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Yekkalam N, Storm Mienna C, Stoor JPA, San Sebastian M. Social determinants of self-reported oral health among Sámi in Sweden. Community Dent Oral Epidemiol 2023; 51:1258-1265. [PMID: 37489613 DOI: 10.1111/cdoe.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/07/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES To investigate the prevalence of poor self-reported oral health and to identify socio-demographic, socio-economic and cultural-related risk factors associated with poor oral health among Sámi in Sweden. METHODS A Sámi sample frame was constructed drawing from three pre-existing registers. All identified persons aged 18-84 were invited to participate in the study during February-May 2021. Among the 9249 invitations, 3779 answered the survey. The frequencies of the independent variables in terms of socio-economic, socio-demographic and cultural-related factors as well as the outcome, self-reported oral health, were calculated first. Prevalence ratios (PRs) and their 95% confidence interval (95% CI) were estimated to assess the relationship between the independent variables and the outcome. RESULTS Overall, 32.5% of the participants reported a poor oral health with a higher prevalence among men compared to women. Among the socio-demographic factors, being old (PR: 1.99; 95% CI: 1.59-2.51), unmarried (PR: 1.17; 95% CI: 1.03-1.33) and divorced or widow-er (PR: 1.27; 95% CI: 1.09-1.46) were statistically associated to poor self-reported oral health. Among the socio-economic factors, a low education level (PR: 1.56; 95% CI: 1.29-1.89), belonging to the poorest quintile (PR: 1.63; 95% CI: 1.35-1.96), and experiencing difficulties to make ends meet several times during the last 12 months (PR: 1.74; 95% CI: 1.51-1.99) were statistically significant related to poor oral health. CONCLUSIONS The self-reported oral health among Sámi in Sweden appears to be worse than that of the general Swedish population. Several socio-economic and socio-demographic factors were found to be strongly associated with poor self-reported oral health. Targeted interventions addressing these social determinants are needed to reduce inequalities in oral health among the Sámi population.
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Affiliation(s)
- Negin Yekkalam
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
| | - Christina Storm Mienna
- Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden
- Várdduo-Centre for Sámi Research, Umeå University, Umeå, Sweden
| | - Jon Petter Anders Stoor
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
| | - Miguel San Sebastian
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
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Tsakos G, Watt RG, Guarnizo-Herreño CC. Reflections on oral health inequalities: Theories, pathways and next steps for research priorities. Community Dent Oral Epidemiol 2023; 51:17-27. [PMID: 36744970 DOI: 10.1111/cdoe.12830] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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Damaskinos P, Koletsi-Kounari C, Mamai-Homata H, Papaioannou W. Social, Clinical and Psychometric Factors Affecting Self-Rated Oral Health, Self-Rated Health and Wellbeing in Adults: A Cross-Sectional Survey. Health (London) 2022. [DOI: 10.4236/health.2022.141009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Hakeberg M, Wide Boman U. Self-reported oral and general health in relation to socioeconomic position. BMC Public Health 2017; 18:63. [PMID: 28747180 PMCID: PMC5530538 DOI: 10.1186/s12889-017-4609-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/19/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the past two decades, several scientific publications from different countries have shown how oral health in the population varies with social determinants. The aim of the present study was to explore the relationship between self-reported oral and general health in relation to different measures of socioeconomic position. METHODS Data were collected from a randomly selected sample of the adult population in Sweden (n = 3500, mean age 53.4 years, 53.1% women). The response rate was 49.7%. Subjects were interviewed by telephone, using a questionnaire including items on self-reported oral and general health, socioeconomic position and lifestyle. RESULTS A significant gradient was found for both oral and general health: the lower the socioeconomic position, the poorer the health. Socioeconomic position and, above all, economic measures were strongly associated with general health (OR 3.95) and with oral health (OR 1.76) if having an income below SEK 200,000 per year. Similar results were found in multivariate analyses controlling for age, gender and lifestyle variables. CONCLUSIONS For adults, there are clear socioeconomic gradients in self-reported oral and general health, irrespective of different socioeconomic measures. Action is needed to ensure greater equity of oral and general health.
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Affiliation(s)
- Magnus Hakeberg
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, 40530 Gothenburg, SE Sweden
| | - Ulla Wide Boman
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 450, 40530 Gothenburg, SE Sweden
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Hakeberg M, Wide Boman U. Dental care attendance and refrainment from dental care among adults. Acta Odontol Scand 2017; 75:366-371. [PMID: 28420315 DOI: 10.1080/00016357.2017.1317105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to analyse dental care utilization, refrainment from self-perceived needed dental care and the association with socioeconomic indicators among adult individuals. MATERIALS AND METHODS This cross-sectional survey included 3500 randomly selected adult individuals. Telephone interviews were conducted and the participants answered a battery of questions regarding dental visiting habits, health, socioeconomic position (SEP), behavioural factors and lifestyle indicators. RESULTS The outcome 'dental visits' was significantly correlated with SEP, especially with monetary dimensions, such as income and economic resources for unforeseen expenditures. However, educational level was not a significant predictor in the tested statistical models. Furthermore, other covariates that contributed significantly to the models were ethnicity, dental anxiety and lifestyle factors, albeit with a different pattern of impact on the two outcome dimensions. Important features of the SEP variables were the stepwise gradient relative to the outcomes, implicating that the lower the SEP status, the greater the risk of reporting irregular dental visiting habits and refraining from dental care due to financial problems. CONCLUSIONS Dental care utilization and refraining from dental care for financial reasons clearly reveal associations with socioeconomic positions among adult individuals.
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Affiliation(s)
- Magnus Hakeberg
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulla Wide Boman
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Melo LAD, Sousa MDM, Medeiros AKBD, Carreiro ADFP, Lima KCD. Factors associated with negative self-perception of oral health among institutionalized elderly. CIENCIA & SAUDE COLETIVA 2016; 21:3339-3346. [PMID: 27828567 DOI: 10.1590/1413-812320152111.08802015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/05/2015] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine self-perception of oral-health in institutionalized elderly, and look into the sociodemographic and clinical aspects associated with negative self-perception. One hundred and sixty-six elderly were assessed by answering a self-perception question that predicts the GOHAI (Geriatric Oral Health Assessment Index). Sociodemographic data was obtained from a previously validated questionnaire and clinical data taken from the WHO file and QST-TMD used to check the existence of TMD (temporomandibular disturbance). The data gathered was submitted to Mann-Whitney, Fisher's Exact and Chi-squared tests with a 5% significance level. The average age of the study population was 80.5, and 75.9% were women. The mean DMFT (decayed, missing, and filled teeth in permanent teeth) was 28.9, the majority of the sample subject (65%) reported good to excellent teeth, gums and prostheses (dentures and bridges). Three questions in the TMD questionnaire (QST-DTM) were associated with negative self-perception. Those claiming that their jaws "lock" when they open or close their mouth, who always have pain at the front or side of their jaw, or whose jaws get tired during the course of the day are less satisfied with their oral health. We conclude that clinical and sociodemographic conditions have little influence on self-perception of oral health, possibly because pain is the main factor associated with negative self-perception in these individuals.
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Affiliation(s)
- Laércio Almeida de Melo
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Meily de Mello Sousa
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Annie Karoline Bezerra de Medeiros
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Adriana da Fonte Porto Carreiro
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Kenio Costa de Lima
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
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Gabardo MCL, Moysés SJ, Moysés ST, Olandoski M, Olinto MTA, Pattussi MP. Social, economic, and behavioral variables associated with oral health-related quality of life among Brazilian adults. CIENCIA & SAUDE COLETIVA 2015; 20:1531-40. [DOI: 10.1590/1413-81232015205.13562014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/14/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the association between sociodemographic, socioeconomic, psychosocial, and behavioral variables and oral health as assessed using the 14-question short version of the Oral Health Impact Profile (OHIP-14). A cross-sectional study was performed with 1095 adult residents from 38 census tracts in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. Responses to the OHIP-14 were dichotomized, and bivariate (Chi-square) and multivariate analysis (logistic regression and Wald's test) were performed. In the bivariate analysis, the worse effects were reported by female individuals, the elderly, those with low family income, less schooling, those reporting a lower quality of life and social support, and smokers. In the multivariate analysis the following variables maintained their statistical significance: gender (female), age (50-59 years), family income (low), quality of life (low), social support (low, moderate), and smoking (smokers). Individuals' self-perception of their oral health was related to sociodemographic, socioeconomic, psychosocial, and behavioral variables, thus confirming that emphasis should be placed on social factors when addressing oral health problems.
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Gabardo MCL, Moysés SJ, Moysés ST, Olandoski M, Olinto MTA, Pattussi MP. Multilevel analysis of self-perception in oral health and associated factors in Southern Brazilian adults: a cross-sectional study. CAD SAUDE PUBLICA 2015; 31:49-59. [DOI: 10.1590/0102-311x00037814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/05/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the association between individual and contextual variables related to self-perception in oral health among residents in the municipality of São Leopoldo, Rio Grande do Sul State, Brazil. The cross-sectional design involved 1,100 adults in 38 census tracts. The self-perception was evaluated using the Oral Health Impact Profile (OHIP-14) tool. A logistic multilevel analysis was performed. The multivariate analysis revealed that those who are of the female gender, older, with lower scores of quality of life and less social support, with poor healthy eating habits, smokers and those living in low-income census tracts presented higher odds of reporting worse oral health self-perception (OHIP-1). We concluded that individual and contextual variables are associated with oral health self-perception. This is essential information for planning health services wishing to meet the health needs of the population.
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Steele J, Shen J, Tsakos G, Fuller E, Morris S, Watt R, Guarnizo-Herreño C, Wildman J. The Interplay between socioeconomic inequalities and clinical oral health. J Dent Res 2014; 94:19-26. [PMID: 25344336 DOI: 10.1177/0022034514553978] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oral health inequalities associated with socioeconomic status are widely observed but may depend on the way that both oral health and socioeconomic status are measured. Our aim was to investigate inequalities using diverse indicators of oral health and 4 socioeconomic determinants, in the context of age and cohort. Multiple linear or logistic regressions were estimated for 7 oral health measures representing very different outcomes (2 caries prevalence measures, decayed/missing/filled teeth, 6-mm pockets, number of teeth, anterior spaces, and excellent oral health) against 4 socioeconomic measures (income, education, Index of Multiple Deprivation, and occupational social class) for adults aged ≥21 y in the 2009 UK Adult Dental Health Survey data set. Confounders were adjusted and marginal effects calculated. The results showed highly variable relationships for the different combinations of variables and that age group was critical, with different relationships at different ages. There were significant income inequalities in caries prevalence in the youngest age group, marginal effects of 0.10 to 0.18, representing a 10- to 18-percentage point increase in the probability of caries between the wealthiest and every other quintile, but there was not a clear gradient across the quintiles. With number of teeth as an outcome, there were significant income gradients after adjustment in older groups, up to 4.5 teeth (95% confidence interval, 2.2-6.8) between richest and poorest but none for the younger groups. For periodontal disease, income inequalities were mediated by other socioeconomic variables and smoking, while for anterior spaces, the relationships were age dependent and complex. In conclusion, oral health inequalities manifest in different ways in different age groups, representing age and cohort effects. Income sometimes has an independent relationship, but education and area of residence are also contributory. Appropriate choices of measures in relation to age are fundamental if we are to understand and address inequalities.
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Affiliation(s)
- J Steele
- School of Dental Sciences and Centre for Oral Health Research, Newcastle University, UK
| | - J Shen
- Institute of Health and Society, Newcastle University, UK
| | - G Tsakos
- Department of Epidemiology and Public Health, University College London, UK
| | - E Fuller
- NatCen Social Research, Northampton Square, London, UK
| | - S Morris
- Department of Applied Health Research, University College, London, UK
| | - R Watt
- Department of Epidemiology and Public Health, University College London, UK
| | - C Guarnizo-Herreño
- Department of Epidemiology and Public Health, University College London, UK
| | - J Wildman
- Economics, Newcastle Business School, Newcastle University, UK
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Guarnizo-Herreño CC, Watt RG, Fuller E, Steele JG, Shen J, Morris S, Wildman J, Tsakos G. Socioeconomic position and subjective oral health: findings for the adult population in England, Wales and Northern Ireland. BMC Public Health 2014; 14:827. [PMID: 25107286 PMCID: PMC4137102 DOI: 10.1186/1471-2458-14-827] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/06/2014] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to assess socioeconomic inequalities in subjective measures of oral health in a national sample of adults in England, Wales and Northern Ireland. Methods We analysed data from the 2009 Adult Dental Health Survey for 8,765 adults aged 21 years and over. We examined inequalities in three oral health measures: self-rated oral health, Oral Health Impact Profile (OHIP-14), and Oral Impacts on Daily Performance (OIDP). Educational attainment, occupational social class and household income were included as socioeconomic position (SEP) indicators. Multivariable logistic regression models were fitted and from the regression coefficients, predictive margins and conditional marginal effects were estimated to compare predicted probabilities of the outcome across different SEP levels. We also assessed the effect of missing data on our results by re-estimating the regression models after imputing missing data. Results There were significant differences in predicted probabilities of the outcomes by SEP level among dentate, but not among edentate, participants. For example, persons with no qualifications showed a higher predicted probability of reporting bad oral health (9.1 percentage points higher, 95% CI: 6.54, 11.68) compared to those with a degree or equivalent. Similarly, predicted probabilities of bad oral health and oral impacts were significantly higher for participants in lower income quintiles compared to those in the highest income level (p < 0.001). Marginal effects for all outcomes were weaker for occupational social class compared to education or income. Educational and income-related inequalities were larger among young people and non-significant among 65+ year-olds. Using imputed data confirmed the aforementioned results. Conclusions There were clear socio-economic inequalities in subjective oral health among adults in England, Wales and Northern Ireland with stronger gradients for those at younger ages. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-827) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol C Guarnizo-Herreño
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 7HB London, UK.
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Lee PH, McGrath CPJ, Kong AYC, Lam TH. Self-reported oral health and quality of life: a latent growth curve analysis. Int J Behav Med 2014; 21:358-63. [PMID: 23615848 DOI: 10.1007/s12529-013-9310-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The longitudinal associations between oral health (OH) and physical and mental health-related quality of life (HRQoL) are unclear. PURPOSE This study examined the relationship of self-reported OH with the trajectories of physical and mental HRQoL in Hong Kong at 3, 9, and 15 months after the measurement period using a latent growth curve model. METHODS This study included 5,710 participants recruited in the FAMILY project cohort study during March-October 2009. Self-report OH was measured using a five-point single-item scale, and HRQoL was measured using the physical component scale (PCS) and mental component scale (MCS) of Short Form 12. Latent growth curve model was used to compute the relationship of self-reported OH with the trajectories on HRQoL over time, adjusted for age and sex. RESULTS The latent growth curve model gave good fit to both the PCS (normed fit index (NFI) = 0.98, comparative fit index (CFI) = 0.99, and standardized root mean square residual (SRMR) = 0.03) and MCS (NFI = 0.97, CFI = 0.98, and SRMR = 0.03). Better self-reported OH was associated with higher PCS and MCS at the baseline. The longitudinal association with PCS remained constant over time (coefficient = -0.02, p = 0.07) but that with MCS diminished over time with baseline oral health status (coefficient = -0.04, p = 0.002). CONCLUSION Better self-reported OH status was associated with higher level of physical and mental HRQoL, and with negative change in mental HRQoL.
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Affiliation(s)
- Paul H Lee
- FAMILY: A Jockey Club Initiative for a Harmonious Society, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
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Lee PH, McGrath CPJ, Kong AYC, Lam TH. Self-report poor oral health and chronic diseases: the Hong Kong FAMILY Project. Community Dent Oral Epidemiol 2013; 41:451-8. [PMID: 23330825 DOI: 10.1111/cdoe.12037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 12/21/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the association between self-reported oral health (SROH) and general health, this study examined the cross-sectional associations between SROH and nine chronic health conditions, namely cancer, diabetes, high blood pressure, high cholesterol, thyroid disease, nervous system disease, eye/nose/throat disease, stomach/intestinal disease, and musculoskeletal disease in Hong Kong. METHODS This study included 41,641 participants recruited in the FAMILY Project cohort study during March 2009-March 2011. SROH was measured on a 5-point Likert scale. Multiple logistic regression model was used to analyze the effect of dichotomized SROH (0: very good/good/average, 1: bad/very bad) on nine chronic health conditions, adjusted for age, sex, education, personal income, smoking and drinking habits, Body mass index (BMI), and blood pressures. RESULTS All the nine chronic health conditions investigated were associated with SROH. SROH showed the strongest cross-sectional association with nervous system disease (odds ratio = 3.30, P < 0.001), while the odds ratio with other significant chronic health conditions ranged from 1.13 (high cholesterol, P = 0.033)-1.73 (stomach/intestinal disease, P < 0.001). CONCLUSIONS Poor SROH is associated with cancer, diabetes, high blood pressure, high cholesterol, thyroid disease, nervous system disease, eye/nose/throat disease, stomach/intestinal disease, and musculoskeletal disease.
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Affiliation(s)
- Paul H Lee
- FAMILY: A Jockey Club Initiative for a Harmonious Society, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
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Lundegren N, Axtelius B, Akerman S. Oral health in the adult population of Skåne, Sweden: a clinical study. Acta Odontol Scand 2012; 70:511-9. [PMID: 22181829 DOI: 10.3109/00016357.2011.640279] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to describe the oral health in the adult population of Skåne by clinical factors with special reference to age, gender, ethnicity and education. MATERIALS AND METHODS Clinical examinations were performed on 451 randomly selected individuals, 20-89 years old, living in Skåne, Sweden. The clinical examination included a radiographic examination and a questionnaire. Clinical variables were put into cross-tabulations along with age, gender, educational level and ethnicity. RESULTS For all of the described clinical variables, except caries, the frequency increased with age. There were no differences in the clinical variables due to gender. The frequencies of missing teeth, caries, periodontal conditions and DMFT were higher among those with a lower educational level. More missing teeth, worse periodontal conditions, more apical destructions and less dental fillings were found in individuals who were not born in Sweden. CONCLUSIONS The oral health in the adult population of Skåne was overall good, with low frequencies of oral disease and a large number of remaining teeth up to a high age. The patients' oral health status, as determined by a dentist's clinical examination, differed due to age, educational level and ethnicity, but not due to gender.
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Affiliation(s)
- Nina Lundegren
- Department of Oral Diagnostics, Faculty of Odontology, Malmö University, Sweden.
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Holtfreter B, Berg MH, Kocher T, Schiffner U, Hoffmann T, Micheelis W. Change in FS-T index in adults in the German national oral health surveys between 1989 and 2005. Community Dent Oral Epidemiol 2012; 41:251-60. [PMID: 22882609 DOI: 10.1111/j.1600-0528.2012.00739.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 06/26/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess changes in the number of functioning teeth (filled and sound teeth, FS-T index) from 1989/1992 to 2005 in West and East Germany and to evaluate survey- and region-specific associations between sociodemographic and behavioral risk factors and the FS-T index. METHODS Within the German Oral Health Studies, random samples from 35-44-year-olds were drawn in 1989, 1992, 1997 and 2005. The FS-T index and a questionnaire with socioeconomic and behavioral items were assessed. Negative binomial regression models were evaluated, including all sociodemographic and behavioral factors simultaneously as independent variables. RESULTS For West Germany, median FS-T index increased by 3 teeth between 1989 and 2005 (Ptrend < 0.001). In East Germans, FS-T index was similar in 1992 and 1997 (median, 24), but increased by one tooth until 2005 (Ptrend < 0.001). For West and East Germany, middle and high school education were significantly associated with higher FS-T indices in all surveys, although effects were most pronounced in 2005. Being married, reporting regular dental visits and good oral hygiene were significantly related to a higher number of functioning teeth in at least one survey year. CONCLUSIONS Dental health assessed as the number of functioning teeth improved between 1989/92 and 2005 in both German parts and across all educational levels. However, considering the educational level, dental health was less equally distributed in 2005 compared with previous surveys.
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Affiliation(s)
- Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany.
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Dumitrescu AL, Zetu L, Teslaru S. Instability of self-esteem, self-confidence, self-liking, self-control, self-competence and perfectionism: associations with oral health status and oral health-related behaviours. Int J Dent Hyg 2011; 10:22-9. [DOI: 10.1111/j.1601-5037.2011.00519.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Pattussi MP, Peres KG, Boing AF, Peres MA, Da Costa JSD. Self-rated oral health and associated factors in Brazilian elders. Community Dent Oral Epidemiol 2010; 38:348-59. [DOI: 10.1111/j.1600-0528.2010.00542.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jamieson LM, Roberts-Thomson KF, Sayers SM. Risk indicators for severe impaired oral health among indigenous Australian young adults. BMC Oral Health 2010; 10:1. [PMID: 20102640 PMCID: PMC2827466 DOI: 10.1186/1472-6831-10-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 01/27/2010] [Indexed: 11/10/2022] Open
Abstract
Background Oral health impairment comprises three conceptual domains; pain, appearance and function. This study sought to: (1) estimate the prevalence of severe oral health impairment as assessed by a summary oral health impairment measure, including aspects of dental pain, dissatisfaction with dental appearance and difficulty eating, among a birth cohort of Indigenous Australian young adults (n = 442, age range 16-20 years); (2) compare prevalence according to demographic, socio-economic, behavioural, dental service utilisation and oral health outcome risk indicators; and (3) ascertain the independent contribution of those risk indicators to severe oral health impairment in this population. Methods Data were from the Aboriginal Birth Cohort (ABC) study, a prospective longitudinal investigation of Aboriginal individuals born 1987-1990 at an Australian regional hospital. Data for this analysis pertained to Wave-3 of the study only. Severe oral health impairment was defined as reported experience of toothache, poor dental appearance and food avoidance in the last 12 months. Logistic regression models were used to evaluate effects of demographic, socio-economic, behavioural, dental service utilisation and clinical oral disease indicators on severe oral health impairment. Effects were quantified as odds ratios (OR). Results The percent of participants with severe oral health impairment was 16.3 (95% CI 12.9-19.7). In the multivariate model, severe oral health impairment was associated with untreated dental decay (OR 4.0, 95% CI 1.6-9.6). In addition to that clinical indicator, greater odds of severe oral health impairment were associated with being female (OR 2.0, 95% CI 1.2-3.6), being aged 19-20 years (OR 2.1, 95% CI 1.2-3.6), soft drink consumption every day or a few days a week (OR 2.6, 95% 1.2-5.6) and non-ownership of a toothbrush (OR 1.9, 95% CI 1.1-3.4). Conclusions Severe oral health impairment was prevalent among this population. The findings suggest that public health strategies that address prevention and treatment of dental disease, self-regulation of soft drink consumption and ownership of oral self-care devices are needed if severe oral health impairment among Indigenous Australian young adults is to be reduced.
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Affiliation(s)
- Lisa M Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
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Tsakos G, Sheiham A, Iliffe S, Kharicha K, Harari D, Swift CG, Gillman G, Stuck AE. The impact of educational level on oral health-related quality of life in older people in London. Eur J Oral Sci 2009; 117:286-92. [PMID: 19583757 DOI: 10.1111/j.1600-0722.2009.00619.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are socioeconomic inequalities in oral health, but the relationship between education and oral health-related quality of life (OHRQoL) among older adults has not been adequately studied. This study assessed whether there is an educational gradient in OHRQoL among older people in London. We employed secondary analysis of baseline data (n = 1,090) from a randomized controlled trial of health-risk appraisal on community-dwelling non-disabled people 65 yr of age and older, registered with three group medical practices in suburban London. Multiple linear regressions were used to analyze the association between OHRQoL [measured using the Geriatric Oral Health Assessment Index (GOHAI)] and education, adjusted for age, gender, pension status, and denture wearing. Overall, 30.6% reported low levels of OHRQoL. Eating discomfort was the most frequent problem (24% reported 'often/always'), while concerns about appearance were also prevalent. Significant variations in OHRQoL existed between socioeconomic groups. In adjusted analyses, there was a clear education gradient in OHRQoL, with worse perceptions at each lower level of education. Low educational level has an independent negative impact on OHRQoL in older people, which is not explained by differences in income or in denture wearing between educational groups. Policies targeting lower educated groups should be complemented with whole-population strategies for the reduction of oral health inequalities.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, UCL Medical School, London, UK.
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The development and testing of a survey instrument for benchmarking dental plan performance: using insured patients' experiences as a gauge of dental care quality. J Am Dent Assoc 2009; 140:229-37. [PMID: 19188420 DOI: 10.14219/jada.archive.2009.0137] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is no standard, nonproprietary method for providing national benchmarks of dental care quality as described by patients. The purpose of this research was to develop such a tool following guidelines of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) initiative. METHODS The authors identified domains of dental care quality via qualitative methods, including a literature review, stakeholder interviews and focus groups with beneficiaries, and they cognitively tested draft questions with patients to yield a pilot survey. Psychometric analyses of pilot data (n = 3,264) identified summary indexes and guided survey revisions. The authors used two waves of subsequent data collection (n = 4,221) to test the validity of the revised survey. RESULTS The mean response rate across three rounds of data collection was 51 percent. Statistical analysis indicated that 17 questions could be reliably collapsed into three composite measures: "Care From Dentist and Staff" (reliability = 0.89, scaling success = 100 percent); "Access to Dental Care" (reliability = 0.78, scaling success = 100 percent); and "Dental Plan Coverage/Service" (reliability = 0.84, scaling success = 100 percent). CONCLUSIONS The validity of the survey was supported in mail and Internet modes for the American English language, and the instrument was approved by the CAHPS consortium for distribution as the CAHPS Dental Plan Survey. PRACTICE IMPLICATIONS. A tool is available now for assessing dental care quality by measuring adult patients' experiences with their dental care and coverage. The authors tested this instrument only in a population with third-party coverage, however, which is a potential limitation that should be considered.
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Dumitrescu A, Kawamura M, Zetu L, Teslaru S. Investigating the Relationship Among Self-Reported Oral Health Status, Oral Health–Related Behaviors, and Self-Consciousness in Romanian Dental Patients. J Periodontol 2009; 80:468-75. [DOI: 10.1902/jop.2009.080412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Johansson AK, Johansson A, Unell L, Ekbäck G, Ordell S, Carlsson GE. A 15-yr longitudinal study of xerostomia in a Swedish population of 50-yr-old subjects. Eur J Oral Sci 2009; 117:13-9. [DOI: 10.1111/j.1600-0722.2008.00597.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Johansson A, Unell L, Carlsson GE, Söderfeldt B, Halling A. Differences in four reported symptoms related to temporomandibular disorders in a cohort of 50-year-old subjects followed up after 10 years. Acta Odontol Scand 2008; 66:50-7. [PMID: 18320419 DOI: 10.1080/00016350801922775] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess possible changes in the prevalence of four temporomandibular disorder (TMD) symptoms reported by subjects at age 50 and again 10 years later. MATERIAL AND METHODS Identical questionnaires were sent out in 1992 and in 2002 to all subjects born in 1942 and living in two Swedish counties. Of those who answered the four questions on TMD symptoms in 1992, 74% responded in 2002 (n=4639). The response alternatives were dichotomized into two groups: 1) No problems and 2) some, rather severe and severe problems. RESULTS The mean prevalence of TMD-related symptoms reflected small and mainly non-significant changes, whereas the prevalence of reported bruxism was significantly greater at age 60 than at age 50. Among those with no TMD symptoms at age 50, 5-7% of the men and 8-9% of the women reported symptoms at age 60. Of those reporting one or more TMD symptoms at age 50, 47-65% of the men and 40-48% of the women had no symptoms 10 years later. There was a significant and markedly increased risk of reporting TMD symptoms and bruxism (OR>10) at age 60 among those who had symptoms at age 50. CONCLUSIONS The mean prevalence of reported TMD symptoms was relatively consistent from age 50 to age 60. The group reporting symptoms at the first examination were highly likely still to have the symptoms 10 years later. However, approximately half of the subjects with TMD symptoms at age 50 reported no symptoms at age 60.
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CARLSSON GUNNARE, JOHANSSON ANDERS, JOHANSSON ANNKATRIN, ORDELL SVEN, EKBÄCK GUNNAR, UNELL LENNART. Attitudes toward Dental Appearance in 50- and 60-Year-Old Subjects Living in Sweden. J ESTHET RESTOR DENT 2008; 20:46-55; discussion 56. [DOI: 10.1111/j.1708-8240.2008.00148.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pattussi MP, Olinto MTA, Hardy R, Sheiham A. Clinical, social and psychosocial factors associated with self-rated oral health in Brazilian adolescents. Community Dent Oral Epidemiol 2007; 35:377-86. [PMID: 17822486 DOI: 10.1111/j.1600-0528.2006.00339.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of this study is to investigate the main social, psychosocial and clinical factors associated with poor self-rated oral health in adolescents. METHODS A cross-sectional survey was carried out in two cities of the Distrito Federal, Brazil. Data were collected by clinical examinations and by self-administered questionnaires from 1302 adolescents aged 14- 15 years in 39 schools. Data analysis was carried out using a Poisson regression model taking into account the cluster sample. RESULTS Adjusting for social, psychosocial and clinical factors, results showed that poor self-rated oral health was significantly associated (P < 0.001) with sex (males) [prevalence ratio (PR) = 0.8, 95% confidence interval (95% CI): 0.7-0.9]; low social class (PR =1.4, 95% CI: 1.2-1.6); poor self-rated general health (PR = 2.6, 95% CI: 2.3-3.1); mouth appearance (PR = 1.9, 95% CI: 1.6-2.2) and with presence of untreated dental decay (PR = 1.4, 95% CI: 1.3-1.6). CONCLUSIONS The single question on self-rated oral health appears to be a simple and easy way to collect dental health information in adolescents. Assessment and understanding of self-rated oral health should take into account social, psychosocial and oral factors.
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Affiliation(s)
- Marcos P Pattussi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil.
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Abstract
There are social gradients in general health and oral health. However, there have been few studies addressing whether similarities exist in the gradients in oral and general health in the same individuals. We set out to test, using data from NHANES III, whether there are social gradients in oral health, and whether they resemble the gradients in general health. Income, indicated by poverty-income ratio, and education gradients were examined in periodontal diseases, ischemic heart disease, and perceived oral/general health. Our analysis demonstrated consistent income and education gradients in all outcomes assessed. In the adjusted regression models, the probabilities of having poorer clinical and perceived health were attenuated, but remained significantly higher at each lower level of income and education for most outcomes. The results showed similar income and education gradients in oral and general health, implying commonalities of the social determinants of both oral and general health.
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Affiliation(s)
- W Sabbah
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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Wamala S, Merlo J, Boström G. Inequity in access to dental care services explains current socioeconomic disparities in oral health: the Swedish National Surveys of Public Health 2004-2005. J Epidemiol Community Health 2007; 60:1027-33. [PMID: 17108297 PMCID: PMC2465506 DOI: 10.1136/jech.2006.046896] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health. Design, setting and outcomes: Cross-sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self-rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index (SDI) was developed, consisting of social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves. PARTICIPANTS Swedish population-based sample of 17 362 men and 20 037 women. RESULTS Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services. After adjusting for age, men with a mild SDI compared with those with no SDI had 2.7 (95% confidence interval (CI) 2.5 to 3.0) times the odds for self-rated poor oral health, whereas odds related to severe SDI were 6.8 (95% CI 6.2 to 7.5). The corresponding values among women were 2.3 (95% CI 2.1 to 2.5) and 6.8 (95% CI 6.3 to 7.5). Nevertheless, people with severe socioeconomic disparities were 7-9 times as likely to refrain from seeking the required dental treatment. These associations persisted even after controlling for living alone, education, occupational status and lifestyle factors. Lifestyle factors explained only 29% of the socioeconomic differences in poor oral health among men and women, whereas lack of access to dental care services explained about 60%. The results of the multilevel regression analysis indicated no additional effect of the administrative boundaries of counties or of municipalities in Sweden. CONCLUSIONS Results call for urgent public health interventions to increase equitable access to dental care services.
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Affiliation(s)
- Sarah Wamala
- National Institute of Public Health, Olof Palmes Gata 17,103 52 Stockholm, Sweden.
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Ugarte J, Abe Y, Fukuda H, Honda S, Takamura N, Kobuke Y, Ye Z, Aoyagi K, Mendoza O, Shinsho F. Self-perceived oral health status and influencing factors of the elderly residents of a peri-urban area of La Paz, Bolivia. Int Dent J 2007; 57:19-26. [PMID: 17378346 DOI: 10.1111/j.1875-595x.2007.tb00114.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM To assess the self-perceived oral health status of the elderly in Bolivia and explore the relationship between the socio-demographic and subjective factors that influence such perception. DESIGN A cross sectional study. SETTING Pampahasi, peri-urban area of La Paz, Bolivia. PARTICIPANTS A 22.5% (300) sample was selected randomly from the total population (1,336) of 60 years and above. Of the participants, 293 agreed to participate in the survey. METHODS Information was collected by interviews at home. RESULTS The mean age was 70 years (SD = 7.7), with more females (57%) than males. Sixty per cent of subjects categorised their oral health as poor. Logistic regression analysis showed that poor self-perceived oral health was associated significantly with not going to school, no/ fair satisfaction with economic status, poor chewing ability, perception of need for dental treatment, and poor self-perceived general health status. CONCLUSIONS Socio-economic factors seem to contribute to poor oral health among the elderly in Bolivia. Considering that these factors are associated with bad oral health behaviour and few visits to dental clinics, there is a need to design dental education programmes and enhance accessibility to dental clinics for elderly people living in the peri-urban areas of La Paz, Bolivia.
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Affiliation(s)
- Juan Ugarte
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
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Unell L, Johansson A, Carlsson GE, Halling A, Söderfeldt B. Changes in reported orofacial symptoms over a ten-year period as reflected in two cohorts of fifty-year-old subjects. Acta Odontol Scand 2006; 64:202-8. [PMID: 16829494 DOI: 10.1080/00016350500520276] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The study presents changes in reported orofacial symptoms over the course of a 10-year period. It was hypothesized that there was an increase of temporomandibular disorder (TMD) and orofacial pain symptoms during the period concurrent with social and demographic changes. MATERIAL AND METHODS All 50-year-old subjects living in two Swedish counties were asked to answer a mail questionnaire in 1992 and 2002. In the two cohorts, 6,343 and 5,798, respectively, responded (response rate 71.3% and 70.2%). RESULTS Striking differences in demographic, occupational, general, and oral health conditions were found. General health was reported to be less good, utilization of dental care decreased, whereas number of teeth increased. The prevalence of a number of intra-oral symptoms and orofacial symptoms increased significantly between 1992 and 2002. Reported bruxism increased from 18% in 1992 to 28% in 2002. CONCLUSION The observed increase in reported orofacial pain symptoms during the 10-year period, concurrent with changes in society, deserves further attention by society and the dental community.
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Affiliation(s)
- Lennart Unell
- Department of Dentistry, Orebro County Council, Orebro, Sweden
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Johansson A, Unell L, Carlsson GE, Söderfeldt B, Halling A. Risk factors associated with symptoms of temporomandibular disorders in a population of 50- and 60-year-old subjects. J Oral Rehabil 2006; 33:473-81. [PMID: 16774504 DOI: 10.1111/j.1365-2842.2005.01574.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aims of this study were first to investigate, by means of a mail questionnaire, variables from three domains: (i) socio-economic attributes; (ii) general and oral health; and (iii) dental attitudes and behaviours in a large sample of 50- and 60-year-old subjects, and second to compare subjects with or without reported temporomandibular joint (TMJ) pain with respect to these variables. In 2002, a questionnaire was mailed to all 50- and 60-year-old subjects in two Swedish counties, Orebro and Ostergötland (n = 17,138; n50 = 8878; n60 = 8260). Individuals not responding within 2 weeks were given a reminder. If still not answering, a new questionnaire was sent. The final response rate was 72.8% (n = 12,468). The reported responses to questions regarding 'pain in the TMJ region' and 'difficulty to open the mouth wide' were dichotomized into two groups: (i) no temporomandibular disorders (TMD) symptoms; and (ii) some, rather great or severe TMD symptoms. Striking differences in demographic, occupational, general and oral health conditions were found between the groups with and without TMD symptoms. The strongest risk indicator for both pain and dysfunction was reported bruxism. Women, younger subjects (50 years old) and blue-collar workers were significantly more prevalent in the TMD symptom groups. Variables related to impaired general and oral health were more common in the groups with reported TMD problems, whereas satisfaction with received dental care and with teeth was lower. Individuals with reported TMD symptoms differed significantly from those without TMD symptoms in socio-economic attributes, general and oral health symptoms, dental conditions and satisfaction with their teeth.
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Affiliation(s)
- A Johansson
- Department of Oral Sciences-Prosthodontics, Faculty of Dentistry, University of Bergen, Bergen, Norway.
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Abstract
AIM To assess factors associated with perception of oral health in older individuals. DESIGN A cross sectional study. SETTING A densely populated urban area in Sri Lanka. PARTICIPANTS 585 older adults aged 60 years and above of which 475 were living at home and 110 in institutions. The present analysis is limited to 235 subjects who were subjected to a clinical oral examination. METHOD The data were collected by means of an interviewer-administered questionnaire and a clinical oral examination. RESULTS Overall, 48% of the dentate and 42% of the edentate perceived their oral health as poor. The final model of the hierarchical logistic regression analysis for the dentate revealed that presence of retained roots, mobile teeth, >20 missing teeth and perceived need for dental care were significantly associated with poor perceived oral health status. For the edentate, perceived need for dental care, loss of taste sensation and difficulty in eating were significantly associated with poor perceived oral health status. CONCLUSIONS Factors associated with perceived oral health status differed between the dentate and the edentate. Clinical oral health indicators emerged as significant predictors of perceived oral health status in the dentate although the explanatory power of these indicators on perception of oral health was low.
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Affiliation(s)
- L Ekanayke
- Department of Community Dental Health, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka.
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Ståhlnacke K, Söderfeldt B, Unell L, Halling A, Axtelius B. Changes over 5 years in utilization of dental care by a Swedish age cohort. Community Dent Oral Epidemiol 2005; 33:64-73. [PMID: 15642048 DOI: 10.1111/j.1600-0528.2004.00198.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the temporal development of the utilization of dental care, in relation to socio-economic factors and also considering perceived oral health, attitudes to dental care, dental anxiety, care organisation and changes in the way that dental care is paid for. A conflict model was used as a theoretical framework. METHODS In 1992, a mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Orebro and Ostergotland, as part of a cross-sectional study. This study group numbered 8888 persons. In 1997, the same population was sent a new questionnaire. There were 5363 persons who completed the questionnaire in both 1992 and 1997. Changes in utilization of dental care were analysed. RESULTS An increase in personal expenditure for care was obvious, 42% paid more in 1997 compared with 1992. In the study, 7% had prolonged their time since most recent visit and 12% had less frequent visits. In regression models, education, occupation, place of residence, country of birth, marital status, gender, dental anxiety, having poor perceived oral health and poor general health were associated with utilization. Care organisation factors showed there was a greater probability of having higher utilization and higher cost of care when private practitioners provided the care. CONCLUSION Small changes in the utilization of dental care occurred during this study time. Inequality in utilization existed and socio-economic factors affected utilization as well as health perception and dental anxiety. Changes in the cost of care did not affect utilization appreciably, probably because of a selected population with high price elasticity. Having a private care provider compared with one in the public system affected the probability of having higher utilization and higher cost for care.
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Affiliation(s)
- Katri Ståhlnacke
- Community Dental Office, Orebro County Council, Box 1613, SE-70116 Orebro, Sweden.
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