analyse the possibilities and limitations of using data drawn from electronic dental patient records (EDPRs) in monitoring dental health among adults in a northern Swedish county.

MATERIALS AND METHODS

The study population comprised all 35-, 50-, 65- and 75-year-old patients who were examined and, where required, received treatment at the Public Dental Service (PDS) in Västerbotten, Sweden, in 2003 and in 2004. In total 2,497 patients in 2003, and 2,546 patients in 2004 met the inclusion criteria. As controls, 779 subjects randomly drawn from the adult population in the same age groups and from the same county were used. They participated in an oral health survey and were examined clinically between October 2002 and March 2003.

RESULTS

When oral health was estimated based on EDPRs the prevalence of edentulous subjects was significantly underestimated, while the mean numbers of teeth and the mean values of sound teeth were significantly overestimated. No statistically significant difference was found in prevalence of primary decayed tooth surfaces (DS). The prevalence of filled teeth (FT) was fairly similar between the study samples. Registrations of periodontal status were mainly missing in the EDPRs. Since registrations related to temporomandibular disorders are not included in the T4 system its prevalence could not be assessed and accordingly not compared with the epidemiological sample.

CONCLUSION

The study shows that clinical registration based on EDPRs is at present not accurate enough to be used as indicators of oral health status among adults in a community.

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.

[Oral health of elderly occupants in residential homes]

Institutionalised elderly often report oral and dental problems which reduce nutrition ability and compromise significantly quality of life. The main objective of this study was to assess the prevalence of oral diseases in a group of residential homes elderly and to evaluate the association between degree of edentulism and some individual characteristics. From November 2004 to April 2005 448 subjects living in 10 residential homes of the city of Rome were enrolled in a special dental health programme in Lazio (Central Italy). The median age was 83.2 yrs, 47.3% of the subjects were edentulous, while 24.8% had 1 to 9 teeth, 63.1% of whom didn't have denture. 57.1% of subjects reported one or more oral disorders. Multivariate analysis showed a significant association between edentulism and the following factors: age > or = 75 yrs (Odds Ratio [OR] = 3.16 CI 95% 2.11-4.74) permanence of stay in the residential home > or = 3 yrs (OR = 1.96 CI 95% 1.13-3.40), lack of routine dental visits (OR = 1.71 CI 95% 1.14-2.58). The study findings confirmed that institutionalised elderly subjects, together with several chronic diseases, also show a poor oral health. Consequently greater attention should be paid to improve actively oral health services in this care setting.

Dental Health and Cognitive Impairment in an English National Survey Population

OBJECTIVES

To investigate the association between dental health and cognitive impairment and to examine the extent to which dental status accounts for the association between cognitive impairment and low body mass index (BMI) in a national survey sample.

DESIGN

A secondary analysis of data from the Health Survey for England 2000.

SETTING

A nationally representative cross-sectional population survey.

PARTICIPANTS

Two thousand four hundred sixty-three adults aged 65 and older living in private households and 1,569 adults aged 65 and older living in care homes.

MEASUREMENTS

Data collected by interview (self-reported or by proxy) included age, sex, level of education, disability, BMI, dental status, and cognitive function (Abbreviated Mental Test Score).

RESULTS

Less than half of the community sample (40.4%) and 67.9% of the care home sample were edentulous; lack of teeth was significantly associated with cognitive impairment (odds ratio=3.59, 95% confidence interval=2.36-5.47). This association remained strong after adjustment for other covariates only in the community sample. Cognitive impairment was associated with lower BMI in both samples, but dental status did not explain this.

CONCLUSION

Poor dentition is associated with cognitive impairment. Nutritional status in people with cognitive impairment is recognized to be at risk. Although dental health did not account for the association between cognitive impairment and low BMI in this sample, other possible nutritional consequences require further evaluation.

Dental state, prosthodontic treatment and chewing ability ? a study of five cohorts of 70-year-old subjects

The aim was to study the relationship between dental state, prosthetic rehabilitation and chewing ability in 70-year-old subjects examined between 1971 and 2001. Five birth cohorts born in 1901/1902 (I), 1906/1907 (II), 1911/1912(III), 1922 (V), and 1930 (VI) were examined at 70 years of age. The number of participants in the odontological cohorts varied between 386 and 583. The prevalence of total edentulism changed from 51% in cohort I to 7% in cohort VI. The proportion of subjects using removable dentures decreased from 76% to 17%, whereas those with >or=20 teeth increased from 13% to 65%. The prevalence of subjects with fixed partial dentures increased from 26% to 58%. Of the 70-year-old subjects examined in 2001, 5% had implant-supported restorations. The self-assessed chewing ability showed only weak associations with dental state, and there was no significant cohort trend. When all cohorts were pooled together, 80% considered their chewing ability good, 16% less good and 4% poor. Among the edentulous subjects, more individuals complained about poor chewing ability in the last two cohorts than in the first three. It was concluded that there were great differences in dental state between the five cohorts of 70-year-old subjects examined from 1971 to 2001. Edentulism and wearing of removable dentures decreased substantially, whereas the proportion of subjects with fixed partial dentures showed a marked increase. In spite of the improved dental state, the self-assessed chewing ability exhibited only minor variation over time.

Association of total tooth loss with smoking, drinking alcohol and nutrition in elderly Japanese: analysis of national database

OBJECTIVE

Various factors may be associated with edentulism in elderly people. Association of total tooth loss with smoking, alcohol intake and nutrition in non-institutionalised elderly Japanese was assessed utilising national database.

MATERIALS AND METHODS

Records of independent surveys, the Survey of Dental Diseases (SDD) and the National Nutrition Survey (NNS) in 1999 were electronically linked using the household identification number.

RESULTS

Among the records of 6903 subjects in the SDD and 12 763 subjects in the NNS, 6805 records were successfully linked. Overall, prevalence of total tooth loss in adults was very similar in males and females at approximately 7.0%, and the smoking rate was 47.6% and 9.9% respectively. Total tooth loss was a rare phenomenon (<2%) in age groups of <60 years. According to the multiple logistic regression analysis involving 2200 subjects aged 60 years or older, significant variables were age, current smokers and vitamin C intake in males, and age and current smokers in females. The variable for current drinkers was significant in females but the odds ratio was <1.0. No significant relationship was detected with respect to former smokers and drinkers, body mass index, vitamin E intake and blood glucose level.

CONCLUSIONS

Current smoking was associated with total tooth loss, although smoking rate was low in females. Gender difference in the association was suggestive with respect to drinking alcohol and vitamin C intake.

Past and Present Geographic Location as Oral Health Markers Among Older Adults

OBJECTIVES

This study evaluated the association between oral health status of community-dwelling elderly adults visiting day health centers in Israel and geographic living location.

METHODS

Oral status was assessed through clinical examination, with additional data obtained using a questionnaire addressing demographic characteristics, dental utilization, and perceived oral health needs.

RESULTS

A representative sample of 338 subjects was examined. Fifty-four percent of the sample was edentulous. Higher rates of edentulism were found among subjects living in urban areas compared to subjects living in rural areas (P<.01). More edentate subjects were found among European immigrants than among immigrants from North Africa or subjects born in Israel (P<.01). Among dentate subjects, the mean number of remaining teeth was 10.4. The mean periodontal loss of attachment was 5.8 mm. Less than 10 percent had mean attachment loss <4 mm. Among subjects living in rural areas, mean attachment loss was higher than among those living in urban areas (P=.05). The mean DF score was 1.9. Forty-seven percent had at least one tooth with untreated caries. Subjects living in urban areas tended to utilize dental services more than subjects living in rural areas (P<.01).

CONCLUSION

Results indicate that present (urban or rural) and past (country of origin) geographic location represented a significant oral health risk marker. The implementation of a comprehensive program for this target population was clearly indicated.

Tooth loss in the elderly and its association with nutritional status, socio-economic and lifestyle factors

OBJECTIVE

Tooth loss impacts on general health and is a risk factor for malnutrition, disability, loss of self-sufficiency, and deterioration in quality of life. The present study was carried out to evaluate the prevalence of edentulism and its association with social and lifestyle factors in a population of elderly Italians.

MATERIAL AND METHODS

Dental, social, and disease conditions were evaluated in a large community-based cohort (3054) of elderly subjects (> or =65 years) of both sexes in northern Italy. Logistic regression analyses with stepwise forward selection were performed to estimate the independent contribution of nutritional, socio-economic, and lifestyle variables to dental status. Adjusted ORs and 95% CI were estimated for variables significantly associated with edentulism.

RESULTS

The prevalence of edentulism was about 44.0%. It was more pronounced in females and it was twice as prevalent in the 90+ years age group. Among edentulous subjects, 17.5% wore no prostheses. Difficulties in chewing and in swallowing were reported by 47.6% and 13.7% of the subjects, respectively. Multivariate analysis indicates that edentulism was associated with age in both sexes. For women, independently associated risk factors were: years since menopause >23 (OR = 1.81; 95% CI: 1.37-2.40), number of children >3 (OR = 1.95; 95% CI: 1.36-2.80), and living alone (OR = 1.47; 95% CI: 1.15-1.88). For men, these were serum albumin <40 g/l (OR = 1.79; 95% CI: 1.22-2.63), current smoking (OR = 4.01; 95% CI: 2.59-6.20), and former smoking (OR = 3.42; 95% CI: 2.42-4.82).

CONCLUSIONS

The prevalence of edentulism among the elderly Italian population studied was at the high end among Western countries, and higher in women than in men. In women, tooth loss correlated with aging, female events (pregnancies, menopausal status), and living alone. In men, aging and smoking are important determinants of edentulism, which is associated with the risk condition of hypoalbuminemia. Difficulty in chewing was associated with dentition type. In our study, the high prevalence of edentulous subjects without prostheses suggests a need for educational and social measures to improve patients' attitudes to dental care and to encourage the use of prostheses among the elderly.

The relationship between nutrition and systemic and oral well-being in older people

BACKGROUND

Diet plays a key role in disease prevention in older age. The aims of this report were to review the causes and consequences of a poor diet in later life and its interrelationship with oral health.

CONCLUSIONS

Energy requirements decrease with age; however, many factors, including poor oral health, loss of appetite and illness, may compromise energy intake. Absorptive capacity may reduce with age; therefore, to prevent deficiencies of micronutrients, a nutrient-dense diet is essential.

CLINICAL IMPLICATIONS

The first signs of micronutrient deficiencies often are manifest in the oral tissues. Consequently, the dentist has an important role in the early diagnosis of malnutrition. Furthermore, optimizing oral health is important in maximizing older patients' functional capacity to consume a healthful and varied diet.

Dental health status of liver transplant candidates

A prerequisite dental evaluation is usually recommended for potential organ transplant candidates. This is based on the premise that untreated dental disease may pose a risk for infection and sepsis, although there is no evidence that this has occurred in organ transplant candidates or recipients. The purpose of this study was to assess the prevalence of dental disease and oral health behaviors in a sample of liver transplant candidates (LTCs). Oral examinations were conducted on 300 LTCs for the presence of gingivitis, dental plaque, dental caries, periodontal disease, edentulism, and xerostomia. The prevalence of these conditions was compared with oral health data from national health surveys and examined for possible associations with most recent dental visit, smoking, and type of liver disease. Significant risk factors for plaque-related gingivitis included intervals of more than 1 yr since the last dental visit (P = 0.004), smoking (P = 0.03), and diuretic therapy (P = 0.005). Dental caries and periodontal disease were also significantly associated with intervals of more than 1 yr since the last dental visit (P = 0.004). LTCs with viral hepatitis or alcoholic cirrhosis had the highest smoking rate (78.8%). Higher rates of edentulism occurred among older LTCs who were less likely to have had a recent dental evaluation (mean 88 months). In conclusion, intervals of more than 1 yr since the last dental visit, smoking, and diuretic therapy appear to be the most significant determinants of dental disease and the need for a pretransplantation dental screening evaluation in LTCs. Edentulous patients should have periodic examinations for oral cancer.

The relationship between sociodemographic factors and oral health-related quality of life in dentate and edentulous community-dwelling older adults

OBJECTIVES

To quantify the associations between sociodemographic factors and oral health-related quality of life (OHRQoL) in dentate and edentulous community-dwelling older adults.

DESIGN

Cross-sectional study using a 54-item OHRQoL questionnaire.

SETTING

Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural).

PARTICIPANTS

Two hundred eighty-eight participants (Dental Study subjects) aged 65 and older were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in older African Americans and non-Hispanic whites.

MEASUREMENTS

Dental Study subjects were queried on their OHRQoL and sociodemographic status and classified into two categories: dentate and edentulous. Bivariate analyses were used to quantify associations between sociodemographic variables and OHRQoL after excluding participants with severe depression. Variables included age, sex, race, marital status, veteran status, residence, income, education, and transportation difficulties.

RESULTS

Dentate and edentulous subjects had similar OHRQoL across age, sex, marital status, veteran status, and residence. Analyses suggested a strong association between OHRQoL and race, education, income, and transportation difficulties in dentate subjects. Sociodemographic factors were less strongly associated with OHRQoL in edentulous participants.

CONCLUSION

OHRQoL decrements were prevalent in dentate and edentulous subjects. Of dentate persons, African Americans and those with a 6th-grade education or less, with income less than 16,000 dollars/year, and with transportation difficulties were more likely to have decrements in OHRQoL. In edentulous persons, these associations were not statistically significant or were weaker. These findings suggest differential associations between sociodemographic factors and OHRQoL when stratified according to dentate status.

The Association Between Cumulative Periodontal Disease and Stroke History in Older Adults

BACKGROUND

Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III).

METHODS

Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS I, based on the median percentage of sites with >/=2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with >/=3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders.

RESULTS

Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke.

CONCLUSIONS

Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.

Dental Health Differences by Social Class in Home-Dwelling Seniors of Barcelona, Spain

BACKGROUND

The aim of this study was to assess dental health differences by social class in home-dwelling seniors in Spain.

METHODS

A cross-sectional household survey of a cohort of senior residents in Barcelona (Spain) was undertaken. Of 891 survivors (72 years or older), 561 (62.9%) oral examinations were completed according to the DMF Index (Decayed, Missing and Filled teeth).

RESULTS

42% of participants were edentate. The individuals of social class IV-V were more likely to be edentate, and to have fewer than 15 teeth compared to those in social class I-II. The DMF Index in dentate individuals (Adjusted mean=16.4) also showed significantly worse dental health for lower social classes (p = 0.001).

CONCLUSIONS

The results of this study indicate a different level of utilization of dental health services and dental health by social class in home-dwelling seniors. Further research is needed to understand the barriers of access and social inequality.

Edentulism among Mexican adults aged 35 years and older and associated factors

We used National Performance Evaluation Survey data to estimate the prevalence and associated factors of edentulism among noninstitutionalized adults aged 35 years and older in Mexico. Statistically, the variables positively associated with edentulism were older age (odds ratio [OR]=1.08) and female gender (OR=1.79). Nonsmoking status (OR=0.70) and having a higher wealth index score (OR=0.72) were negatively associated. This information constitutes the first large-scale evaluation in Mexico for one of the World Health Organization's priority oral health problems.