Dental health and disease determinants among 35-year-olds in Oslo, Norway

Exploring socioeconomic inequality in caries experience in an adult Norwegian population; the HUNT4 Oral Health Study

OBJECTIVES

To investigate socioeconomic inequality in caries experience in an adult Norwegian population.

METHODS

This population-based study included 4549 dentate participants aged 25-94 years from the cross-sectional HUNT4 Oral Health Study conducted in Central Norway in 2017-2019. Participants were randomly sampled from the larger HUNT4 Survey and answered questionnaires and underwent clinical and radiographic examinations. Caries experience was measured as numbers of decayed, missing and filled teeth (DMFT index) and socioeconomic position was denoted by education and household income. Negative binomial regression models were used to estimate associations between caries experience and socioeconomic position.

RESULTS

Lower levels of both education and income were associated with higher caries experience, particularly pronounced for missing teeth. Socioeconomic gradients were observed for all outcomes DMFT, DT, MT and FT (p-value linear trends <.001). Gradients were similar for both income and education and were apparent for all age groups but were most evident in middle-aged and older individuals. High level of education was associated with a 50% lower mean number of missing teeth compared with basic level education, whereas high income was associated with a 24% lower mean number of decayed teeth and a 15% higher mean number of filled teeth than low income.

CONCLUSIONS

There was a socioeconomic gradient for caries experience in the study population that was present from early adulthood and increased with age. The gradient was particularly pronounced for missing teeth. Findings indicate that inequality was more associated with treatment given than with untreated disease.

Oral health and oral health behavior in young adults with caries disease

Objective

The aim of this study was to describe and analyze oral health, oral health behaviors, and oral health-related quality of life (OHRQoL) in relation to the level of caries disease among caries-active young adults.

Material and methods

This study presents data from a sample of young adults (n = 135) with active caries disease who were enrolled in a clinical, randomized controlled trial. The independent variables of sociodemographics, oral health (gingivitis, plaque), oral health behaviors (such as toothbrushing, dental attendance, sugar-containing sweets and drinks), dental anxiety, self-rated oral health, and OHRQoL were collected. Multinomial logistic regression was used to simultaneously evaluate the associations between the independent variables and caries severity.

Results

Multinominal logistic regression showed that poor OHRQoL and gingivitis were associated with caries severity in a gradient fashion in accordance with caries disease activity. Also, irregular dental care and frequent consumption of sugary soda were significantly associated with very high caries severity.

Conclusions

The risk factors related to caries severity among young adults were poor OHRQoL, gingivitis, consumption of sugary soda and irregular dental care attendance, indicating the need for a combination of different interventions specifically health behavior change. Furthermore, these findings may contribute to identifying high caries-risk individuals.

Caries experience among adults in core Sámi areas of Northern Norway

OBJECTIVES

Dental caries is a major oral health problem among indigenous people worldwide, but knowledge on this issue among the indigenous Sámi people in Norway is scarce. The aim of the study was to describe dental caries experience in an adult population in core Sámi areas of Northern Norway and to assess the corresponding associations with socio-demographic, socioeconomic and oral health-related behavioural factors.

METHODS

This cross-sectional study is based on data from the Dental Health in the North study (2033 participants aged 18-75 years). A questionnaire was used to collect data on socio-demographic, socioeconomic and oral health-related behavioural factors. Clinical examinations were performed by dentists and dental hygienists at Public Dental Service (PDS) clinics in core Sámi areas of Northern Norway.

RESULTS

About 68% (n = 1380) of participants reported Sámi ethnicity, and the mean number of decayed (D), missed (M) and filled (F) teeth (T) was 16.2 (standard deviation [SD] = 6.7). The mean DMFT was 15.7 (SD = 6.7) among Sámi and 17.0 (SD = 6.7) among non-Sámi. The mean DT among Sámi was 1.0 (SD = 1.6), with a significant, higher prevalence among coastal Sámi (DT = 1.3, SD = 1.8) than inland Sámi (DT = 0.8, SD = 1.5). Living in the coastal region, consumption of sugary soft drinks several times a week or daily, toothbrushing less than daily and irregular dental visits were associated with DT.

CONCLUSIONS

Caries experience among adults in core Sámi areas of Northern Norway was common. Dental caries were more common in the coastal than the inland region, with minor differences in caries experience between Sámi and non-Sámi people within these regions.

Socioeconomic Factors and Caries in People between 19 and 60 Years of Age: An Update of a Systematic Review and Meta-Analysis of Observational Studies

This study is aimed to perform an update of a systematic review and meta-regression to evaluate the effect modification of the socioeconomic indicators on caries in adults. We included studies that associated social determinants with caries, with no restriction of year and language. The Newcastle-Ottawa Scale was used to evaluate the risk of bias. With regard to the meta-analysis, statistical heterogeneity was evaluated by I², and the random effect model was used when it was high. A subgroup analysis was conducted for socioeconomic indicators, and a meta-regression was performed. Publication bias was assessed through Egger's test. Sixty-one studies were included in the systematic review and 25 were included in the meta-analysis. All of the studies were published between 1975 and 2016. The most frequent socioeconomic indicators were schooling, income, and socioeconomic status (SES). In the quantitative analysis, the DMFT (decayed, missing, filled teeth) variation was attributed to the studies' heterogeneity. The increase of 10.35 units in the proportion of people with lower SES was associated with an increase of one unit in DMFT, p = 0.050. The findings provide evidence that populations with the highest proportions of people with low SES are associated with a greater severity of caries. The results suggest the need for actions to reduce the inequalities in oral health (PROSPERO [CRD42017074434]).

[Inequalities in the distribution of dental caries in Brazil: a bioethical approach]

The scope of this paper was to analyze the problem of dental caries as a public health issue of epidemiological relevance. It is a case study based on documentary analysis of national epidemiological surveys on oral health in the years 1986, 2003 and 2010, with the Bioethics of Protection as an analytical support. The surveys revealed inequalities between population groups; and such inequalities were analyzed with respect to the reduction of the disease in the younger population, access to oral health care, and tooth loss, which is the worst outcome for tooth decay. The good results presented in the surveys have not reached the whole population; data have shown inequalities regarding family income and Brazilian region. It was also found that from 2003 government interventions in protective actions such as the adoption of criteria of equity in the allocation of health resources and inclusion of vulnerable population have contributed to a reduction in caries. Nevertheless, it is considered necessary update oral health care models by using Epidemiology as a structuring tool, and an interface with socially responsible protective bioethics, since regional differences continued to be marked in the analysis.

High dental caries among adults aged 35 to 44 years: case-control study of distal and proximal factors

The aim of this study was to determine whether a high degree of dental caries severity is associated with the distal and proximal determinants of caries in a group of Brazilian adults aged 35 to 44 years. A population-based case-control study was conducted using two groups—a case group with high caries severity (DMFT ≥ 14) and a control group without high caries severity (DMFT < 14). The sample comprised adults from metropolitan Belo Horizonte, Brazil (180 cases and 180 controls matched for gender and age). The exam was performed by calibrated dentists using the DMFT index. The statistical analysis used the Mann-Whitney test and bivariate and multivariate logistic regression (the conditional backward stepwise method). The mean DMFT was 8.4 ± 3.9 in the control group and 20.1 ± 4.5 in the case group. High caries severity was associated with regular visits to the dentist, low income, use of private/supplementary dental service and not petitioning the authorities for community benefits. The results of the study underscore the importance of considering distal and proximal factors in the assessment of the severity of dental caries. Greater caries severity persists among low-income families and among groups with a low degree of social cohesion.

Measuring socio-economic inequalities in edentate Scottish adults--cross-sectional analyses using Scottish Health Surveys 1995-2008/09

OBJECTIVES

To investigate the appropriateness of different measures of socio-economic inequalities, in relation to adult oral health in Scotland, utilizing data from a series of large, representative population surveys.

METHODS

The Scottish Health Surveys (SHeS) (1995; 1998; 2003; 2008/09) are cross-sectional national population-based surveys used to monitor health status in those living in private households. The age groups included in this study are as follows: 45-54; 55-64 years: all survey years; 65-74: 1998 onwards; 75+: 2003 onwards. Primary outcome was no natural teeth (edentulism). Three measures of socio-economic position: Occupational social class, Education, Carstairs deprivation score (2001) were used. Simple (absolute/relative differences) and complex measures (Slope Index, Relative Index, Concentration Index and c-index) of inequality were produced for each age group across all four surveys.

RESULTS

Simple and complex (absolute) measures of inequality have both demonstrated narrowing disparities in edentulism over time in the 45- to 64-year-old group, a levelling off in those aged 65 and above, and a rise in those aged 75+. Complex relative measures (RII, Concentration Index and c-index), however, show an increasing trend in inequalities over time for all age groups, suggesting that rates of improvement in edentulism rates are not uniform across all social groups.

CONCLUSIONS

Simple absolute inequality provides a quick and easy indication of the extent of disparities between extreme groups, whereas complex measures (absolute and relative) consider the gradient in health across all social groups. We have demonstrated that both are useful measures of inequality and should be considered complementary to one another. The appropriate choice of complex measure of inequality will depend on the audience to whom the results are to be communicated. This methodological approach is not confined to oral health but is applicable to other health outcomes that are socially patterned.

A systematic review of socioeconomic indicators and dental caries in adults

Increasing evidence suggests that socioeconomic factors may be associated with an increased risk of dental caries. To provide better evidence of the association between dental caries in adults and socioeconomic indicators, we evaluated the relation between these two conditions in a thorough review of the literature. Seven databases were systematically searched: Pubmed, Cochrane, Web of Science, Bireme, Controlled Trials, Clinical Trials and the National Institute for Health and Clinical Excellence. No restrictions were placed on the language or year of publication. The search yielded 41 studies for systematic review. Two independent reviewers screened the studies for inclusion, extracted data and evaluated quality using the Newcastle-Ottawa scale. The following socioeconomic indicators were found: educational level, income, occupation, socio-economic status and the community index. These indicators were significantly associated with a greater occurrence of dental caries: the subject's education, subject's income, subject's occupation and the Gini coefficient. A high degree of heterogeneity was found among the methods. Quality varied across studies. The criteria employed for socioeconomic indicators and dental caries should be standardized in future studies. The scientific evidence reveals that educational level, income, occupation and the Gini coefficient are associated with dental caries.

The severity of dental caries in adults aged 35 to 44 years residing in the metropolitan area of a large city in Brazil: a cross-sectional study

Background

In recent decades, studies in the field of public health have increasingly focused on social determinants that affect the health-illness process. The epidemiological perspective considers oral health to be a reflection of socioeconomic and environmental aspects, and it is particularly influenced by the social context. The aim of the present study was to assess the association between the severity of dental caries among adults aged 35 to 44 years and characteristics on the different levels at which the determinants of caries operate (individual, social structure and social context).

Methods

A home-based, cross-sectional field study was carried out involving a sample of 1,150 adults (35 to 44 years of age) residing in metropolitan Belo Horizonte, Brazil. The DMFT (decayed, missing, filled tooth) index (≥14) was used to determine the severity of dental caries. Bivariate and multivariate analyses were carried out using the Poisson regression model with the level of significance set at 5% (p < 0.05) and 95% confidence intervals.

Results

The majority of the participants (68.5%) had high caries severity. The rate of high-severity caries in the group between 40 and 44 years of age was 1.15-fold (CI: 1.04-1.26) greater than that among those aged 35 to 39 years. A greater prevalence of high caries severity was found among those who frequently visited the dentist (PR = 1.18; CI: 1.07-1.30), those with a lower income (PR = 1.11; CI: 1.01-1.23), those who reported that their neighborhood did not come together in the previous year to petition political leaders for benefits (PR = 1.16; CI: 1.05-1.28) and those who are unable to make decisions (without empowerment) (PR = 1.12; CI: 1.01-1.24).

Conclusions

The present study revealed high dental caries severity in adults, which was associated with individual characteristics, health-related behavior and social structure and contextual variables. These findings underscore the importance of considering social determinants involved in the health-illness process when carrying out epidemiological studies on dental caries.

Dental caries in relation to smoking and the use of Swedish snus: epidemiological studies covering 20 years (1983-2003)

OBJECTIVE

The aim of this study was to evaluate some intra-oral caries-associated variables and tobacco use on dental caries.

MATERIALS AND METHODS

The participants were randomly recruited from three cross-sectional studies in Jönköping, Sweden, in 1983, 1993 and 2003. Each study consisted of 130 individuals in each of the 20, 30, 40, 50, 60 and 70-year age groups. Of these, 550, 552 and 523 dentate individuals attended respective year of examination. They were all examined both clinically and radiographically. A questionnaire was completed in conjunction with the examination. In the studies, 345 were smokers, 104 snus users and 1142 non-tobacco users, in total 1591 individuals.

RESULTS

In 1983 and 1993, there were no significant differences in mean DFS between non-users and smokers, but a statistically significantly higher mean DFS in comparison with snus users. In 2003, there was no statistically significant difference in mean DFS between the groups. Multiple regressions showed that, after adjusting for age, gender and socio-demographic variables, there was a statistically significant association between DFS and smoking in 1983 (smoking excluded in favour of lactobacilli when further analysed) and DFS and plaque index (PLI) in 1993. In 2003, there was no association, apart from buffer capacity (Power rising) between DFS and the examined intra-oral caries-associated variables and tobacco use.

CONCLUSIONS

The results of these epidemiological studies, performed in 1993 and 2003, indicate that daily smoking or snus use does not increase the risk of dental caries.

Family history and oral health: findings from the Dunedin Study

CONTEXT

The effects of the oral health status of one generation on that of the next within families are unclear.

OBJECTIVES

  To determine whether parental oral health history is a risk factor for oral disease.

METHODS

Oral examination and interview data were collected during the age-32 assessments in the Dunedin Study. Parental data were also collected on this occasion. The sample was divided into two familial-risk groups for caries/tooth loss (high risk and low risk) based on parents' self-reported history of tooth loss at the age-32 assessment interview.

MAIN OUTCOME MEASURES

Probands' dental caries and tooth loss status at age 32, together with lifelong dental caries trajectory (age 5-32).

RESULTS

Caries/tooth loss risk analysis was conducted for 640 proband-parent groups. Reference groups were the low-familial-risk groups. After controlling for confounding factors (sex, episodic use of dental services, socio-economic status and plaque trajectory), the prevalence ratio (PR) for having lost 1+ teeth by age 32 for the high-familial-risk group was 1.41 [95% confidence interval (CI) 1.05, 1.88] and the rate ratio for DMFS at age 32 was 1.41 (95% CI 1.24, 1.60). In the high-familial-risk group, the PR of following a high caries trajectory was 2.05 (95% CI 1.37, 3.06). Associations were strongest when information was available about both parents' oral health. Nonetheless, when information was available for one parent only, associations were significant for some outcomes.

CONCLUSIONS

People with poor oral health tend to have parents with poor oral health. Family/parental history of oral health is a valid representation of the intricacies of the shared genetic and environmental factors that contribute to an individual's oral health status. Associations are strongest when data from both parents can be obtained.

Incidence of caries lesions in approximal surfaces: a radiographic study of a general adult Danish population

The aim was to describe the incidence of caries lesions in a randomly selected adult population, and to identify risk factors related to the incidence of caries lesions in approximal surfaces. In 1997, 616 adults participated in a study including a radiographic survey. In 2003 these individuals were contacted again and offered a second radiographic survey; 473 consented and attended this examination. In approximal surfaces, presence/absence of caries lesions and presence and type of coronal fillings were recorded. The incidence of caries lesions in surfaces with no caries lesions in 1997 was studied. Potential risk factors included information at three levels: (1) person, (2) tooth, and (3) surface. The analysis was carried out by multilevel logistic regression. For the analyses 23,701 approximal surfaces were eligible. In 23,243 approximal surfaces no caries lesions were detected in 1997, 17,007 of these were surfaces without fillings, and 6,236 were filled surfaces. In unfilled surfaces several factors affected the risk for development of a caries lesion: young age, high number of fillings, number of teeth and status of the adjacent surface. In filled surfaces few factors affected the incidence of caries lesions: status of the adjacent surface, smoking and distal surfaces. Differences in risk factor patterns for the incidence of caries lesions were found for unfilled and filled surfaces. The study emphasizes the importance of assessing factors related to the incidence of caries lesions in adults. Further it underlines the need to analyse the fate of filled surfaces separately, because once a surface has received a filling it needs continuous attendance.

Maternal oral health predicts their children's caries experience in adulthood

The long-term effects of poor maternal oral health are unknown. We determined whether maternal oral health when children were young was a risk indicator for caries experience in adulthood, using oral examination and interview data from age-5 and age-32 assessments in the Dunedin Study, and maternal self-rated oral health data from the age-5 assessment. The main outcome measure was probands' caries status at age 32. Analyses involved 835 individuals (82.3% of the surviving cohort) dentally examined at both ages, whose mothers were interviewed at the age-5 assessment. There was a consistent gradient in age-32 caries experience across the categories of maternal self-rated oral health status (from the age-5 assessment): it was greatest among the probands whose mothers rated their oral health as "poor" or who were edentulous, and lowest among those whose mothers rated their oral health as "excellent". Unfavorable maternal self-rated oral health when children are young should be regarded as a risk indicator for poor oral health among offspring as they reach adulthood.

Sense of coherence and oral health status in an adult Swedish population

OBJECTIVE

To investigate sense of coherence in relation to oral health status in an adult Swedish population in order to better understand the determinants of positive oral health-promoting behavior and differences in oral health.

MATERIAL AND METHODS

A stratified random sample of 910 individuals from Jönköping, Sweden aged 20, 30, 40, 50, 60, 70 and 80 years was obtained. The investigation used the Swedish short version of the Sense of Coherence (SOC) questionnaire comprising 13 items and a self-report questionnaire to elicit demographic information. In addition, a clinical and radiographic oral examination was performed.

RESULTS

A total of 525 individuals, 261 men and 264 women, consented to participate in the study. Bivariate analysis revealed that higher mean SOC scores were statistically significantly associated with more decayed and filled surfaces (DFS) and filled surfaces (FS), fewer decayed surfaces (DS), fewer teeth with calculus and periodontal health. Multivariate analysis showed that higher SOC scores represented a predictor of fewer occurrences of a periodontal probing pocket depth of ≥4 mm and a lower risk of plaque in different regression models.

CONCLUSIONS

Higher SOC scores may be a protective determinant of plaque and periodontal disease, indicating an association between SOC and oral health.