Oral health care needs and oral health-related quality of life (OHIP-14) in homeless people

Exploring the oral health experiences of homeless people: a deconstruction-reconstruction formulation

OBJECTIVE

To explore qualitatively, using a grounded theory approach, homeless people's awareness of their oral health needs and how they access dental services using a deconstruction-reconstruction formulation, and provide recommendations for service designers and dental professionals who work with people experiencing homelessness.

METHODS

A qualitative study using grounded theory methodology was conducted. A purposive sample of homeless people was recruited from health facilities and organizations serving homeless populations in four Scottish cities and towns. Participants were interviewed about their oral health within the wider context of their experiences of homelessness. Initial research questions were open and focused on social processes such as oral health practices and interaction with dental services. Data collection and analysis were carried out simultaneously and iteratively, with emerging findings informing subsequent cycles. Data analysis was guided by Glaser and Strauss's grounded theory methodology and involved constant comparison, coding of transcripts and detailed memo-writing.

RESULTS

Thirty-four homeless people took part. Participant experiences were conceptualized as a journey into and through the stages of homelessness, towards 'reclaiming life'. Oral health experiences were mapped as a parallel 3-stage journey from the deconstruction of self-care, to the construction and maintenance of the neglected dentine, and finally to the reclamation of oral health resulting in a reconstructed functioning dentition.

CONCLUSIONS

This qualitative exploration using a deconstruction-reconstruction formulation has added to the understanding of homeless people's oral health awareness and dental treatment access while permitting an examination of the wider socioeconomic and psychosocial issues that disrupt their intentions to attend for treatment. These findings provide service designers and dental professionals with recommendations for the provision of responsive, acceptable and appropriate dental health services for those experiencing homelessness.

Oral Health Inequalities

Recent research has emphasized the relationships between environmental and individual factors that may influence population oral health and lead to health inequalities. However, little is known about the effect of interactions between environmental and individual factors on inequalities in clinical (e.g., decayed teeth) and subjective oral health outcomes (e.g., oral health–related quality of life [OHQoL]). This cohort study aimed to explore the direct and mediated longitudinal interrelationships between key environmental and individual factors on clinical and subjective oral health outcomes in adults. Self-reported measures of OHQoL and individual (sense of coherence [SOC], social support, stress, oral health beliefs, dental behaviors, and subjective socioeconomic status [SES]) and environmental factors (SES and social network) were collected at baseline and 3-mo follow-up, together with a baseline clinical examination of 495 adult employees of an automobile parts manufacturer in India. Lagged structural equation modeling was guided by the adapted Wilson and Cleary/Brunner and Marmot model linking clinical, individual, and environmental variables to quality of life. The study provides tentative evidence that SES may influence levels of resources such as social support and SOC, which mediate stress and in turn may influence subjective oral health outcomes. Accordingly, the present findings and the adapted Wilson and Cleary/Brunner and Marmot model on which they are predicted provide support for the psychosocial pathway being key in the SES–oral health relationship. The pathways through which environmental factors interact with individual factors to impact subjective oral health outcomes identified here may bring opportunities for more targeted oral health promotion strategies.

Associação do risco familiar com saúde bucal, qualidade de vida e variáveis socioeconômicas

Objetivo: avaliar a relação do risco familiar com saúde bucal, qualidade de vida e variáveis socioeconômicas. Métodos: estudo observacional transversal com 311 indivíduos com idade entre 18 e 71 anos, residentes na área de abrangência de quatro unidades de saúde da família (USF), localizadas em dois municípios do estado de São Paulo. Os voluntários foram avaliados de acordo com: (1) situação clínica (CPO-D e necessidade de tratamento), (2) autopercepção de saúde bucal (OHIP-14), (3) qualidade de vida (WHOQOL-BREF), e (4) condição socioeconômica. Para avaliar o risco familiar, utilizou-se a Escala de Coelho. Os dados foram analisados por meio de modelo multinível formado por componentes fixos (representados pelas variáveis estudadas) e componentes aleatórios (representados pelos bairros e pelas variâncias nos diferentes níveis). Resultados: a média de idade dos participantes foi de 36,7 anos (dp=13), com CPO-D médio de 12,9 (dp=7,0). A média da Escala de Risco de Coelho entre os voluntários foi de 2,67 com erro padrão de 0,32. Apresentaram maior escore de risco total os indivíduos de maior idade (p=0,0486), que moravam em casas com mais residentes (p<0,001), com menos anos de escolaridade (p=0,0137), que não possuíam automóvel (p=0,0048) e com maior escore de OHIP-14 (p=0,0130). Conclusão: a escala de risco familiar associou-se positivamente às variáveis socioeconômicas, e os indivíduos com maior risco familiar apresentaram pior autopercepção da saúde bucal, mas não percebiam uma pior qualidade de vida em geral.

Oral health impacts and quality of life in an urban homeless population

BACKGROUND

Homeless people experience a much higher burden of general health conditions and have much poorer oral health than the rest of the population. The aim of this study was to determine the oral health impacts and general quality of life of an urban homeless population.

METHODS

A convenience sample of 58 adults (dentate n = 56) experiencing homelessness were assessed using a survey which included the 14-item Oral Health Impact Profile and the 26-item World Health Organization's Quality of Life - short version. A subset (n = 34) also underwent a dental examination.

RESULTS

The study participants were younger, more likely to be Indigenous, smoked daily and avoided dental care because of cost than the rest of the population. Dentate homeless adults reported significantly greater oral health impacts when compared with the Australian dentate population. General quality of life was significantly poorer than for the rest of the population. Treatment need was associated with greater oral health impacts.

CONCLUSIONS

Poor oral health is prevalent and adversely impacts quality of life for homeless people, but it is only one of a range of complex social and health challenges being faced by these individuals. Dental care should be better integrated within homeless support services.

Impacto da cárie dentária na qualidade de vida de adultos residentes no entorno de Belo Horizonte, MG, Brasil

O artigo discute o impacto da cárie dentária na qualidade de vida das pessoas. O objetivo foi avaliar a qualidade de vida de adultos moradores no entorno de Belo Horizonte, Minas Gerais, Brasil, conforme a prevalência e a severidade de cárie dentária. Trata-se de estudo transversal, de base domiciliar realizado a partir de amostragem por conglomerados. Os indicadores utilizados na coleta de dados foram o índice de cárie CPOD e a Escala WHOQOL-bref. A prevalência de cárie foi definida a partir da presença de pelo menos um dente cariado (C > 1) e a maior gravidade pelo CPOD > 25. A população examinada foi de 1138 adultos, sendo que 461 tinham pelo menos um dente cariado. Houve melhores índices de qualidade de vida para os grupos de pessoas sem cárie e com menor gravidade de cárie. À medida que o número de dentes cariados e o CPOD aumentam a qualidade de vida diminuí (p < 0,001). A correlação negativa entre cárie e qualidade de vida foi verificada nos domínios psicológico, relações sociais e meio ambiente. Concluiu-se que a cárie dentária resulta em impacto negativo na qualidade de vida de adultos. Os indicadores subjetivos contribuíram para qualificar as informações clínicas de saúde bucal.