Tooth loss, chewing ability and quality of life

Relationship between autoantibody associated with rheumatoid arthritis and tooth loss

INTRODUCTION

This study evaluated the relationship between serum Rheumatoid Factor (RF) levels and tooth loss in a community-dwelling elderly Japanese women. It was hypothesised that women with high baseline RF levels would experience greater tooth loss over 10 years than age-matched women with lower baseline serum RF levels.

MATERIALS AND METHODS

The study population consisted of 197 women aged 70 years with ≥12 teeth at baseline. One hundred and twenty-four participants completed a 10-year follow-up and were divided into 2 groups according to their baseline serum RF levels as follows: RF negative (<15 U/mL; n = 114) and RF positive (>15 U/mL; n = 10). Negative binomial regression was used to investigate the relationship between baseline RFs and tooth lost over the 10-year period. RF and its interaction with the baseline number of teeth were independent variables, with 9 other adjustment covariates.

RESULTS

Baseline RFs were significantly associated with tooth loss (P = .035). In addition, a statistical interaction between baseline RFs and baseline number of teeth was identified (P = .023), modifying the association between RFs and tooth loss. The adjusted incidence rate ratio (IRR) for RF-positive participants with 21 baseline teeth was 1.88 (95% confidence interval (95% CI): 0.76, 4.65). IRRs obtained for participants who had 25 baseline teeth (3.02; 95% CI: 1.03, 8.83) or 30 baseline teeth (5.47; 95% CI: 1.29, 23.13) suggested that RF-positive participants with a high number of baseline teeth would exhibit greater tooth loss than RF-negative participants.

CONCLUSION

High serum RF levels were associated with a greater IRR for future tooth loss in elderly Japanese women.

Masticatory efficiency in patients with partially dentate dentitions

OBJECTIVES

To assess associations amongst masticatory performance, dental functional status, and perceived chewing problems with common soft and hard foods.

MATERIALS AND METHODS

387 adult participants with reduced natural dentitions were included and underwent an oral examination, completed a written structured questionnaire and performed a two-color chewing gum test for masticatory efficiency. A multivariate regression model was used to analyze associations between masticatory efficiency and a number of dental conditions, with age, gender and perceived chewing difficulties as background variables. Likelihood ratios were calculated to analyze the relationship between masticatory efficiency and dental conditions within a validated hierarchical dental functional classification system expressed by (1) number of teeth in upper and lower jaw, (2) completeness of anterior regions, (3) number of premolar occluding pairs, and (4) number of molar occluding pairs.

RESULTS

The regression model showed a significant positive association between unmixed ratio and self-reported problems with chewing (p = .004), and age (p < 0.001), and negative associations with having a sufficient premolar region (p < 0.001). In the hierarchical dental functional classification system, the likelihoods of having a high unmixed ratio and chewing problems with hard foods were highest for the predictor 'less than 10 teeth in each jaw' (LRs 4.01, respectively 13.06).

CONCLUSIONS

In partially dentates people, perceived chewing difficulties were associated with lower objective masticatory efficiency. Having fewer than 10 teeth in each jaw and having an impaired premolar region were best predictors for low masticatory efficiency.

CLINICAL SIGNIFICANCE

This study shows that having fewer than 10 teeth in each jaw and having an impaired premolar region are associated with low masticatory efficiency and chewing problems. Preservation of at least 10 teeth in each jaw and 3 to 4 premolars is important for preventing chewing difficulties.

Mechanical adaptation of trabecular bone morphology in the mammalian mandible

Alveolar bone, together with the underlying trabecular bone, fulfils an important role in providing structural support against masticatory forces. Diseases such as osteoporosis or periodontitis cause alveolar bone resorption which weakens this structural support and is a major cause of tooth loss. However, the functional relationship between alveolar bone remodelling within the molar region and masticatory forces is not well understood. This study investigated this relationship by comparing mammalian species with different diets and functional loading (Felis catus, Cercocebus atys, Homo sapiens, Sus scrofa, Oryctolagus cuniculus, Ovis aries). We performed histomorphometric analyses of trabecular bone morphology (bone volume fraction, trabecular thickness and trabecular spacing) and quantified the variation of bone and tooth root volumes along the tooth row. A principal component analysis and non-parametric MANOVA showed statistically significant differences in trabecular bone morphology between species with contrasting functional loading, but these differences were not seen in sub-adult specimens. Our results support a strong, but complex link between masticatory function and trabecular bone morphology. Further understanding of a potential functional relationship could aid the diagnosis and treatment of mandibular diseases causing alveolar bone resorption, and guide the design and evaluation of dental implants.

Oral Health-Related Quality of Life and Associated Factors in Brazilian Adolescents

This study aimed to assess the impact of oral health on the quality of life of adolescents. A cross-sectional study was performed with students from public and private schools from Passo Fundo, Brazil. All students were aged between 15 and 19 years old. The proportional random sample consisted of 736 adolescents from 20 schools. A structured questionnaire was applied, and an oral examination was performed, counting the number of teeth. Oral health-related quality of life was assessed by OHIP-14. Associations between quality of life and associated factors were analyzed. The mean OHIP-14 score was 7.25. Age, ethnicity and studying in a public school were associated to the OHIP-14 score. Tooth loss (p=0.79) was not associated with quality of life. Additionally, questions related to appearance, such as whether teeth appearance bothers the adolescent (p=0.68) were not associated with quality of life. Attending a public school (OR=1.63; CI95%: 0.98-2.70) and self-reported halitosis (OR=1.48; CI95%: 1.01-2.16) were strongly associated to higher impact on quality of life. It was concluded that socioeconomic conditions and halitosis were associated to higher impact on quality of life of adolescents.

Associations among Obesity, Eating Speed, and Oral Health

OBJECTIVE

This study was conducted to understand how eating speed and oral health condition are associated with obesity in Japanese working men.

METHODS

We studied a total of 863 men attending an annual medical checkup of the Japanese Maritime Self Defense Force in Sasebo City, Japan. Participants answered a questionnaire about their eating speed, and we examined their anthropometric status in terms of BMI, waist circumference, and oral health condition, especially periodontal disease and number of functional teeth. Multivariate logistic regression analyses adjusting for potential confounding variables were performed.

RESULTS

The multivariate-adjusted odds ratio for waist circumference greater than 90 cm of the 'very fast' group compared to the 'slow, very slow' group was 5.22 (95% confidence interval 1.81-15.06) after adjusting for potential confounding factors. Individuals were more likely to have waist circumference greater than 90 cm if they had a larger 'number of missing functional teeth' (odds ratio 1.14; 95% confidence interval 1.01-1.28) and severe periodontal disease (odds ratio 2.74; 95% confidence interval, 1.46-5.13).

CONCLUSION

Eating speed, the number of missing functional teeth, and severe periodontal disease are associated independently with larger waist circumference.

Practicing Dentists' Self-Efficacy and Associated Factors in Managing the Treatment of Adults with Mental and Physical Disabilities: An Exploratory Cross-Sectional Study in Riyadh, Saudi Arabia

Background: Provision of oral healthcare to adults with mental and physical disabilities (AMPD) remains a challenging area across various healthcare systems. The present study aimed to assess self-reported efficacy and investigate factors associated with self-efficacy in the management of AMPD among practicing dentists in Saudi Arabia. Methods: A pilot-tested, self-administered questionnaire was distributed to a convenience sample of 1000 dentists. Descriptive and inferential analyses were performed on the collected responses. Results: Among the respondents (54%), 43% were males. Only 14% described their self-efficacy in managing AMPD as "High". Multivariable regression analyses revealed significant associations between "High" self-efficacy and male gender (Odd ratio (OR) = 2.39, 95% CI = 1.16-4.89), experience practicing dentistry for 11 years or more (OR = 2.19, 95% CI = 1.04-4.47), specialization in pediatric dentistry (OR = 3.98, 95% CI = 1.31-12.07), previous experience in managing AMPD (OR = 4.23, 95% CI = 1.59-11.22), and awareness of regulations for managing AMPD (OR = 2.62, 95% CI = 1.42-4.38). The interaction of gender x age was significantly associated (p = 0.028) with "High" self-efficacy. Gender-stratified analyses revealed a significant association between age and "High" self-efficacy among male dentists only. Conclusions: The findings of the present study highlight that a large percentage of dentists reported "Low/Moderate" self-efficacy in managing AMPD, particularly among female dentists. However, further studies are required to verify the factors associated with self-efficacy in the present study, and to identify other factors that may influence self-efficacy in managing AMPD.

Using Electromagnetic Articulography to Measure Denture Micromovement during Chewing with and without Denture Adhesive

Purpose

To study the effects of denture adhesive upon denture micromovements in three dimensions during the chewing of hard, sticky, and tough food items observed using a novel method involving an electromagnetic articulograph (EMA) speech research system.

Materials and Methods

Ten volunteers (mean age 60.9 ± 10.4 years) with fair‐ or poor‐fitting complete maxillary dentures were enrolled. Chewing experiments were conducted using two treatments (adhesive or no‐adhesive control) and three foods: carrots (hard), raisins (sticky), and processed meat stick (tough). Denture micromovement was measured through a novel application of a Northern Digital Wave EMA System. Three‐dimensional denture position was captured during mastication using three sensors embedded into a replica denture for each subject. Following individual characterization of a “home” reference position, the Euclidean Distances from Home (DfH) were calculated for each recorded sample of the chewing experiments. The DfH at each sample represented the denture movement for that 1/100th of a second of the activity. The DfH data were then summarized as the mean DfH, the maximum DfH, and total distance traveled by the denture. Several thresholds were also analyzed, including the percent of time that the DfH ≥1.5 mm, ≥2.0 mm, and ≥2.5 mm.

Results

With adhesive treatment, the mean DfH of dentures during chewing was reduced by 26.8% for carrot, 30.3% for raisin, and 31.0% for meat stick, when compared with no‐adhesive treatment (p < 0.001 for all comparisons). Similar results were also seen for the maximum DfH and total distance travelled endpoints across foods. For the threshold endpoints, adhesive treatment was associated with a statistically significant reduction in denture micromovements at all three thresholds across foods. At the threshold of DfH ≥ 1.5 mm, adhesive treatment was associated with a reduction in micromovement by 61.6%, 56.2%, and 70.0% with carrot, raisin, and meat stick, respectively (p ≤ 0.004 for all comparisons).

Conclusions

Observations of denture movement using the Wave EMA System were able to differentiate systematically between adhesive treatment and no‐adhesive treatment for denture micromovements during different chewing challenges. Use of adhesive was associated with statistically significant reductions in denture micromovements for hard, sticky, and tough foods as measured with both distance and threshold endpoints.

Trends in the incidence of tooth extraction due to periodontal disease: results of a 12-year longitudinal cohort study in South Korea

Purpose

This study evaluated trends in tooth extraction due to acute and chronic periodontal disease (PD) using data from the National Health Insurance Service-National Sample Cohort for 2002–2013.

Methods

A random sample of 1,025,340 individuals was selected as a representative sample of the population, and a database (DB) of diagnostic and prescription codes was followed up for 12 years. We used multivariate logistic regression analysis to assess the incidence of total extraction (TE), extraction due to periodontal disease (EPD), and immediate extraction due to periodontal disease (IEPD) according to sociodemographic factors (sex, age, household income, health status, and area of residence).

Results

The incidence of tooth extraction was found to be increasing, and at a higher rate for TE in PD patients. In 2002, 50.6% of cases of TE were caused by PD, and this increased to 70.8% in 2013, while the number of cases of IEPD increased from 42.8% to 54.9% over the same period. The incidence rates of extraction due to acute and chronic PD increased monotonically. We found that the incidence rates of TE, EPD, and IEPD were all 2-fold higher among patients with high income levels and those who were not beneficiaries of health insurance.

Conclusions

The rates of TE, EPD, and IEPD have been steadily increasing despite dental healthcare policies to expand public health insurance coverage, increasing the accessibility of dental clinics. Moreover, the effects of these policies were found to vary with both income and education levels. Consistent patient follow-up is required to observe changes in trends regarding tooth extraction according to changes in dental healthcare policies, and meticulous studies of such changes will ensure optimal policy reviews and revisions.

Impact of Removable Partial Dental Prostheses on the Oral Health-Related Quality of Life of a South African Cohort with Varied Distributions of Missing Posterior Teeth

PURPOSE

To determine the impact of removable partial dental prostheses on satisfying the daily functioning and quality of life (QoL) of adult patients with different distributions of missing posterior teeth.

MATERIALS AND METHODS

A cross-sectional interventional study was carried out on 80 patients having variously distributed posteriorly shortened and interrupted arches. Treatment comprised provision of partial dentures by senior dental students, supervised by senior clinical teachers who had knowledge of the potential benefits of the shortened dental arch (SDA) concept. The Oral Impacts on Daily Performance Index was completed before and 6 months after prosthetic treatment across groups comprising Kennedy Classes I, II, and III arches. Analysis included descriptive statistics and associations and comparisons between variables.

RESULTS

Mean age of patients was 57.4 years (SD = 13.1), many were retired (72.2%), and a majority were females (60%). Most patients lived in urban areas (95%), and were largely unemployed (63.3%). At pretreatment, only 31.3% of patients reported having good dental health and satisfaction with their current oral state, while 82.5% said they had a great need for treatment. The negative oral impacts that were most frequently experienced were those of eating (67.5%), smiling (50%), and being emotionally disturbed (63.8%). Post-treatment, 76.3% indicated good oral health and satisfaction with no significant differences between the 3 Kennedy groups. Any further negative impacts were reported mostly for Kennedy Classes I and II.

CONCLUSIONS

Overall, significant reductions of negative impacts were observed following treatment with dentures, across the 3 Kennedy groups, with respect to improved function, satisfaction, and oral health-related QoL. The findings confirm the reliance by partially dentate patients in all 3 Kennedy groups on dentures for improved oral health, although the possible benefits of the SDA concept as an alternative treatment option was not specifically explored.

Restorative treatment for initial, cavitated and gross coronal carious lesions

BACKGROUND

Treatment patterns for caries have been shown to reflect high rates of restorative services. The objective of this study was to investigate types of restorative treatment provided to patients with a main diagnosis of coronal caries in relation to the severity of the caries lesion.

METHODS

A random sample of Australian dentists was surveyed by mailed questionnaires in 2009-2010 (response rate 67%). Data on types of restorative treatment, patient characteristics and main diagnosis were collected from a service log.

RESULTS

Models of service rates adjusted for age, gender, insurance status and reason for visit showed that compared to the reference category of initial caries lesions, there were lower rates [Rate Ratio, 95% CI] of adhesive anterior restorative services [0.57, 0.34-0.95] and lower rates of adhesive posterior restorations [0.56, 0.40-0.79] for gross lesions.

CONCLUSIONS

Treatment of coronal caries was characterized by high rates of adhesive posterior restorative services, but gross lesions had lower rates of both anterior and posterior adhesive restorations. Types of restorative treatment for coronal caries were similar between initial and cavitated lesions. This could indicate scope for the adoption of more minimum intervention approaches to the management of initial carious lesions.

Dentition status and frailty in community-dwelling older adults: A 5-year prospective cohort study

AIM

To examine the longitudinal association between dentition status and incidence of frailty in older adults.

METHODS

The present prospective cohort study included community-dwelling Japanese adults aged 75 years at baseline (n = 322). Dental examinations, biochemical blood examinations, physical performance and anthropometric measurements, and structured questionnaires were carried out at baseline. The presence of ≥20 teeth with nine or more occluding pairs of teeth was defined as functional dentition. Annual follow-up examinations, including physical performance, anthropometric measurements and structured questionnaires, were carried out over a 5-year period to determine the incidence of frailty, defined as three or more of the following five components derived from the Cardiovascular Health Study: weight loss, weakness, slowness, poor energy and low physical activity level. Adjusted hazard ratios of frailty incidence according to dentition status were calculated from Cox proportional hazards regression analyses.

RESULTS

At baseline, 118 participants (36.6%) were defined as having functional dentition. During the follow up, 48 participants (14.9%) developed frailty. The adjusted hazard ratio for frailty in participants with functional dentition was 0.50 (95% confidence interval 0.25-0.98) compared with participants without functional dentition, after adjusting for sex, income, education, smoking status, body mass index, serum biomarkers and comorbidities.

CONCLUSIONS

Functional dentition was significantly associated with a lower risk of frailty defined by the Cardiovascular Health Study frailty index in older Japanese adults. These results suggest that maintaining healthy and functional dentition into later life is important for frailty prevention. Geriatr Gerontol Int 2018; 18: 256-262.

Influence of functional dentition on satisfaction with oral health and impacts on daily performance among Brazilian adults: a population-based cross-sectional study

BACKGROUND

Dental esthetics, chewing and speech should be preserved in a dentition denominated functional and are closely related to satisfaction with oral health (SOH), impacts caused by oral problems and have a possible association with Oral Health-Related Quality of Life. Thus, the purpose of the present study was to investigate the influence of different concepts of functional dentition (FD) on both SOH and impacts on daily performance (IDP) among Brazilian adults.

METHODS

A cross-sectional study was conducted with 9564 adults (35-44 years). SOH and IDP were evaluated using the Oral Impacts on Daily Performance (OIDP) questionnaire. FD was considered based on four different definitions: I-classification of the World Health Organization (FDWHO = ≥20 teeth); II-well-distributed teeth (WDT = ≥10 teeth in each arch); III-classified by esthetics and occlusion (FDClass5 = sequential presence of one tooth in each arch, ≥10 teeth in each arch, 12 anterior teeth, ≥three posterior occluding pairs [POPs] of premolars and ≥one POP molar bilaterally); and IV-classified by esthetics, occlusion and periodontal status (FDClass6 = FDClass5 plus all sextants with CPI ≤ 3 and/or CAL ≤ 1). The proportion of adults satisfied with oral health and without overall impact (OIDP = 0) was calculated for each definition of FD. Multiple Poisson regression models were adjusted by demographic-socioeconomic characteristics, self-reported oral problems and the use of dental services for each dependent variable.

RESULTS

When FDClass5 and FDClass6 were considered a greater proportion of adults reported being satisfied (52.1 and 53.1%, respectively) and have OIDP = 0 (52.4 and 53.3, respectively). In the multiple models, SOH was associated with FDClass5 (RP = 1.21) and FDClass6 (RP = 1.24) and OIDP = 0 was associated with WDT (RP = 1.14) and FDClass6 (RP = 1.21).

CONCLUSIONS

The greater influence of WDT, FDClass5 and FDClass6 on aspects related to quality of life in comparison to FDWHO demonstrates the need for the establishment of a broader definition of FD that encompasses subjective aspects.

Oral Health Related Quality of Life and Dental Status of Adult Patients

Background: The aim of this study was to assess the oral health-related quality of life in adult patients who visit the Dental Clinic of the Faculty of Stomatology, Pancevo, using a Serbian version of 14-items Oral Health Impact Profile (OHIP14) Questionnaire. Material and Methods: A total of 89 respondents (42 women and 47 men, mean age 52.83 ± 13.74 years) filled in the questionnaire themselves. Three calibrated dentists recorded the oral health status of the respondents (number of healthy, decayed, filled and missing teeth), the type and time of wearing prosthodontic replacements, if they existed, and assessed the need for prosthodontic treatment. The total OHIP-14 score was calculated by adding scores for all fourteen items; OHIP-14 subscale scores were calculated by adding the scores for the two items in each of the seven subscales. Results: Mean total OHIP score was 10.25 ± 8.89. Patients with less than eight extracted teeth, wearers of fixed prosthodontic appliances and patients without replacements who did not need prosthodontic treatment reported better oral health-related quality of life. The most severe oral impacts assessed by the subscale OHIP14 scores were recorded in psychological discomfort (2.44 ± 2.18), physical pain (1.87 ± 1.73) and psychological disability subscale (1.83 ± 1.88). Women more often than men were dissatisfied with their diet and had been irritable in contact with other people. Conclusion: Further studies using the OHIP14 questionnaire in a larger sample will permit identification of key factors related to poor oral health and planning of treatment protocols and preventive programs for the adult population in Serbia.

Oral Conditions and Health-Related Quality of Life: A Systematic Review

The objective of this study was to verify whether oral conditions (tooth loss, periodontal disease, dental caries) are negatively associated with health-related quality of life (HRQoL) in adults. A search was carried out on PubMed, EMBASE, Web of Science, Scopus, SciELO, and LILACS databases until the end of July 2016 with no date restrictions. Quantitative observational studies written in English were included and data extraction was performed independently by 2 reviewers. HRQoL was investigated as the outcome, and tooth loss, periodontal diseases, and dental caries were exposures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used and the quality of the selected studies was assessed by using the Joanna Briggs Institute Meta-Analysis of Statistics assessment and review instrument (JBI-MAStARI). Twenty-one studies were included. The sample sizes ranged from 88 to 15,501 subjects; 20 studies were cross-sectional designs, while 1 was a case-control study. Case definitions of the exposures were different across the studies, mainly for tooth loss, which was defined according to 11 different criteria. Fifteen studies were of “high” and 6 of “medium” quality. Eight HRQoL instruments were identified, and the most frequent was the EuroQol ( n = 8). Ten of 16 studies reported a negative impact of tooth loss on HRQoL. Four of 7 studies reported that periodontal disease impairs HRQoL, and 1 study showed that periodontal disease is positively associated with HRQoL. All studies that assessed dental caries reported a negative association between this condition and HRQoL. Despite the different definitions and measures of tooth loss and dental caries, the majority of the available evidence reported a negative impact of these conditions on HRQoL. Mixed and inconclusive findings were observed for the association between periodontal disease and HRQoL. Longitudinal prospective studies are suggested to improve the strength of the findings.

Tooth loss and general quality of life in dentate adults from Southern Brazil

PURPOSE

This study aimed to estimate the association between the number of teeth and general quality of life in adults.

METHODS

A population-based study was conducted with 1720 individuals aged 20-59 years residing in Florianópolis, Brazil, in 2009. Data were collected at participants' households using a structured questionnaire. In 2012, a second wave was undertaken with 1222 individuals. Oral examinations were performed for number of teeth, prevalence of functional dentition (≥21 natural teeth), and shortened dental arch (SDA), which were considered the main exposures. General quality of life was the outcome and was assessed with the WHO Abbreviated Instrument for Quality of Life (WHOQOL-BREF). Covariates included sociodemographic factors, health-related behaviors, and chronic diseases. Multivariable linear regression models were performed to test the associations between the main exposures and the outcome adjusted for covariates.

RESULTS

In 2012, 1222 individuals participated in the study (response rate = 71.1%). Having more teeth was associated with greater scores on physical domain of the WHOQOL-BREF [β = 0.24 (95% CI 0.01; 0.46)] after adjustment for covariates. Absence of functional dentition was associated with lower scores on the physical domain [β = -3.94 (95% CI -7.40; -0.48)] in the adjusted analysis. There was no association between both SDA definitions and the domains of general quality of life.

CONCLUSIONS

Oral health as measured by tooth loss was associated with negative impacts on general quality of life assessed by the WHOQOL-BREF. There was a lack of evidence that SDA is a condition that negatively affects general quality of life.

Impact of occlusal support and perceived chewing ability on oral health-related quality of life among patients attending a private dental institution in India

Purpose:

Presence of functional tooth units is essential for preserving masticatory function among individuals. Representing the essence of health promotion practice, demand to measure varied evaluation outcomes is highlighted.

Aim and Objectives:

(1) To assess the influence of occlusal support and perceived chewing ability on oral health-related quality of life (OHRQoL) among adults attending a private dental institution in Mangalore. (2) To evaluate occlusal support using Eichner index (EI), perceived chewing ability using a self-administered questionnaire and OHRQoL using Oral Health Impact Profile-14 (OHIP-14).

Materials and Methods:

Overall, 300 adults attending a private dental institution in Mangalore were included. EI was used to group participants into three groups. The chewing ability was assessed using a questionnaire on perceived difficulty while chewing eight common foods. OHRQoL was measured employing OHIP-14. Perceived general and oral health status and demographic information were collected.

Results:

The mean perceived chewing ability score was 12.98 ± 6.2 and the mean total OHIP score was 9.23 ± 8.9. EI showed a significant relation with perceived chewing ability, OHIP, and perceived general health status (P < 0.05). Perceived chewing ability and OHIP demonstrated a significant correlation (r = 0.31, P < 0.001). Age, gender, education, occupation, monthly income, family income, and number of family members demonstrated a significant association with EI (P < 0.05). Binary logistic regression analysis revealed that EI, perceived chewing ability, and perceived oral health emerged as significant predictors of OHRQoL (P < 0.05).

Conclusions:

Occlusal support was significantly associated with perceived chewing ability, OHRQoL, and perceived general health status.

Edentulism and associated factors among community-dwelling middle-aged and elderly adults in China

OBJECTIVE

To investigate the prevalence of self-reported edentulism and its associated risk factors among community-dwelling adults aged 45 years and older in China.

MATERIALS AND METHODS

Data from the national baseline survey (2011-2012) of the China Health and Retirement Longitudinal Study (CHARLS) were used for this study (N = 17 167). Bivariate and multivariate logistic regressions were conducted to assess the predictors of edentulism. Models 1 and 2 were based on the whole sample. Models 3 and 4 were based on the subsample (N = 9933) from whom anthropometric and blood biomarker data were available.

RESULTS

The prevalence of edentulism was 8.64% among Chinese adults aged 45 and above. As shown by Model 1, older age was a robust predictor for edentulism (odds ratio [OR] = 3.81 for people aged 55-64; OR = 11.22 for people aged 65-74; OR = 24.05 for people aged 75 and above). Other factors positively associated with edentulism included being female (OR = 1.25), rural residence (OR = 1.30), asthma (OR = 1.48), depression (OR = 1.20), reduced physical function (OR = 1.37) and current smoking status (OR = 1.36). People with higher educational levels (OR = 0.75 for people who can read and write; OR = 0.64 for people who obtained a junior high school education or above) and better-off economic status (OR = 0.80) were less likely to be edentate. The association between edentulism and age, educational level, economic status and physical function remained significant in Model 3, and in addition, being underweight appeared as another strong predictor (OR = 1.93).

CONCLUSIONS

The estimated prevalence of edentulism and the identified associated factors will provide epidemiologic evidence for future research and interventions in the target population in China.

Change in Quality of Life and Its Association with Oral Health and Other Factors in Community-Dwelling Elderly Adults-A Prospective Cohort Study

OBJECTIVES

To determine whether changes in oral health status were associated with decline in quality of life (QoL).

DESIGN

Prospective cohort study.

SETTING

Carlos Barbosa, southern Brazil.

PARTICIPANTS

A random sample of 872 community-dwelling individuals aged 60 and older was evaluated in 2004. The current study population consisted of 389 participants available for follow-up in 2012.

MEASURES

Change in QoL was assessed through the use of the short version of the World Health Organization QoL Assessment tool (WHOQOL-BREF) at baseline and follow-up. Each WHOQOL domain generates a score, with changes being calculated for each domain. Individuals with the same or higher scores at follow-up were categorized as having improved QoL, and those with lower scores were categorized as having a decline in QoL. Sociodemographic and health variables were assessed in an interview, and tooth loss, use of dental prostheses, and satisfaction with chewing ability and oral appearance were verified through oral examinations. Interviews and examinations were repeated. Risk ratios (RRs) relative to the outcome and independent variables were estimated using Poisson regression with a robust variance estimator.

RESULTS

Tooth loss was a risk factor for decline in the psychological domain of QoL (RR = 1.04, 95% confidence interval (CI) = 1.02-1.06). Improvement in satisfaction with chewing ability was a protective factor for decline in this same domain (RR = 0.69, 95% CI = 0.50-0.97). Greater satisfaction with oral appearance was a protective factor against decline in social (RR = 0.84, 95% CI = 0.72-0.98) and environmental (RR = 0.77, 95% CI = 0.61-0.97) domain scores.

CONCLUSION

Preventing tooth loss and recognizing and properly addressing concerns about chewing and dental appearance can affect the general well-being of community-dwelling elderly adults.

Retention of Teeth and Oral Health–Related Quality of Life

The authors aimed to critically review the literature regarding the relationship between retention of teeth and oral health–related quality of life (OHRQoL) and the extent to which tooth retention can ensure OHRQoL among adults. The authors investigated studies that assessed the relationship between number of teeth and OHRQoL and how the position, type, and/or pattern of the teeth is related to OHRQoL. Relevant papers published in English from January 2004 to September 2015 were searched via PubMed and EMBASE. Twenty-nine papers—including cross-sectional, longitudinal, clinical trial, and case-control studies—were included and categorized according to 4 subthemes to achieve the stated aim: 1) number of teeth or missing teeth and OHRQoL, 2) occluding pairs or functional units and OHRQoL, 3) position of remaining or missing teeth and OHRQoL, and 4) shortened dental arches (SDAs) and OHRQoL. The main findings for each subtheme were as follows: 1) A significant association between number of teeth and OHRQoL was shown in most studies; however, those studies found different cutoff points regarding the number of teeth that affect OHRQoL, after adjusting for other factors in the analyses (e.g., age, sex, cultural background, and study locations). 2) The number of occluding pairs and the location of remaining teeth have great impacts on OHRQoL. 3) Having fewer anterior occluding pairs had a greater negative impact on aesthetics and thus affected OHRQoL. 4) Two randomized clinical trials on SDAs indicated that people with SDAs do not show worse OHRQoL than do those with removable dentures. The only 2 population-based studies on SDAs showed that adults with SDAs have no impaired OHRQoL when compared with those having more natural teeth. To conclude, this review found evidence that retention of teeth is associated with better OHRQoL. The number of occluding pairs and the location of remaining teeth have great impacts on OHRQoL. People with SDAs maintain an acceptable level of OHRQoL.

Surveillance for Certain Health Behaviors, Chronic Diseases, and Conditions, Access to Health Care, and Use of Preventive Health Services Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States, 2012

PROBLEM

Chronic diseases (e.g., heart diseases, cancer, chronic lower respiratory disease, stroke, diabetes, and arthritis) and unintentional injuries are the leading causes of morbidity and mortality in the United States. Behavioral risk factors (e.g., tobacco use, poor diet, physical inactivity, excessive alcohol consumption, failure to use seat belts, and insufficient sleep) are linked to the leading causes of death. Modifying these behavioral risk factors and using preventive health services (e.g., cancer screenings and influenza and pneumococcal vaccination of adults aged ≥65 years) can substantially reduce morbidity and mortality in the U.S.

POPULATION

Continuous monitoring of these health-risk behaviors, chronic conditions, and use of preventive services are essential to the development of health promotion strategies, intervention programs, and health policies at the state, city, and county level.

REPORTING PERIOD

January-December 2012.

DESCRIPTION OF THE SYSTEM

The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services related to the leading causes of death and disability. This report presents results for all 50 states, the District of Columbia, participating U.S. territories that include the Commonwealth of Puerto Rico (Puerto Rico) and Guam, 187 Metropolitan/Micropolitan Statistical Areas (MMSAs), and 210 counties (n = 475,687 survey respondents) for the year 2012.

RESULTS

In 2012, the estimated prevalence of health-risk behaviors, chronic diseases or conditions, access to health care, and use of preventive health services substantially varied by state and territory, MMSA, and county. The following portion of the abstract lists a summary of results by selected BRFSS measures. Each set of proportions refers to the range of estimated prevalence for health-risk behaviors, chronic diseases or conditions, and use of preventive health care services among geographical units, as reported by survey respondents. Adults with good or better health: 64.0%-88.3% for states and territories, 62.7%-90.5% for MMSAs, and 68.1%-92.4% for counties. Adults aged 18-64 years with health care coverage: 64.2%-93.1% for states and territories, 35.4%- 93.7% for MMSAs, and 35.4%-96.7% for counties. Adults who received a routine physical checkup during the preceding 12 months: 55.7%-80.1% for states and territories, 50.6%-85.0% for MMSAs, and 52.4%-85.0% for counties. An influenza vaccination received during the preceding 12 months among adults aged ≥65 years: 26.3%-70.1% for states and territories, 20.8%-77.8% for MMSAs, and 24.1%-77.6% for counties. Ever received pneumococcal vaccination among adults aged ≥65 years: 22.2%-76.2% for states and territories, 15.3%-83.4% for MMSAs, and 25.8%-85.2% for counties. Adults who had a dental visit in the past year: 53.7%-76.2% for states and territories, and 44.8%-81.7% for MMSAs and counties. Adults aged ≥65 years who have lost all of their natural teeth from tooth decay or gum disease: 7.0%-33.7% for states and territories, 5.8%-39.6% for MMSAs, and 5.8%-37.1% for counties. Adults aged 50-75 years who received a colorectal cancer screening on the basis of the U.S. Preventive Services Task Force recommendation: 40.0%-76.4% for states and territories, 47.1%-80.7% for MMSAs, and 47.0%-81.0% for counties. Women aged 21-65 years who had a Papanicolaou test during the preceding 3 years: 68.5% to 89.6% for states and territories, 70.3% to 92.8% for MMSAs, and 65.7%-94.6% for counties. Women aged 50-74 years who had a mammogram during the preceding 2 years: 66.5%- 89.7% for states and territories, 61.1%-91.5% for MMSAs, and 61.8%-91.6% for counties. Current cigarette smoking among adults: 10.6%-28.3% for states and territories, 5.1%-30.1% for MMSAs, and 5.1%-28.3% for counties. Binge drinking among adults during the preceding month: 10.2%-25.2% for states and territories, 6.2%-28.1% for MMSAs, and 6.2%-29.5% for counties. Heavy drinking among adults during the preceding month: 3.5%-8.5% for states and territories, 2.0%-11.0% for MMSAs, and 1.9%-11.0% for counties. Adults who reported no leisure-time physical activity: 16.3%-42.4% for states and territories, 9.2%-47.3% for MMSAs, and 9.2%-39.0% for counties. Self- reported seat belt use: 62.0%-93.7% for states and territories, 54.1%-97.1% for MMSAs, and 50.1%-97.4% for counties. Adults who were obese: 20.5%-34.7% for states and territories, 14.8%-44.5% for MMSAs and counties. Adults with diagnosed diabetes: 7.0%-16.4% for states and territories, 3.4%-17.4% for MMSAs, and 3.1%-17.4% for counties. Adults who ever had any type of cancer: 3.0%-13.7% for states and territories, 3.8%-19.2% for MMSAs, and 4.5%-19.2% for counties. Adults with current asthma: 5.8%-11.1% for states and territories, 3.1%-15.0% for MMSAs, and 3.1%-15.7% for counties. Adults with some form of arthritis: 15.6%-36.4% for states and territories, 16.8%-45.8% for MMSAs, and 14.8%-35.9% for counties. Adults having had a depressive disorder: 9.0%-23.5% for states and territories, 9.2%-28.3% for MMSAs, and 8.5%-28.4% for counties. Adults aged ≥45 years who have had coronary heart disease: 7.4%-19.0% for states and territories, 6.1%-23.3% for MMSAs, and 6.1%-20.6% for counties. Adults aged ≥45 years who have had a stroke: 3.1%-7.3% for states and territories, 2.1%-9.3% for MMSAs, and 1.5%-9.3% for counties. Adults with limited activities because of physical, mental, or emotional problems: 15.0%-28.6% for states and territories, 12.0%-31.7% for MMSAs, and 11.3%-31.7% for counties. Adults using special equipment because of any health problem: 4.8%-11.6% for states and territories, 4.0%-14.7% for MMSAs, and 2.8%-13.6% for counties.

INTERPRETATION

This report underscores the need for continuous surveillance of health-risk behaviors, chronic diseases or conditions, health care access, and use of preventive care services at state and local levels. It will help to identify high-risk populations and to evaluate public health intervention programs and policies designed to reduce morbidity and mortality from chronic disease and injury.

PUBLIC HEALTH ACTION

State and local health departments and agencies can continue to use BRFSS data to identify populations at high risk for unhealthy behaviors and chronic diseases or conditions, lack of health care access, and inadequate use of preventive care services. Additionally, states can use the data to design, implement, monitor, and evaluate public health programs and policies at state and local levels.

Psychometric properties of the Albanian version of chewing-function questionnaire CFQ-ALB

Background

The new Chewing Function Questionnaire (CFQ) was lately developed in Croatia to measure the chewing ability in prosthodontic patients, as a one-dimensional instrument consisting of 10-items. Therefore, the objective of this study was to develop an Albanian version of the CFQ questionnaire and to test its psychometric properties in a new typical environment among the Kosovo population.

Materials and methods

The original version of CFQ questionnaire was translated and cross-culturally adapted from the English language into Albanian in accordance with international guidelines. Its validity (construct, convergent and discriminative) and internal consistency (reliability) were tested in 205 participants. Test-retest reliability was evaluated in 61 subjects with natural teeth, and responsiveness was evaluated in 51 prosthodontic patients with treatment needs.

Results

Internal consistency of CFQ-ALB indicated excellent agreement, with Cronbach’s alpha values of 0.974 and average inter-item correlation of 0.792. Intraclass correlation coeficinets for test-retest were found without significant differences by 95 % of confidence intervals (p > 0.05). Construct validity was supported by a single factor that accounted for 81.711 % of the variance observed. Convergent validity was supported by the association between self-reported general satisfactions with chewing and CFQ summary scores. Discriminat validity was supported as statistically significant differences were observed between pre-defined groups. Responsiveness was confirmed by the significant difference between baseline summary scores and the after treatment scores; the mean change was 15.57 (SD =2.49) (p < 0.001).

Conclusion

The obtained results suggest excellent psychometric properties of the CFQ-ALB questionnaire for determining chewing function in the Republic of Kosovo.

Pilot Study on the Influence of Nutritional Counselling and Implant Therapy on the Nutritional Status in Dentally Compromised Patients

Objectives

To investigate the impact of implant-prosthetic rehabilitation combined with nutritional counseling on the nutritional status of patients with severely reduced dentitions.

Design

An explorative intervention study including an intra-individual comparison of 20 patients with severely reduced dentitions in terms of nutrition- and quality of life-related parameters recorded at baseline and at six and twelve months after implant-prosthetic rehabilitation.

Participants

Twenty patients from the Department of Prosthetic Dentistry of Justus-Liebig University of Giessen, with an mean age of 63 years, who had fewer than ten pairs of antagonists.

Measurements

The baseline data collection included dental status, a chewing ability test, laboratory parameters, anthropometric data (body mass index), energy supply, a 3-day dietary record, an analysis of the oral health-related quality of life (OHRQoL) with the OHIP-G14, the Mini-Mental Status (MMS) and Mini Nutritional Assessment (MNA). Six months after implantation and prosthetic rehabilitation, individual nutritional counseling was performed by a dietician. Data were again collected and analyzed. A final follow-up was conducted 12 months after prosthetic rehabilitation.

Results

Despite the highly significant improvement in masticatory ability and OHRQoL after implant-prosthetic rehabilitation, no significant changes were observed regarding MNA, anthropometric data or energy supply. Except for cholinesterase (p = 0.012), ferritin (p = 0.003), folic acid (p = 0.019) and vitamin A (p = 0.004), no laboratory parameter changed significantly during the investigation period. In addition, no general significant differences were observed for nutrient intake or food choice.

Conclusion

The present study does not confirm the assumption that the implant-prosthetic rehabilitation of patients with severely reduced residual dentitions with or without an individual nutritional counseling influences nutritional status.

Associations between falls and general health, nutrition, dental health and medication use in Swedish home-dwelling people aged 75 years and over

The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥ 75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34-1.95), poor dental health (aOR: 1.22; CI: 1.07-1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03-1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04-1.46) or living in a house (aOR: 1.28; CI: 1.02-1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11-1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls.

Dental pain related to quality of life and mental health in South Korean adults

High levels of stress, anxiety and depression have been reported in patients with orofacial pain. Dental pain has the potential to reduce quality of life (QOL), and pain relief is important aspect of QOL. The purpose of this study was to assess the relationships of dental pain with QOL and mental health using a nationally representative, population-based study. This study analyzed data from the 2012 Korea National Health and Nutrition Examination Survey (N = 5469). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Health-related QOL (HRQOL) was evaluated using EQ-5D and EQ-VAS, and mental health was evaluated by questionnaires. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Among 5469 adults, 1992 (36.42%) presented self-reported dental pain. Participants with anxiety/depression or pain/discomfort, and participants with stress, melancholy, suicidal thought or depression showed significantly higher prevalence of dental pain. After adjusting for covariates, five aspects of QOL and five aspects of mental health were related with dental pain. The AORs (95% CI) for dental pain were 1.39 (1.06-1.81) for mobility, 1.77 (1.19-2.63) for self-care, 1.38 (1.02-1.85) for usual activities, 1.73 (1.43-2.09) for pain/discomfort and 1.50 (1.13-1.98) for anxiety/depression. For mental health status factors, the AORs (95% CI) for dental pain were 1.29 (1.11-1.51) for stress, 1.37 (1.09-1.74) for melancholy, 1.26 (1.01-1.58) for suicidal thoughts, 1.43 (.93-2.19) for consultation to psychiatrist and 1.53 (1.07-2.19) for depression. This study showed that dental pain has an association with lower HRQOL and worse mental health status in South Korean adults.

Relationship Between Self-Rated Masticatory Ability and Independent Life in Community-Dwelling Older Adults

Objective: The aim of the present study was to elucidate the influence of self-rated masticatory ability on independent living in community-dwelling older adults. Method: A total of 1,377 subjects aged 65 and over who lived in Kumamoto City, Japan were participated in a survey to investigate critical factors for self-reliance in older adults. In this study, we defined independent life in older adults as self-perceived adequate health without long-term care certification. Logistic regression analysis was used to assess self-perceived masticatory ability in relation to the independent life. Results: The population with adequate self-rated masticatory ability included a significantly higher proportion of subjects with good self-perceived health without long-term care (72.7%) than the remaining subjects (27.3%). A logistic regression analysis revealed that there was significant relationship between subjective adequate mastication and living a self-reliant healthy life (p < .001). Conclusion: Our results showed that satisfactory masticatory function was positively related to a self-reliant life with subjective healthy conditions in community-dwelling older adults, which was associated with an extended active life expectancy.

Dental Implant Supported Restorations Improve Quality of Life in Osteoporotic Women

Introduction. The aim of this study is to compare the quality of life (QoL) in partially edentulous osteoporotic women who have missing teeth restored with dental implant retained restorations with those who do not and, secondarily, to report the rate of osteonecrosis in this sample. Methods. 237 participants completed the Utian QoL survey, a 23-question document measuring across psychosocial domains of well-being including occupational, health, emotional, and sexual domains which together contribute to an overall score. The subset of participants having dental implant supported prosthesis (64) was compared to the subset having nonimplant supported fixed restorations (47), the subset having nonimplant supported removable restorations (60), and the subset having no restoration of missing teeth (66). Results. ANOVA showed significant difference in all QoL domains between the four subsets (p < 0.05). Although 134 reported oral bisphosphonate and 51 reported IV bisphosphonate use, no signs of ONJ were identified in any participants. Conclusion. These findings show implant retained oral rehabilitation has a statistically significant impact over nonimplant and traditional fixed restorations, removable restorations, and no restoration of missing teeth in far reaching areas including occupational, health, emotional, sexual, and overall QoL. These findings also support future examination of psychosocial outcomes associated with oral rehabilitation and the incorporation of oral health into women's health promotion.

Factors related to number of present teeth in Korean elderly adults aged 55-84 years

OBJECTIVES

The aim of this study was to determine the associations between the number of present teeth (NT) and socio-economic, demographic and oral health behavioural factors among Korean adults aged 55-84 years.

METHODS

The total subjects comprised 3767 individuals who were examined and who answered the questions on socio-economic status and oral health behaviour from the fourth Korean National Health and Nutrition Examination Survey conducted from 2007 to 2009. The dependent variable was NT, with binary status divided by the median. Socio-economic and demographic factors included gender, educational level, parent's educational levels, region of residence, household income, type of health insurance and mother's economic activity. Oral health behaviours were as follows: daily toothbrushing frequency, smoking status, recent dental visit and illegal dental treatment. Multivariate logistic regression models were applied to explain the associations between NT and other variables.

RESULTS

In a model adjusted by socio-economic, demographic and oral health behavioural variables, subjects who lived in urban areas were more likely to have larger NT compared to those in suburban areas (OR: 1.22, P = 0.025). Males were more likely to have larger NT (OR: 1.90, P < 0.001), and daily toothbrushing frequency was associated with NT (OR = 1.25, P = 0.023). Non-smokers (OR: 2.44, P < 0.001) and past smokers (OR: 1.70, P < 0.001) were more likely to have lager NT compared to current smokers. Subjects without illegal dental treatments were more likely to have lager NT compared to those with illegal dental treatments (OR = 2.21, P < 0.001).

CONCLUSIONS

Interventions aiming to preserve present teeth in elderly adults should consider socio-economic, demographic and oral health behavioural factors.

Oral health equity and unmet dental care needs in a population-based sample: findings from the Survey of the Health of Wisconsin

OBJECTIVES

We used objective oral health screening and survey data to explore individual-, psychosocial-, and community-level predictors of oral health status in a statewide population of adults.

METHODS

We examined oral health status in a sample of 1453 adult Wisconsin residents who participated in the Survey of the Health of Wisconsin Oral Health Screening project, conducted with the Wisconsin Department of Health Services during 2010.

RESULTS

We found significant disparities in oral health status across all individual-, psychosocial-, and community-level predictors. More than 15% of participants had untreated cavities, and 20% did not receive needed oral health care. Individuals who self-reported unmet need for dental care were 4 times as likely to have untreated cavities as were those who did not report such a need, after controlling for sociodemographic and behavioral factors.

CONCLUSIONS

Our results suggested that costs were a primary predictor of access to care and poor oral health status. The results underscored the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers (e.g., the costs associated with unmet dental care) and promoting preventive health behaviors (e.g., teeth brushing).

Dental status and self-assessed chewing ability in 70- and 80-year-old subjects in Sweden

The objective was to compare two cohorts of elderly people, 70 and 80 years old, with respect to dental status and self-assessed chewing ability. The hypotheses were as follows: (i) dental status is associated with self-assessed chewing ability; (ii) chewing ability is poorer among the 80- than the 70-year-old subjects. Identical questionnaires were in 2012 sent to all subjects born in 1942 and 1932, living in two Swedish counties. The response rate was 70.1% resulting in samples of 5697 70- and 2922 80-year-old subjects. Answers to questions on self-assessed chewing ability, dental status and some other factors have been analysed. Dental status varied but was in general good; 72% of the 70- and 60% of the 80-year-old subjects reported that they had all or only few missing teeth. Rate of edentulism was 3% and 7%, respectively. Removable partial dentures were reported by 6% and 10%, respectively, implant treatment by 13% in both cohorts. Self-assessed chewing ability was mostly good and correlated with the number of teeth (Spearman rho = 0.46). A majority of the edentulous subjects assessed their chewing ability as very or fairly good. Logistic regression showed that self-assessed chewing ability was significantly associated with a number of dental variables but also with general health. In conclusion, dental status was relatively good at both ages but somewhat poorer in the older cohort. Dental status, some other dental variables and being healthy were in both age groups significantly associated with self-assessed chewing ability.

Oral health among the elderly in 7 Latin American and Caribbean cities, 1999-2000: a cross-sectional study

BACKGROUND

To describe the prevalence of missing teeth, use of bridges and dentures and unmet dental needs among those aged 60 years and above. The associations of these conditions with socio-demographics, type 2 diabetes mellitus and depression were also studied. The work was carried out in 7 Latin American and Caribbean (LAC) cities in 1999-2000.

METHODS

A secondary analysis was conducted on the Survey of Health and Well-Being of Elders (SABE) dataset. The 7 cities were Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. This survey did not employ any oral examinations. Descriptive statistics, chi-square and regression analysis were used to test for associations.

RESULTS

Data for 10 902 persons were analyzed. Females made up 62% of the population. Across the SABE population, between 93.7% (Mexico City) to 99.9% (Santiago) reported missing teeth, with an average of 97.5%. Of those with missing teeth, between 55.1% (Mexico City) and 82.4% (São Paulo) reported having bridges or dentures, with an average of 70.1% across all SABE cities. The proportion of the SABE population with 'unmet dental needs' ranged from 85.8% (Santiago) to 98.4% (Havana), with an average of 94.5%. Bridgetown, São Paulo and Mexico City demonstrated a statistically significant association between aging and tooth loss. Generally a greater proportion of females (97.6%) reported tooth loss compared with males (96.8%), but in only São Paulo and Montevideo was there a statistically significant association between sex and tooth loss. Generally those with higher education reported less tooth loss, primary education (97.6% had tooth loss), secondary (96.8%) and tertiary (94.7%). All the SABE cities except Buenos Aires demonstrated a statistically significant association between tooth loss and education.

CONCLUSIONS

The prevalence of missing teeth, use of bridges and dentures and unmet dental needs were high in the SABE cities in 1999-2000. In general across the SABE cities, the elderly with the most missing teeth were less educated or less likely to be a professional. They tended to be not working and were receiving a pension. Additionally they were less likely to report their health as 'excellent', were diabetic and were more likely to give responses suggestive of depression.

Edentulism and quality of life among older Ghanaian adults

Background

Edentulism affects the quality of life and general health of an individual. But in ageing individuals, it has been observed to have greater impact, manifesting in functional, psychological and social limitations. With an increasing older adult population in Ghana, its burden is likely to increase. This study was thus carried out to explore the association between edentulism and quality of life among older Ghanaian adults.

Methods

Secondary analysis of WHO’s Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Participants included a nationally representative sample of adult’s aged 50 years and older living in Ghana. Quality of life was measured using the 8 item WHOQOL measure and a single item measure which was a question “How would you rate your overall quality of life?”. To assess the association between edentulism and the independent variables, a bivariate analysis was carried out. A Poisson regression model was then performed, adjusting for age, sex, income, education and the diagnosis of a chronic disease condition. A Spearman’s correlation analysis was also carried out between the single and multi item measure of quality of life to assess how well they correlate.

Results

Edentulism was observed to be associated with significantly lower levels of SWB among older adults using both the single-item and multiple-item measure (WHOQOL). It, however, showed no association with happiness. Among edentulous respondents, females and those with no formal education reported significantly lower quality of life. The WHOQOL correlated positively and strongly with the single-item measure.

Conclusion

Edentulism may not be life threatening and yet it has been shown to have a negative effect on the quality of life of older adult Ghanaians. More emphasis may thus need to be placed on the oral health of the aging population in Ghana to avoid it.

Oral health impacts on self-rated general and oral health in a cross-sectional study of working age adults

OBJECTIVES

The aims were to assess the joint effects of oral health and general health functional problems on self-ratings of general and oral health among adults.

METHODS

Data were collected from adults aged 30-61 years in Australia by mailed survey in 2009-2010. Self-rated health of 'very good/excellent' was analysed by oral health impact (OHIP-14) and number of health problems (EQ-5D) controlling for socio-demographics.

RESULTS

Responses were collected from n = 1093 persons (response rate = 39.1%). General health self-ratings were higher in the high-income group (prevalence ratio [PR] = 1.06, 1.00-1.12) but lower for those with a higher number of health problems (PR = 0.84, 0.76-0.93). The interaction of health problems with oral health impact indicated that self-rated general health was worst when both the number of health problems and OHIP score were higher. Oral health self-ratings were lower for males (PR = 0.92, 0.87-0.98), those aged 50-61 years (PR = 0.92, 0.85-0.99), for those with more health problems (PR = 0.82, 0.71-0.95) and higher oral health impact scores (PR = 0.54, 0.46-0.64).

CONCLUSIONS

For working age adults, oral health impact was associated with general health for those with more health problems indicating those in worse health suffer more impact from oral health problems.

Treatment of caries in relation to lesion severity: implications for minimum intervention dentistry

OBJECTIVES

To date there is little evidence of minimum intervention in relation to treatment patterns, particularly for initial carious lesions. The objective of this study was to investigate treatment provided to patients with a main diagnosis of coronal caries in relation to the severity of the caries lesion.

METHODS

A random sample of Australian dentists was surveyed by mailed questionnaires in 2009-2010 (response rate 67%). Data on services, patient characteristics and main diagnosis were collected from a service log.

RESULTS

Models of service rates adjusted for age, sex, insurance status and reason for visit showed that compared to the reference category of gross caries lesions, there were higher rates [rate ratio, 95% CI] of restorative services for initial [1.63, 1.31-2.03] and cavitated [1.69, 1.39-2.05] lesions, higher rates of prophylaxis for initial [3.77, 2.09-6.79] and cavitated [3.88, 2.29-6.58] lesions, lower rates of endodontic services for initial [0.07, 0.02-0.30] and cavitated [0.11, 0.04-0.30] lesions, and lower rates of extraction for initial [0.15, 0.06-0.34] and cavitated [0.15, 0.07-0.31] lesions.

CONCLUSIONS

Treatment of coronal caries was characterized by high rates of restorative services, but gross lesions had lower restorative rates and higher rates of endodontic and extraction services. There was little differentiation in treatment of coronal caries between initial and cavitated lesions, suggesting scope for increased management of initial carious lesions by the adoption of more minimum intervention approaches.

Chewing ability in an urban and rural population over 40 years in Shandong Province, China

Objectives

This study aimed to assess chewing ability related to dental status.

Material and methods

One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. Chewing ability was analyzed using multivariable logistic regression including five dental conditions (≥10 teeth in each jaw’; ‘complete anterior regions’; “sufficient premolar regions’ (≥3 posterior occluding pairs (POPs)); ‘sufficient molar regions’ (bilaterally ≥1 POP); and tooth replacement), adjusted for six background variables. Likelihood ratios for chewing problems were assessed at each level of the hierarchical classification system based on these dental conditions.

Results

Seventy-eight to 91 % of subjects reported no or minor chewing problems. The conditions ‘≥10 teeth in each jaw’, and ‘complete anterior regions’ were not associated, whereas ‘sufficient’ premolar regions’ and ‘sufficient molar regions’ were associated with chewing problems (Ors, 0.33–0.58). If classified hierarchically, the condition ‘≥10 teeth in each jaw’ was relevant for chewing problems (likelihood ratios 3.3–3.7). ‘Sufficient premolar region’ and ‘sufficient molar region’ were relevant to reduce the likelihood ratios for having chewing problems (both approximately with a factor 2), both for soft and for hard foods. Subjects with artificial teeth added had similar chance for chewing problems compared to counterparts with natural teeth only. However, if comparing replaced teeth with natural teeth, subjects with tooth replacement showed higher chance for chewing problems.

Conclusions

Chewing ability was strongly associated with dental conditions.

Clinical relevance

The presence of at least 10 teeth in each jaw had highest impact on chewing ability.

Injectable bone tissue engineering using expanded mesenchymal stem cells

Patients suffering from bone defects are often treated with autologous bone transplants, but this therapy can cause many complications. New approaches are therefore needed to improve treatment for bone defects, and stem cell therapy presents an exciting alternative approach. Although extensive evidence from basic studies using stem cells has been reported, few clinical applications using stem cells for bone tissue engineering have been developed. We investigated whether injectable tissue-engineered bone (TEB) composed of mesenchymal stem cells (MSCs) and platelet-rich plasma was able to regenerate functional bone in alveolar deficiencies. We performed these studies in animals and subsequently carried out large-scale clinical studies in patients with long-term follow-up; these showed good bone formation using minimally invasive MSC transplantation. All patients exhibited significantly improved bone volume with no side effects. Newly formed bone areas at 3 months were significantly increased over the preoperation baseline (p < .001) and reached levels equivalent to that of native bone. No significant bone resorption occurred during long-term follow-up. Injectable TEB restored masticatory function in patients. This novel clinical approach represents an effective therapeutic utilization of bone tissue engineering.

Chewing ability and associated factors in a Sudanese population

This study aimed to assess self-reported chewing ability among a sample of Sudanese adults and to identify factors associated with impaired oral function. A total of 1,888 adults (≥16 years old) attending outpatient clinics in Khartoum State were included. Subjective chewing ability was assessed by interviewing participants on chewing complaints and perceived difficulty of chewing 15 common Sudanese foods. Pearson and multivariate analyses were used to examine relationships between chewing ability and characteristics obtained from interviews and clinical examination. Chewing complaints were reported by 33.5% of subjects; 15.2-33.4% had perceived difficulty of chewing hard foods, whereas only 1.5-6.9% had difficulty eating soft foods. The likelihood of chewing complaints was higher in people with dry mouth, <20 teeth, tooth decay, poor self-rated oral health, perceived difficulty of chewing, and higher oral health-related quality of life (OHRQoL) scores. Individuals with <20 teeth, poor self-rated general health, and higher OHRQoL scores were all more likely to have perceived difficulty of chewing certain foods. Impaired chewing ability was rather highly prevalent among Sudanese adults. Addressing factors such as dry mouth and tooth loss/decay, which have been identified to be associated with impaired oral function, might help to decrease the risk of omission of essential foods from the diet and improve OHRQoL.