Rural-urban disparity in oral health-related quality of life

Urban-rural differences in the prevalence of having a family dentist and their association with income inequality among Japanese individuals: a cross-sectional study

BACKGROUND

Few reported studies evaluate the status of those who have a family dentist (FD) by regional differences and the socioeconomic factors associated with this status. This study aimed to assess the prevalence of having an FD among Japanese individuals across three samples of municipality type: urban, intermediate, and rural areas, and determine the factors associated with having an FD.

METHODS

This was a cross-sectional study involving a web-based survey. In total, 2,429 participants (comprising men and women aged 20-69 years) were randomly selected from among the registrants of a web research company: 811 urban residents, 812 intermediate residents, and 806 rural residents. In each area, we categorized the participants into those who had an FD (FD group) and those who did not (non-FD group). A multivariate modified Poisson regression analysis was used to determine the factors associated with the FD group as compared to the non-FD group.

RESULTS

The proportion of the FD group was lowest in rural areas (42.3%), followed by intermediate (48.6%) and urban areas (49.7%). The regression analysis revealed a statistically significant tendency between associated factors in the two groups; that is, the higher the household income, the more likely that the family belonged to the FD group (prevalence ratio (95%CI), JPY 4-6 million: 1.43 (1.00-2.03), JPY ≥ 8 million: 1.72 (1.21-2.44)).

CONCLUSIONS

Rural areas have the lowest proportion of people with an FD among the three areas, and income inequality is associated with having an FD. Thus, when planning policies to encourage individuals to have an FD to manage their oral health, it is necessary to consider regional differences.

Oral health community engagement programs for rural communities: A scoping review

This scoping review aims to identify the available literature on oral health community engagement programs that have been developed to guide oral health care in rural communities and to summarize their outcomes. This review was conducted using the 5-stage scoping review framework outlined by Arksey and O'Malley. We conducted a literature search with defined eligibility criteria through electronic databases such as Science Direct, PubMed, ProQuest, Scopus, EBSCOhost, and Wiley Online; other well-established online scientific health and dental organizations such as the WHO, the Fédération Dentaire Internationale of the World Dental Federation, the American Dental Association, and the South African Dental Association; and grey literature spanning the time interval from January 2012 to August 2023. The charted data were classified, analysed, and reported using descriptive and thematic analyses. A total of 19 records were included in the final review. These records were classified into four categories of interventions: community-based, school-based, integrated dental-based, and non-dental volunteer oral health programs. The findings imply that there is a growing appreciation for the significance of qualitative data in enhancing oral healthcare interventions and outcomes. Furthermore, the study showed that oral health strategies were successful in shaping the understanding and perception of oral health among children and mothers/caregivers, and in improving the oral health and quality of life of edentulous older adults and children living in rural communities.

Differences in the health-related quality of life in patients with asthma living in urban and rural areas in the Amur Region of Russian Federation

BACKGROUND

Asthma usually arises from an interaction between host and environmental factors. Growing attention has been paid to a place of residence as a factor shaping health-related quality of life (QoL). This study investigated the rural-urban disparity in QoL among adult asthma patients in the Amur region of Russian Federation.

MATERIALS AND METHODS

This cross-sectional study included 351 randomly selected adults with asthma. We analyzed QoL (SF-36 and AQLQ scores), asthma control (ACT), and anxiety and depression (HADS) depending on the place of residence (urban vs. rural).

RESULTS

The scale "Role Emotional" (RE) of SF-36 was significantly lower in patients from rural areas compared to urban residents (59.3±3.1 vs. 70.4±2.3 points; p = 0.0042). In the urban group, the correlation analysis demonstrated a clear influence of RE on patients' own assessment of their physical functioning (PF, r = 0.53; p<0.0001). Both groups demonstrated low "Social Functioning" (SF). In the group of urban residents, correlation analysis revealed the presence of positive correlations of SF-36 domains reflecting physical (PF, RP, BP) and social functioning (SF, VT) with most scales of both QoL questionnaires. The domains of the emotional sphere (RE and MH) positively correlated with all scales of both QoL questionnaires among urban residents. In the group of rural residents, a comparative analysis showed the absence of significant correlations between more of the QoL scales. Although Asthma Control Test did not differ between groups, we noted a significantly higher need for β2-agonists in rural areas compared to urban areas (4.2±0.6 vs. 2.7±0.3 inh/day, respectively; p = 0.0221). The frequency of urban residents with a clinically significant level of anxiety (56 persons, or 25.2%) turned out to be lower compared to rural residents (45 persons, or 34.8%; χ2 = 34.08; p<0.001).

CONCLUSION

The burden of asthma introduces a greater imbalance in the health-related QoL of rural residents compared to urban residents in the Amur region of the Russian Federation. The absence of interrelationships of some QoL domains in rural residents suggested a disunity of the physical, psychological and social aspects of life. The rural residents suppress physical discomfort by the more frequent use of short bronchodilators. They often showed emotional instability with a predominance of anxiety, which affected the decrease in QoL in the psycho-emotional sphere.

Rural-urban disparities in the incidence and treatment intensity of periodontal disease among patients with diabetes

Background

Diabetes threatens population health, especially in rural areas. Diabetes and periodontal diseases have a bidirectional relationship. A persistence of rural-urban disparities in diabetes may indicate a rural-urban difference in periodontal disease among patients with diabetes; however, the evidence is lacking. This retrospective study aimed to investigate rural-urban discrepancies in the incidence and treatment intensity of periodontal disease among patients who were newly diagnosed with type 2 diabetes in the year 2010.

Methods

The present study was a retrospective cohort design, with two study samples: patients with type 2 diabetes and those who were further diagnosed with periodontal disease. The data sources included the 2010 Diabetes Mellitus Health Database at the patient level, the National Geographic Information Standardization Platform and the Department of Statistics, Ministry of Health and Welfare in Taiwan at the township level. Two dependent variables were a time-to-event outcome for periodontal disease among patients with type 2 diabetes and the treatment intensity measured for patients who were further diagnosed with periodontal disease. The key independent variables are two dummy variables, representing rural and suburban areas, with urban areas as the reference group. The Cox and Poisson regression models were applied for analyses.

Results

Of 68,365 qualified patients, 49% of them had periodontal disease within 10 years after patients were diagnosed with diabetes. Compared to urban patients with diabetes, rural (HR = 0.83, 95% CI: 0.75-0.91) and suburban patients (HR = 0.86, 95% CI: 0.83-0.89) had a lower incidence of periodontal disease. Among 33,612 patients with periodontal disease, rural patients received less treatment intensity of dental care (Rural: RR = 0.87, 95% CI: 0.83, 0.92; suburban: RR = 0.93, 95% CI: 0.92, 0.95) than urban patients.

Conclusion

Given the underutilization of dental care among rural patients with diabetes, a low incidence of periodontal disease indicates potentially undiagnosed periodontal disease, and low treatment intensity signals potentially unmet dental needs. Our findings provide a potential explanation for the persistence of rural-urban disparities in poor diabetes outcomes. Policy interventions to enhance the likelihood of identifying periodontal disease at the early stage for proper treatment would ease the burden of diabetes care and narrow rural-urban discrepancies in diabetes outcomes.

Caries Experience in Preschoolers in Three Ecuadorian Communities

Dental caries in the preschool population presents a significant challenge in the field of global public health, including Ecuador. Early detection of this disease is crucial for developing effective strategies for prevention and promotion of oral health, which can have a substantial impact on the quality of life of preschool-aged children. This study evaluated 600 children aged 3 to 5 years attending preschool education centers using the ICDAS II diagnostic criteria. The Student's t-test was used to analyze differences between the means of two independent groups. Additionally, an analysis of variance (ANOVA) was conducted to assess differences between the means of three or more groups. The prevalence of caries was 87%, with a dft index of 3.85 in the three provinces studied. A high treatment need was observed in 84.17% of the population. No significant differences in the DFT index were found based on gender, although both groups exhibited elevated values. No significant differences were observed in relation to province and environment. The second molar was the most affected tooth, with a caries prevalence of 58.8%. Despite the lack of significant differences among the evaluated variables, a high prevalence and experience of dental caries were found in the studied population.

Rural-urban disparities in Oral Health-related Quality of Life for middle-aged and older adults with diabetes in Taiwan

Background

Public health faces a significant challenge in reducing rural-urban disparities in diabetes. Since dietary control is part of the medical regimen for diabetes management, how diabetic patients perceive the impact of oral health on their quality of life is critical. The present study aimed to compare the Oral Health-related Quality of Life (OHRQoL) between rural and urban diabetic patients.

Methods

The study design was cross-sectional. The study sample included 831 self-reported diabetic patients, extracted from the first wave of the new-cohort Taiwan Longitudinal Study on Aging survey (NC_TLSA) that comprised a nationally representative sample of community-dwelling adults aged 50 and above in Taiwan. The composite score generated from the Oral Health Impact Profile-7 (OHIP-7), which has seven questions, was used to construct two OHRQoL measures, the severity of perceived poor OHRQoL and the prevalence of poor OHRQoL. These two OHRQoL measures were treated as dichotomous variables. Multivariate logistic regression models were applied for analysis.

Results

Rural diabetic patients had a higher likelihood of experiencing the severity of perceived poor OHRQoL than those in urban areas (OR = 2.40, 95% CI: 1.30-4.40). Although rural diabetic patients also had a higher prevalence of poor OHRQoL than urban diabetic patients, the difference was not significant (OR = 1.47, 95% CI: 0.95-2.28). Social determinants, such as education, are essential factors attributed to both OHRQoL measures.

Conclusion

Overall, rural diabetes community-dwelling patients had a poorer OHRQoL than those in urban areas. Given a bidirectional relationship between oral health and diabetes, improving oral health in rural areas may be a critical avenue to improve the quality of diabetes care in rural areas.

A Bibliometric Mapping Study of the Literature on Oral Health-related Quality of Life

BACKGROUND

Oral health is an indispensable component of overall health, and oral health status significantly influences people's physical, mental, and social well-being. Oral health-related quality of life (OHRQoL), an important and widely used dental patient-reported outcome (dPRO), is attracting more and more researchers' attention and interest. This study aimed to analyze and map the existing scientific literature regarding OHRQoL through a bibliometric approach, including a summary of the characteristics of OHRQoL-related publications, the identification of prolific entities, high-frequency keywords analysis, and research trend analysis via periodic high-impact keywords.

METHODS

A literature search was conducted in the Web of Science Core Collection to collect OHRQoL-related original research and review articles. After examination and deduplication, the following bibliometric information was extracted from each article: title, abstract, keywords, authors, affiliations, geographic origin (countries/regions), year of publication, journal name, and references. Various scientometric mapping tools including Microsoft Office spreadsheet, VOSviewer, Biblioshiny R-package software, and Scimago Graphica were used to analyze basic bibliometric parameters, leading producers, high-impact keywords, and research trends.

RESULTS

A total of 3324 OHRQoL-related articles (3119 original research articles and 205 review papers) were collected, which received 65,704 citations. A total of 9950 authors from 2429 organizations contributed to this body of research. Prolific authors from Europe, USA, Brazil, New Zealand, China, and Canada were identified, and they also centered collaboration clusters in the co-author network. Community Dentistry and Oral Epidemiology was the most prolific journal. Twenty-one keywords with more than 200 occurrences, and 23 keywords with more than 150 occurrences, were identified for publications of 1994-2021 and 2012-2021, respectively. Keyword analysis revealed hot topics such as instrument development and validation, studies targeting children and adolescents, as well as clinical studies in operative dentistry, implantology, orthodontics, and community dentistry. Oral Health Impact Profile is the most commonly used instrument in OHRQoL-related research.

CONCLUSIONS

OHRQoL is an impactful topic in dental health care as it is not only useful in dental research and patient-centered clinical outcome measures but also provides valuable guidance in dental public health administration and policy making. OHRQoL-related research presents a dynamic landscape and is expected to continue presenting high productivity and broad application in the future.

Peruvian Children's Access to Oral Health Information during the COVID- 19 Pandemic

Aim

The aim of this study was to determine the impact of COVID-19 pandemic on access to oral health information of Peruvian children.

Materials and Methods

The Demographic and Family Health Survey generates annually a national database of Peruvian children between 0 and 11 years old, which is collected through direct interviews applied in the homes of residents of the country. A cross-sectional study was applied with this information collected during 2019 and 2020, with a final sample of 39 124 subjects, 15 974 from the year 2019 (62.03%) and 7088 from the year 2020 (55.54%). The dependent variable was access to oral health information and the independent variable was year; in addition, there were considered sociodemographic and geographical covariates. Finally, there were executed descriptive, bivariate, and multivariate analyses.

Results

Access to oral health information was 59.85% (n = 23 062). For the bivariate analysis, the dependent variable showed association with year, natural region, sex, altitude, health insurance coverage, area, place of residence and wealth index. During multivariate analysis, year manifested a negative association with access to oral health information (aPR: 0.89; 95%CI: 0.85-0.92; P < 0.001), adjusted for co-variables that previously manifested association.

Conclusion

Access to oral health information for Peruvian children had a negative impact during 2020, in which COVID-19 pandemic occurred.

Awareness of professional fluoride application and its caries prevention role among women in KSA

Objectives

Considering the high caries prevalence among Saudi females, spreading knowledge on caries prevention modalities such as high-concentration professional fluoride (PF) applications could decrease their risk of dental caries. However, little is known about the current level of female awareness on the important caries prevention role of PF applications. Therefore, this study assessed the level of awareness of female adults in the KSA regarding PF application and its role in caries prevention.

Methods

An electronic self-administered anonymous questionnaire was distributed among women in Almadinah Almunawwarah, KSA using social media groups. It consisted of four sections: demographic data, caries experience, knowledge regarding fluoride and caries prevention, and knowledge regarding PF application and caries prevention. For the statistical analyses, simple descriptive statistics as means and frequency distributions were calculated, whereas comparisons were performed using the chi-squared test.

Results

A total of 405 females participated in the study. Participants were mostly married non-working Saudi women aged between 18 and 55 years. The education level of the majority of participants was at least a bachelor's degree. Most of the participants reported a high caries experience indicated by the presence of cavities (69.1%), fillings (87.2%), and missing teeth due to cavities (64.7%). Regarding PF questions, 34.8% knew the role of PF in caries prevention and 35.6% responded correctly to forms of PF. Only 14.5% reported receiving PF, whereas 57.3% did not know the frequency of PF application. A significant relationship was found between a lack of knowledge regarding the role of PF application and the presence of cavities (p = 0.003). Only 30.4% of participants reported receiving advice from their dentists regarding PF application.

Conclusion

Most female adults in Almadinah Almunawwarah, KSA have limited knowledge of the importance of PF application in caries prevention, which could contribute to their caries experience.

Caries Experience and Treatment Needs in Urban and Rural Environments in School-Age Children from Three Provinces of Ecuador: A Cross-Sectional Study

In Ecuador, national epidemiological surveys have not been updated; however, some regional studies in the northern areas of the country still report a high prevalence of dental caries. The aim of this study was to determine the experience, severity, and need for treatment of dental caries in school children aged 6 to 12 years in urban and rural settings in three provinces of southern Ecuador. This cross-sectional, relational study examined 1938 schoolchildren in the provinces of Azuay, Cañar, and Morona Santiago. The survey instruments were based mainly on the WHO manual Methods of Oral Health Surveys (dmft) for primary and permanent dentition (DMFT), as well as the prevalence, severity, and Significant Caries Index (SCI). The parametric Student’s t-test was used to compare two groups, and the Spearman’s Rho and Tau-c Kendall correlation coefficients were used to associate the categorical variables. Results: The prevalence of caries in the primary dentition was 78% and 89.2% in the permanent dentition. The dmft (M = 4.12, SD = 2.86) and DMFT (M = 3.62: SD = 3.07) placed the general group in a moderate caries index. The need for treatment was 90.68% in the primary dentition, while it was 87.99% in the permanent dentition. Caries severity in both dentitions was high (M = 7.74; SD = 3.42). Conclusions. Alarming indicators of caries experience and the need for treatment were observed in the population studied.

Characteristics of Individuals in Japan Who Regularly Manage Their Oral Health by Having a Family Dentist: A Nationwide Cross-Sectional Web-Based Survey

Dental healthcare systems may differ between countries; however, having a family dentist is generally important for proper oral health management. This study aims to analyze the proportion of people in Japan who have a family dentist, and their characteristics. A nationwide web-based survey with 3556 participants (1708 men and 1848 women) showed that 45.6% of men and 54.1% of women had a family dentist (FD group). A multiple logistic regression analysis revealed that men in the FD group mostly belonged to older age groups (≥70 s, OR: 2.41), received higher household incomes (≥8000 K JPY, OR: 1.47), brushed their teeth three or more times daily (OR: 1.60), practiced habitual interdental cleaning (OR: 3.66), and fewer lived in rural areas (towns and villages, OR: 0.52). Regarding the women, the majority belonged to older age groups (60 s, OR: 1.52; ≥70 s, OR: 1.73), practiced habitual interdental cleaning (OR: 3.68), and fewer received lower household incomes (<2000 K JPY, OR: 0.61). These results suggest that despite Japan being a country with a public insurance coverage system for both men and women, having a family dentist is associated with disparities in individual socioeconomic factors, particularly age and household income.

Impact of Parents' Oral Health Literacy on Their Own and Their Children's Oral Health in Chinese Population

Background

Oral health literacy (OHL) has been recognized as a component of oral health disparities; however, the precise relationship between literacy and oral health outcomes has not been established. To explore the role of parents' OHL for their own subjective oral health, related behavior, and for the proxy assessment of their child's oral health, oral health-related behavior.

Methods

Survey data were collected from 406 parents of 4- to 7-year-old children in Beijing, China. The background characteristics, oral health assessment, oral health-related behavior, knowledge and attitudes, and diet-related questions of parents and their children were surveyed by a questionnaire. OHL was assessed with the Hong Kong Rapid Estimate of Adult Literacy in Dentistry (HKREAL-30) Scale and a revised version that asked the respondents to indicate if they understood the words (HKREALD-30-Understand).

Results

The HKREALD-30 responses correlated with the HKREALD-30-Understand responses. The higher the parents' HKREALD-30-Understand scores, the better they described the health of their own teeth and gums, the greater their child's diet was influenced by the protein, sugar and calories of the food, and the more positive their oral health-related attitudes were. The higher the parent's HKREALD-30 scores, the healthier they described their child's teeth and gums.

Conclusions

Both the HKREALD-30 and HKREALD-30-Understand Scores correlate with parents' self and proxy oral health-related responses. Chinese parents could understand that the word would add predictive value to the prediction of how parents' oral health literacy affects their own oral health care, children's oral health and other related aspects.

Health literacy and quality of life among people in semi-urban and urban areas

OBJECTIVE

to investigate health literacy level, quality of life and related factors in semi-urban and urban areas.

METHOD

this cross-sectional study was carried out between December 2018 and February 2019 with 595 participants. The variables found significant in the bivariate regression analysis were included in the multivariate regression analysis.

RESULTS

according to the scores obtained from the Health Literacy Scale, participants' health literacy 76.5% levels were adequate. The factors affecting the Health Literacy Scale score in semi-urban areas were educational status, income status, presence of a chronic disease, perceived health, and understanding the health information provided. The factors affecting the Health Literacy Scale score in urban areas were age, marital status, reading habits, presence of a chronic disease, and understanding the health information provided (p < .05). There was a statistically significant difference between participants living in semi-urban and urban areas in terms of their health literacy and quality of life levels (p < .001).

CONCLUSION

the health literacy level was inadequate in three out of ten participants, and it was even lower in semi-urban areas.

Sociodemographic factors affect the quality of life and burden of caregivers in special care in dentistry

AIMS

To analyze the epidemiological profile and quality of life (QoL) of patients with special needs and overload their caregivers.

METHODS AND RESULTS

Health-related QoL was assessed in a quantitative, observational, cross-sectional study of prospective characteristics using the WHOQOL-BREF and ZARIT-22 questionnaires. This study included 122 patients were included; they were divided into patients without caregiver assistance (n = 63) who answered WHOQOL-BREF, 49 caregivers (n = 49) who responded to ZARIT-22, and 10 patients were secondarily caregivers of their parents and answered the ZARIT-22 + WHOQOL-BREF questionnaires. The WHOQOL-BREF general score was 71.94 ± 10.58, and patients born in urban areas and married had positive correlations (p < .05) with the QoL scores in the physical and social domains. ZARIT-22 scores showed an average of 58.63 ± 14.07. Data cross-checking revealed that patients of white races (p = .030) and who lived in urban regions (p = .003) generated less overload to caregivers.

CONCLUSION

In the WHOQOL-BREF analysis, family income was a factor with direct impact, and all caregivers referred to moderate-to-high overload, with an increase in prevalence as far away from the service the patient resides.

Interseções entre resiliência e qualidade de vida em mulheres rurais: estudo de métodos mistos

Resumo Objetivo: analisar as interseções entre qualidade de vida e resiliência de mulheres rurais. Método: estudo de métodos mistos convergente, no qual foram triangulados um estudo quantitativo de corte transversal e um estudo qualitativo guiado pela da história oral de vida. Os dados foram concomitantemente coletados utilizando-se de um formulário sociodemográfico, da Escala de Resiliência, do Medical Outcomes Study 36-Item Short-Form Health Survey e mediante entrevistas abertas. A análise deu-se por estatística descritiva e inferencial e análise temática indutiva, com posterior integração. Resultados: constatou-se associação entre o domínio aspectos sociais de qualidade de vida e o grau moderado de resiliência, relacionado às características do cotidiano rural. A integração dos resultados possibilitou reconhecer que a interseção entre os dois construtos, que se influenciam mutuamente, ocorre pela mediação de fatores de proteção para resiliência elaborados pelas mulheres rurais, como a espiritualidade, a formação de redes de apoio social e os sentimentos de encantamento e pertencimento ao seu contexto. Conclusão: a partir da elaboração de fatores de proteção, as mulheres rurais desencadeiam atitudes resilientes que contribuem para sua qualidade de vida. A identificação desses fatores permite o desenvolvimento de intervenções psicossociais que podem contribuir para a promoção da saúde da mulher rural.

Intersections between rural women’s resilience and quality of life: a mixed-methods study

Objective:

to analyze the intersections between rural women’s quality of life and resilience.

Method:

convergent mixed methods design in which a cross-sectional quantitative study is triangulated with a qualitative study guided by Oral History. Data were collected concomitantly, using a socio-demographic form, Resilience Scale, Medical Outcomes Study 36-Item Short-Form Health Survey, and open-ended interviews. The analysis was based on descriptive and inferential statistics and inductive thematic analysis, which was integrated later.

Results:

an association was found between the social aspects domain of quality of life and a moderate level of resilience related to the characteristics of life in rural areas. The integration of results enabled verifying that these two constructs (which mutually influence each other) are mediated by protective factors, resilience developed by the rural women, such as spirituality and the formation of social support, enchantment, and a feeling of belonging to their context.

Conclusion:

by developing protective factors, rural women develop a resilient behavior that favors their quality of life. Identifying these factors enables the development of psychosocial interventions to promote rural women’s health.

Intersecciones entre resiliencia y calidad de vida en mujeres rurales: estudio de métodos mixtos

Resumen Objetivo: analizar las intersecciones entre calidad de vida y resiliencia en mujeres rurales. Método: estudio de métodos mixtos convergentes, en el que fueron triangulados un estudio cuantitativo de corte transversal y un estudio cualitativo guiado por la historia oral de vida. Los datos fueron concomitantemente recolectados utilizando formulario: sociodemográfico de la Escala de Resiliencia y del Medical Outcomes Study 36-Item Short-Form Health Survey; y, mediante entrevistas abiertas. El análisis se realizó con la estadística descriptiva e inferencial, y con el análisis temático inductivo, con posterior integración. Resultados: se constató asociación entre el dominio aspectos sociales de calidad de vida y el grado moderado de resiliencia, relacionado con las características de lo cotidiano rural. La integración de los resultados posibilitó reconocer que la intersección entre los dos constructos, que se influencian mutuamente, ocurre por la mediación de factores de protección para la resiliencia, elaborados por las mujeres rurales, como la espiritualidad, la formación de redes de apoyo social, y los sentimientos de encantamiento y pertenencia a su contexto. Conclusión: a partir de la elaboración de factores de protección, las mujeres rurales desencadenan actitudes resilientes que contribuyen para su calidad de vida. La identificación de esos factores permite el desarrollo de intervenciones psicosociales que pueden contribuir para la promoción de la salud de la mujer rural.

Rural-urban differences in oral health among older people in Southern Brazil

This study aimed to assess the association between oral health and rurality in an older Brazilian population. Population-based samples of 1,451 urban and 411 rural elders were obtained from two databases. Several oral health and related measures, including the number of teeth lost, use of dental prostheses, dental visits, self-reported oral health, and perceived need for a dental prosthesis, were compared. Oral health-related information was obtained by a trained research team with interviews conducted in the individuals' homes. Regression models were used to verify the association between living in rural areas and oral health outcomes after adjusting for possible confounding factors. The elderly population mostly comprised of women in rural or urban areas, and the mean age was 70 years in both locations. Less-educated individuals (without or with complete elementary schooling) were more common in rural regions than in urban areas. After adjustment for socioeconomic characteristics, living in rural areas was associated with a lower perceived need for dental prostheses (PR 0.68, 95% CI 0.56-0.84), poor self-reported oral health (OR 1.24; 95% CI 1.05-1.46), and having fewer teeth (β -1.31; 95% CI -2.18 to -0.45). The place of residence had a significant impact on oral health indicators, with rurality negatively influencing oral health. These findings suggest that preventive and curative strategies for dental services may be needed for the Brazilian rural population.

[Quality of life related to oral health in adults in the city of Macas, Ecuador, 2021]

Objective

To determine the quality of life related to oral health in 18-99-year-old people in the city of Macas-Ecuador 2021.

Materials and methods

This was a descriptive, cross-sectional study following a quantitative approach. A total of 415 people over 18 years of age from Macas-Ecuador were evaluated. The instrument of measure was a OHIP-14 instrument composed of 7 dimensions, each of which had 2 questions. The study variables (sex, age, socioeconomic level, occupation) were analyzed using the Mann-Whitney U statistical test, with p <0.05 being considered as significant.

Results

There was a predominance of 63% of women. The dimension of "psychological distress" had the highest overall impact of all the items answered. Comparison of the OHIP-14 dimensional scores between men and women showed statistically significant differences in functional limitation and handicap with p = 0.012 and p = 0.036, respectively.

Conclusions

There is a relationship between quality of life and oral health among the inhabitants of the city of Macas-Ecuador. The OHIP-14 instrument showed the dimension of "psychological distress" to be the main factor of oral problems.

Rural-urban disparities in patient satisfaction with oral health care: a provincial survey

Background

Identifying spatial variation in patient satisfaction is essential to improve the quality of care. Thus, the objective of this study was to investigate rural–urban disparities in patient satisfaction and to determine the factors that could influence satisfaction with oral health care.

Methods

Data from 1788 parents/caregivers of children who participated in the Quebec Ministry of Health clinical study were subject to secondary analysis. The Perneger model of patient satisfaction was used as the conceptual framework for the study. Satisfaction with oral health care was measured using the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II). Explanatory variables included predisposing factors and enabling resources. Statistical analyses included descriptive statistics, as well as bivariate and linear regression models.

Results

Individuals with higher income, dental insurance coverage, having a family dentist, reporting ease in finding a dentist, and having access to a private dental clinic were more satisfied with oral health care (p < 0.001). There were statistically significant differences between rural and urban Quebec residents in their ratings of patient satisfaction on four items, including dental office location (p = 0.013), dental equipment (p = 0.016), cost of dental treatment (p < 0.001), and cleanliness of dental office (p = 0.004), with greater satisfaction for urban dwellers. The multiple linear regression model showed that major determinants of patient satisfaction were being born in Canada, income ≥ 40,000$ CAD, having a family dentist, and having visited the dentist in the last year for regular checkups. However, ethnicity, having difficulty finding a dentist, and being in need of dental treatment negatively influenced patient satisfaction with oral health care.

Conclusions

These findings suggest that Quebec rural–urban disparity exists in patient satisfaction with care and that determinants of health influence this outcome. Intensive and powerful knowledge dissemination activities are needed to mobilize policymakers in implementing public health strategies to reduce this disparity.

Examining the Relationship between Social and School Environment and Children's Caries Experience Using Primary and Secondary Data: A Cluster Analysis

Dental caries is still prevalent worldwide, even with advances in preventive and curative measures. The aim was to examine clustering patterns of socioeconomic and environmental characteristics of schools and their associations with caries experience of schoolchildren. An epidemiological survey with cross-sectional design was conducted in 2014/2015 and included 5,213 students (aged 2-11 years) from 38 public schools of Carapicuíba (SP, Brazil). Primary data consisted of dental examinations performed at schools by 6 calibrated examiners to evaluate caries experience (dmf/DMFT index). Secondary data were extracted from the last official Demographic Census (2010) and School Census (2014 and 2015) to assess the socioeconomic and environmental characteristics of the territorial units and infrastructure of each school, respectively. Cluster analysis and ANOVA were applied to identify schools with similar social and environmental aspects and children's caries experience. A logistic regression model was used to ascertain the effects of cluster variables on the likelihood that participants have caries experience, controlling for the stage of dentition and sex. Two valid and reliable clusters were identified: cluster 1 ("advantaged group"), characterized by 33 schools with the highest percentages of children without caries experience and located in regions with better socioenvironmental indicators, and cluster 2 ("least advantaged group"), characterized by 5 schools with higher percentages of children with caries experience, lower percentages of households with sanitary sewer and water supply, higher residents/household ratio and higher percentages of families living with up to 1 minimum wage. An increase in the odds of having caries experience for each percent of houses with well water and families which live with up to 1 minimum wage was observed. By using primary and secondary data, the study draws attention to the relationship between socioeconomic and environmental indicators and caries experience, identifying least advantaged regions and helping to design strategic health plans for this target population.

Anti-inflammatory effect of salt water and chlorhexidine 0.12% mouthrinse after periodontal surgery: a randomized prospective clinical study

OBJECTIVES

The purpose of this study was to compare the anti-inflammatory efficacy of sodium chloride- and a 0.12% chlorhexidine mouth rinses in patients undergoing minimal invasive periodontal surgery.

MATERIALS AND METHODS

Forty-seven patients with a diagnosis of periodontitis and indication for access flap procedure were randomly selected. Group A: a sodium chloride (salt)water-based mouth rinse (test group) or group B: a 0.12% chlorhexidine mouth rinse (control group) administered after surgery. Gingival Index (GI) were evaluated in the whole mouth and in the surgical site at baseline (T1), a week later (T2), and 12 weeks (T3) after the treatment. Total MMP activity was measured in GCF using a commercial kit and plate reader. Medians of total MMP activity and GI were compared for time intervals T1 vs. T2, T1 vs. T3, and T2 vs T3 using Friedman tests and Wilcoxon signed rank tests, and were also compared between test and control using Mann-WhitneyU tests at each timepoint.

RESULTS

The average GI values showed significant differences between baseline and T2 (p = 0.0005) and baseline and T3 (p = 0.003) in the test group.

CONCLUSION

The sodium chloride-mouth rinse use after periodontal surgery seems to have similar anti-inflammatory properties as CHX mouth rinse and can be used regularly postoperatively after periodontal surgical procedures.

CLINICAL RELEVANCE

The use of salt water mouthwash showed an anti-inflammatory effect similar to CHX 0.12% after minimal invasive periodontal surgery. Salt water mouthwash is accessible to the world population and can contribute on the healing process after periodontal surgery.

How do the influencing factors of health-related quality of life of the injured patient differ according to activity limitations?

PURPOSE

This study aimed to ascertain the general characteristics of injured patients and use the Andersen Model to identify factors affecting health-related quality of life (QOL) in injured patients with or without activity limitations.

METHODS

We used data of 1602 injured patients from 2014 to 2017 from the population-based Korea National Health and Nutrition Examination Survey, South Korea. QOL was measured using the EQ-5D-3L, and activity limitations were analyzed alongside predisposing factors (gender, age, education level, and marital status), enabling factors (basic living security, health insurance type, private insurance status, household income, and living with family), need factors (number of chronic diseases, subjective health status, and unmet medical needs), and health behaviors (smoking status, alcohol consumption, physical activity, and health screening). Data were analyzed using homogeneity testing, t tests, and logistic and multiple regression.

RESULTS

The mean EQ-5D index was 0.8 with activity limitations and 0.9 without activity limitations. In mobility domain, patients without activity limitations showed significant effects of age, education level, number of chronic diseases, subjective health status, and unmet medical needs on mobility, whereas patients with activity limitations only showed a significant effect of age. In self-care domain, age, household income, and number of chronic diseases showed significant factors on patients without activity limitations, but there was no significant factor associated with activity limitations. Among the factors affecting usual activities, gender was found to have a significant effect only on patients with activity limitations, and subjective health status was found to have a significant effect regardless of activity limitations. Among the factors affecting pain/discomfort, living with family only affected pain/discomfort in patients with activity limitations. Among the factors affecting anxiety/depression, gender and alcohol consumption had significant effects only on patients with activity limitations.

CONCLUSION

Factors affecting the QOL of injured patients differed depending on whether patients had activity limitations. Therefore, when assessing injured patients, it may be necessary to ascertain the extent of activity limitations, and medical institutions and local communities need when implementing education and interventions to improve their QOL.

Variation in dental services by rurality among privately insured adults in the United States

OBJECTIVES

Rurality is associated with reduced dental access and worse oral health outcomes. It is unknown whether there is variation in dental services received by rural adults who visit a dentist.

METHODS

This was a retrospective analysis of claims data from a large private insurer. All individuals who had at least one dental visit in 2018 were included. Patient demographics, whether or not a patient's ZIP code was rural as defined by the Federal Office of Rural Health Policy, as well as ZIP code demographics were collected. Differences in the frequency of dental services received were evaluated using χ² tests. Multilevel logistic regressions were used to evaluate the individual and ZIP code-level correlates of receiving a preventive dental procedure, a tooth extraction, or a denture-related dental procedure.

RESULTS

Rates of preventive, oral and maxillofacial surgery, and denture-related procedures were higher among rural adults. Accounting for individual age and gender, and ZIP code average income and dentist density, rural dwellers were more likely to receive a preventive procedure [odds ratio (OR) 1.15, P < 0.0001] or tooth extraction (OR 1.08, P < 0.0001), and less likely to have a denture-related procedure (OR 0.94, P = 0.015) compared to nonrural dwellers. Female gender was the strongest predictor of receiving a preventive procedure (OR 1.30, P < 0.0001).

CONCLUSIONS

Even among privately insured individuals with known access to dental care, rurality was associated with significant differences in the frequency of various dental procedures. Rural dental patients may have higher needs for oral surgical procedures, even when they have access to preventive care.

Oral health-related quality of life among 12-year-olds

Aim: To assess oral health-related quality of life (OHRQoL) and associated factors among the 12-year-old population of the state of Minas Gerais, Brazil. Methods: Cross-sectional data from the SB-Minas Gerais 2012 study were used. The presence of poor OHRQoL was assessed using the Oral Impact on Daily Performance (OIDP) and its dimensions (physical, psychological and social domains). Independent variables included sociodemographic factors and variables related to the use of dental care and oral health conditions. The association between the outcomes and the independent variables were tested using logistic regression and the results reported as odds ratio with 95% confidence interval. Results: Prevalence of poor OHRQoL was 31.4%; the psychological domain was the most affected (22.6%). Pain and dissatisfaction with oral health were associated with poor OHRQoL on overall OIDP and all its domains. Non-whites had greater poor OHRQoL than whites on overall OIDP and physical domain. Conclusion: Self-perceived oral health and social inequalities were associated with poor OHRQoL.

Gingival inflammation influences oral health-related quality of life in individuals living in a rural area of southern Brazil

AIM

The aim of the present cross-sectional study was to evaluate whether the extent levels of gingival inflammation (GI) in whole mouth or restricted to the anterior region are independently associated with oral health-related quality of life (OHRQoL) in individuals living in a rural area of southern Brazil.

MATERIALS AND METHODS

A probability sample of 688 individuals was submitted to a full-mouth periodontal examination at six sites on each tooth. Extent levels of GI in whole mouth and restricted to anterior region were dichotomously considered when bleeding on probing (BoP) occurred at 20% or more of whole-mouth sites and at 10% or more of anterior region sites, respectively, in individuals with probing depths ≤3 mm, totalling 121 individuals analysed, aged 15-82 years. OHRQoL was assessed using the simplified version of the Oral Health Impact Profile (OHIP₁₄ ) questionnaire. Adjusted multilevel Poisson regression analysis was used with a conceptual hierarchical approach to calculate the rate ratio (RR) of OHIP₁₄ scores.

RESULTS

In the adjusted model, higher extent levels of full-mouth GI (RR = 1.23; 95% confidence interval [CI]: 1.06-1.44; p = .004) and GI restricted to the anterior region (RR = 1.29; 95% CI: 1.11-1.51; p ≤ .001) were significantly associated with poorer OHRQoL.

CONCLUSIONS

The extent of GI in whole mouth (≥20% of sites with BoP) and in the anterior region (≥10% of sites with BoP) was independently associated with OHRQoL in individuals living in a rural area.

Oral health impacts among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18

BACKGROUND

This paper examines oral health impacts of toothache experience, self-rated oral health (SROH), being uncomfortable with dental appearance, and avoiding foods in the Australian adult population.

METHODS

The explanatory variables include age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data were collected in the interview in NSAOH 2017-18.

RESULTS

There were lower percentages with: toothache in the highest (14.8%) than middle (21.2%) and lower income tertiles (25.2%); fair/poor SROH in the highest (15.8%) than middle (24.1%) and lower tertiles (34.8%); uncomfortable with appearance in the highest (29.1%) than middle (35.3%) and lower tertiles (42.2%); and food avoidance in the higher (15.3%) than middle (22.9%) and lower tertiles (34.4%). There were higher percentages with: toothache in the unfavourable (32.2%) than intermediate (23.1%) and favourable (11.7%) visiting groups; fair/poor SROH in the unfavourable (44.0%) than intermediate (27.4%) or favourable (10.2%) groups; being uncomfortable about appearance in the unfavourable (47.6%) than intermediate (39.5%) or favourable (25.8%) groups; and avoiding foods in the unfavourable (34.8%) than intermediate (26.0%) or favourable (14.5%) groups.

CONCLUSIONS

Socioeconomic status and dental visiting were associated with oral health impacts. Oral health impacts were worse for those with lower income and unfavourable visiting patterns.

Utilisation of dental services by Brazilian adults in rural and urban areas: a multi-group structural equation analysis using the Andersen behavioural model

Background

The utilisation of health services is determined by complex interactions. In this context, rural populations face greater barriers in accessing dental services than do urban populations, and they generally have poorer oral health status. The evaluation of the determinants of health services utilisation is important to support planning and management of dental services. The aim of this study was to evaluate the predictors of dental services utilisation of Brazilian adults living in rural and urban areas.

Methods

Data from 60,202 adults aged 18 years or older who took part in the Brazilian National Health Survey carried out in 2013 were analysed. Predisposing (age, sex, education, social networks), enabling financing (income, durable goods and household’s crowding), enabling organisation (health insurance, registration in primary health care [PHC]) and need variables (eating difficulties, self-perceived tooth loss and self-perceived oral health) were selected based upon the Andersen behavioural model. Multi-group structural equation modeling assessed the direct and indirect associations of independent variables with non-utilisation of dental services and the interval since the last dental visit for individuals living in rural and urban areas.

Results

Adults living in urban areas were more likely to use dental services than those living in rural areas. Lower enabling financing, lower perceived dental needs and lack of PHC registration were directly associated with lower utilisation of dental services (non-utilisation, β = − 0.36, β = − 0.16, β = − 0.03, respectively; and interval since last dental visit, β = 1.25, β = 0.82, β = − 0.12, respectively). The enabling financing (non-utilisation, β_rural = − 0.02 [95%CI: − 0.03 to − 0.02], β_urban = 0.00 [95%CI: − 0.01 to 0.00]) and PHC registration (non-utilisation, β_rural = − 0.03 [95%CI: − 0.04 to − 0.02], β_urban = − 0.01 [95%CI, − 0.01 to − 0.01]) non-standardised total effects were stronger in rural areas. Enabling organisation (β = 0.16) and social network (β = − 2.59) latent variables showed a direct effect on the interval since last dental visit in urban areas. Education and social networks influenced utilisation of dental services through different pathways. Males showed less use of dental services in both urban and rural areas (non-utilisation, β_rural = − 0.07, β_urban = − 0.04; interval since last dental visit, β_rural = − 0.07, β_urban = − 0.07) and older adults have used dental services longer than younger ones, mainly in rural areas (β_rural = 0.26, β_urban = 0.17).

Conclusion

Dental services utilisation was lower in rural areas in Brazil. The theoretical model was supported by empirical data and showed different relationships between the predictors in the two geographical contexts. In rural areas, financial aspects, education, primary care availability, sex and age were relevant factors for the utilisation of services.

Smoking cessation is related to change in metabolic syndrome onset: A rural cohort study

INTRODUCTION

Relatively few, mainly cross-sectional, studies have examined the relationship between smoking cessation and metabolic syndrome (MetS). In particular, information on smoking cessation after MetS is limited. This study aimed to investigate the probability of smoking cessation after the onset of MetS.

METHODS

In this study we used cohort data from a rural area of Korea and extracted the data of 1054 smokers who were identifiable at baseline and were followed up. Of these, 1041 individuals were selected. Descriptive statistical analyses were performed to identify the basic characteristics of smokers. Multiple logistic regression was performed to determine the association between changes in MetS and smoking cessation.

RESULTS

The probability of smoking cessation was 1.84 times higher in the newly developed MetS cohort than in the reference group (without MetS at any time point), and it was 1.61 times higher in the persistent MetS cohort than in the reference group, with both probabilities being significant.

CONCLUSIONS

We found that patients with MetS were more likely to quit smoking than those without MetS. However, intervention is still needed, as numerous patients with MetS continued to smoke. Interventions that actively involve medical institutions or organizations are among the most effective approaches to promote smoking cessation in patients with MetS. In particular, women, farmers and current drinkers should be prioritized.

Association between gingival parameters and Oral health-related quality of life in Caribbean adults: a population-based cross-sectional study

BACKGROUND

Good oral health has been associated with better quality of life and general health. In the Caribbean, there have been no studies regarding the association between oral health conditions and the quality of life of the population. The main purpose of this study was to investigate the association between gingival parameters and oral health-related quality of life (OHRQoL) in Caribbean adults. A secondary aim of the study was to gain more information on factors that impact OHRQoL in this population.

METHODS

This cross-sectional, epidemiological, population-based study was conducted in community settings. After the participants with missing Oral Health Impact Profile (OHIP) data were excluded, the sample size was 1821 (weighted according to the age and gender distribution in each target population). OHIP-14 standardized questionnaires were used to collect information. In addition, a medical/oral health questionnaire including sociodemographics, general health, dental visits, oral hygiene habits and knowledge, the frequency of dental visits, prosthesis use/hygiene, and smoking was administered. A multivariate model included predictors that showed significant associations in the univariate models. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported; statistical significance was set at 0.05.

RESULTS

In the multivariate analysis, current smokers (OR = 2.34, 95% CI: 1.74-3.14 vs. never smokers), those who visited the dentist only when problems arose (OR = 1.65, 95% CI: 1.13-2.40 vs. those visiting once a year), and participants with any chronic disease/condition (OR = 1.38, 95% CI: 1.06-1.78) had higher odds of being in the highest tertile for OHIP score (poorer health).

CONCLUSIONS

The present multicenter study identified potential modifiable risk factors for poor OHRQoL among adults in three Caribbean cities.

Oral health-related quality of life in caregivers of individuals with Cerebral Palsy: a case-control study

AIM

The object of this study is to evaluate the oral health-related quality of life (OHRQoL) of caregivers of individuals with Cerebral Palsy (CP).

METHODS

Ninety-eight caregivers of individuals with CP (SG) and 196 caregivers of individuals without special needs (CG) completed the reduced version of the Oral Health Impact Profile (OHIP-14). In addition, a questionnaire with demographic and socioeconomic questions was used. Groups were matched according to gender, schooling and family income. Fisher's exact tests, Chi square and Mann-Whitney, and bi/multivariate logistic regression were used (p < 0.05).

RESULTS

The impact on OHRQoL was similar for SG and CG (OHIP-14 total score). For SG, the high negative impact was in the following OHIP domains: "Functional limitation", "Physical disability", "Psychological incapacity" and "Disadvantages". For SG, a higher number of caregivers was single, unemployed, received government financial aid. There was a statistically significant association between the number of children a caregiver has and a negative impact on OHRQoL.

CONCLUSIONS

Being a caregiver of children with or without CP had a negative impact of similar magnitude on ORHQoL. The negative impact on OHRQoL of caregivers of children with CP was associated with having a high number of children; the higher the number of children, the greater the negative impact on their OHRQoL.

Utilization of a Mobile Dental Vehicle for Oral Healthcare in Rural Areas

Oral diseases remain one of the major global public health challenges, and the worldwide urban–rural disparities in oral health are significant. Residents in rural areas generally suffer from a higher prevalence and severity of dental caries and periodontal disease, yet they face numerous difficulties and barriers in accessing oral healthcare. Conventional strategies, such as building of dental clinics or, hospitals, or the provision of outreach services by using disposable materials, are neither practical nor effective in rural settings. Mobile dental vehicles (MDVs) have been proposed as an alternative strategy to supplement the traditional oral healthcare in many regions. They have usually been utilized in school-based oral health programs, providing dental care to the homeless or migrants, and screening programs for the population for various oral diseases. Due to their high mobility, MDVs are particularly valuable for the underserved populations living in rural areas. The advance of dental devices enables MDVs to be operated in a self-sufficient manner. This allows the MDV to function almost as well as a conventional dental clinic, providing a variety of dental treatments, including scaling, restoration, and oral surgery. This article discusses the use of MDVs as a solution to urban–rural inequality in receiving oral healthcare.

Oral Health-Related Quality of Life among Elderly People with Edentulous Jaws in Hafar Al-Batin Region, Saudi Arabia

Aims and Objectives:

The aims of this study were to determine oral health-related quality of life (OHRQoL) among elderly people aged 65 and above years from Hafar Al-Batin area, Saudi Arabia, by utilizing Arabic version of Geriatric Oral Health Assessment Index (GOHAI-Ar).

Materials and Methods:

This was a cross-sectional study undertaken from October 2017 to December 2017. A convenience sampling methodology was employed to select the elderly patients aged ≥65 years attending dental clinics of primary health-care centers in five different regions of the Hafar Al-Batin, Saudi Arabia. OHRQoL of the participants was measured using the Saudi Arabian version of GOHAI-Ar. The oral examinations performed to record a total number of remaining natural teeth, complete and removable partial dentures, and fixed partial dentures. Descriptive and inferential statistics were performed.

Results:

A total of 200 elderly participants (M = 157 and F = 43) having mean age (± standard error [SE]) was 69.26 (±0.34) years, participated in the study. Mean ± SE of GOHAI-Ar was 27.68 ± 0.54, physical function 9.12 ± 0.26, pain and discomfort (6.87 ± 0.18), and psychological discomfort (11.69 ± 0.25). Remaining natural teeth and prosthodontic status significantly correlated with pain and discomfort. The presence of prosthesis was found to influence the psychological function. Gender and prosthodontic statuses were found to have significant correlation with OHRQoL.

Conclusion:

Poor OHRQoL among elderly from Hafar Al-Batin city was found, and presence dental prosthesis showed a positive impact on OHRQoL.

Oral Health-Related Quality of Life in Young Adults: A Survey of Russian Undergraduate Students

Background: Oral health (OH) is poor among young adults in Russia, but there is little information on OH-related quality of life (OHRQoL) in this population. We investigated how socio-demographic factors, self-reported OH characteristics, oral health behaviour, and clinically-assessed OH are related to OHRQoL in medical and dental students in North-West Russia. Methods: This cross-sectional study included 391 medical and 275 dental Russian undergraduate students aged 18–25 years. Information on socio-demographic, self-reported OH characteristics, and oral health behaviour was obtained from a structured, self-administered questionnaire. A clinical examination was performed to assess dental caries experience based on the decayed (D) missing (M) filled (F) teeth (T) index; Simplified Oral Hygiene Index; and Gingival Index. OHRQoL was measured by the OH Impact Profile (OHIP-14). Results: 53.6% of students reported low OHRQoL during the last 12 months. Female sex (odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.00–2.19), rural place of childhood residence (OR = 1.56, 95% CI: 1.06–2.28), poor self-assessed dental aesthetic (OR = 1.75, 95% CI: 1.16–2.64), dissatisfaction with mouth and teeth (OR = 2.51, 95% CI: 1.68–3.77), and DMFT index (OR = 1.05, 95% CI: 1.01–1.09), were all significantly, independently associated with low OHRQoL. Conclusion: Socio-demographic factors (rural place of childhood residence, female sex), poor self-reported OH characteristics, and high DMFT index were associated with low OHRQoL.