Self-reported oral health status, edentulism and all-cause mortality risk in 12 809 Australian older adults: a prospective cohort study

OBJECTIVE

To investigate the association between oral health status and all-cause mortality in older adults using prospective cohort study design.

SETTING AND PARTICIPANTS

In total, 12 809 adults aged ≥70 years (54.3% females) were participants of the ASPREE Longitudinal Study of Older Persons (ALSOP).

METHODS

Participants self-reported the presence of natural teeth and oral health status. The association of self-reported oral health, edentulism and the integrative measure of the two with all-cause mortality were explored using the Cox-regression models adjusted for age, gender, socio-economic status, health-related behaviours, weight status, aspirin and polypharmacy. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported.

RESULTS

In total, 22.2% of participants reported edentulism and 13.8% had fair/poor oral health. After adjustment for confounders, risk of all-cause mortality was higher among those with edentulism (vs. no edentulism) HR (95% CI) 1.43 (1.18, 1.73); and those with edentulism and reporting poor/fair oral health HR (95% CI) 1.69 (1.02, 2.82), or with no edentulism but reporting poor/fair oral health HR (95% CI) 1.46 (1.19-1.80) vs. no edentulism and reporting good/very good/excellent oral health. No association was observed between self-reported oral health alone and all-cause mortality.

CONCLUSIONS

The risk of all-cause mortality was 69% higher among older adults reporting both edentulism and poor/fair oral health compared with those with teeth and more favourable self-reported oral health. © 2023 Australian Dental Association.

The scope of practice of geriatric dentistry in British Columbia (Canada): An exploratory study

AIMS

The oral health needs of frail older adults are increasing with an aging population in Canada. The objective of this study was to explore the perceptions of dentists in British Columbia regarding their view of geriatric dentistry as a distinct scope of practice and in relation to special needs dentistry.

METHODS AND RESULTS

Qualitative data were gathered thorough semi guided interviews of a purposeful sample of dental clinicians, educators and members of organized dentistry with specialized knowledge of oral health for frail older adults. Interviews were transcribed, coded, and analyzed using a thematic approach. Thematic saturation was reached with the 10 participants in this study. Through the method of interpretative description, patient, dentist, and systemic factors that shaped scope of practice for geriatric dentistry were identified as well as the broader skill sets required for geriatric dentistry.

CONCLUSION

The study found that participants perceived geriatric dentistry as unique scope of practice from general dentistry requiring special knowledge in the management of challenges associated with aging with frailty as well as the ability to work in long-term care. Similar to special needs dentistry, geriatric dentistry requires person-centered care and emphasized the need for interprofessional collaboration in alternative care settings.

Emotional labour and turnover intention among nurses in China: Mediating effects of nurse-patient relationship and self-rated health

AIM

This study tested the mediating role of the nurse-patient relationship and self-rated health in the effect of emotional labour on turnover intention among nurses in China.

BACKGROUND

The underlying mechanism behind the effect of emotional labour on turnover intention remains inadequately understood.

INTRODUCTION

Nurses with a high level of emotional labour are predisposed to experiencing poor health and tension in their relationships with patients, which may increase turnover intention.

METHODS

A cross-sectional survey of 527 nurses in a public tertiary hospital in Qiqihar, located in China's Heilongjiang province, was conducted. Emotional labour and turnover intention were assessed using existing validated scales containing multiple items, while the nurse-patient relationship and self-rated health were assessed using single items, respectively. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were adopted to test the mediating effects of the nurse-patient relationship and self-rated health in the association between emotional labour and turnover intention after adjusting for variations in sociodemographic and job characteristics.

RESULTS

Emotional labour was positively associated with turnover intention. Self-rated poor health and a disharmonious nurse-patient relationship partially mediated the positive effect of emotional labour on turnover intention.

CONCLUSIONS

Emotional labour significantly affects the turnover intention of nurses working in public tertiary hospitals in China, and this effect is partially mediated by self-rated health and the nurse-patient relationship.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

Giving more attention to nurses' negative emotions and work attitudes is crucial. Developing comprehensive strategies for enhancing nurses' emotional management ability, promoting their physical and psychological well-being, and improving nurse-patient relationship to reduce nurses' turnover.

Characteristics of Self-Rated Oral Health among Syrian Refugee Parents in Ontario

Background

Canada has been hosting Syrian refugees since early 2015. Almost half of the Syrian refugee population lives in Ontario, with dental health being at the top of the list of important immediate needs. The objective of the study was to evaluate self-rated oral health and its associated factors among Syrian refugee parents residing in Ontario.

Methods

This was a cross-sectional study where 540 Syrian refugee parents, residing in Ontario and with at least one child less than 18 years of age, were interviewed. Information about self-rated oral health was collected based on the question "In general, how would you rate the health of your teeth and mouth?" with answers ranging from 1 representing "excellent" and 5 representing "very poor." Multiple linear regression analysis was performed to assess the independent relationship between each of the sociodemographic-, migration-, health-, dental-related factors, and self-rated oral health.

Results

The overall prevalence of poor and very poor self-rated oral health was 43.5%. The results showed that the presence of dental health insurance, private sponsorship, improved physical and mental health, and regular visits to the dentist were factors related to improved oral health. Discussion. To achieve better oral health outcomes among refugee populations, including Syrian refugees, efforts should be focused on improving dental care and dental insurance for vulnerable populations.

Barriers to oral care: a cross-sectional analysis of the Canadian longitudinal study on aging (CLSA)

BACKGROUND

Oral health plays a role in overall health, indicating the need to identify barriers to accessing oral care. The objective of this study was to identify barriers to accessing oral health care and examine the association between socioeconomic, psychosocial, and physical measures with access to oral health care among older Canadians.

METHODS

A cross-sectional study was conducted using data from the Canadian Longitudinal Study on Aging (CLSA) follow-up 1 survey to analyze dental insurance and last oral health care visit. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between socioeconomic, psychosocial, and physical measures with access to oral care, measured by dental insurance and last oral health visit.

RESULTS

Among the 44,011 adults included in the study, 40% reported not having dental insurance while 15% had not visited an oral health professional in the previous 12 months. Several factors were identified as barriers to accessing oral health care including, no dental insurance, low household income, rural residence, and having no natural teeth. People with an annual income of <$50,000 were four times more likely to not have dental insurance (adjusted OR: 4.09; 95% CI: 3.80-4.39) and three times more likely to report not visiting an oral health professional in the previous 12 months (adjusted OR: 3.07; 95% CI: 2.74-3.44) compared to those with annual income greater than $100,000.

CONCLUSIONS

Identifying barriers to oral health care is important when developing public health strategies to improve access, however, further research is needed to identify the mechanisms as to why these barriers exist.

[Association between oral health and cognitive decline in older Chileans]

OBJECTIVE

To identify the association between oral health and suspected cognitive impairment in older adults in Chile.

METHOD

Cross-sectional study including 1826 people ≥60 years who participated in the National Health Survey of Chile, 2016-2017. Oral health was evaluated by the number of teeth, presence of caries, use of dental prostheses, self-reported oral health, and pain and/or discomfort in the oral cavity. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE). The association was evaluated by logistic and linear regression, adjusted for sociodemographic and lifestyle variables.

RESULTS

Compared with people without suspicion of cognitive impairment, people with suspected impairment had five fewer teeth (13.4 vs. 8.5 teeth), a much higher difference in women than in men, and a higher frequency of oral pain. Edentulism and fewer teeth were associated with a higher likelihood of suspected cognitive impairment, associations that were not maintained in adjusted models. Oral pain was associated with a higher likelihood of suspected impairment even in the most adjusted model (odds ratio: 1.99; 95% confidence interval [95%CI]: 1.09-3.63). In linear models, an increase of 2% (95%CI: 0.01-0.05) in the MMSE score was observed for each additional tooth.

CONCLUSIONS

Poor oral health, particularly tooth loss and the presence of pain, was associated with cognitive impairment in older adults in Chile.

Oral Health Problems among Canadians Aged 45 to 85: Data from the Canadian Longitudinal Study on Aging Baseline Survey (2011-2015)

Oral health is a critical component of overall health. The objective of this study was to describe oral health problems among 47,581 adults aged 45 to 85 in the Canadian Longitudinal Study on Aging (CLSA) among those who have at least one natural tooth (92%) and those without natural teeth across various demographic categories. Among the 47,581 participants in the study, 92% reported having at least one natural tooth (dentate). Among those without teeth, 63% reported an income less than CAD 50,000 versus 39% among those with teeth. Whether they had teeth or not, over 30% of people reported two or more oral health problems. Older adults appear to be retaining their natural teeth (28.9%), but still report experiencing oral health problems. As the population ages, loss of all teeth may not be the most useful proxy for poor oral health, and a population-level understanding of oral health problems may help to better define poor oral health.

Pathways that explain racial differences on edentulism among older adults: 2019 Brazil National Health Survey

This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3-52.6), and 36.8% (95%CI: 35.7-37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

Body mass index and self‐rated oral health in Korean adults in 2017

OBJECTIVE

To investigate the association between obesity and self-rated oral health (SROH). This study examined the cross-sectional associations between body mass index (BMI) and SROH in Korean adults.

MATERIALS AND METHODS

This study used data from 217 304 adults (100 110 men and 117 194 women aged > 19 years) from the 2017 Korean Community Health Survey. Participants were categorised into six ordinal groups based on BMI: underweight (<18.5 kg/m² ), normal weight (18.5-22.9 kg/m² ), overweight (23.0-24.9 kg/m² ), obese-I (25.0-27.4 kg/m² ), obese-II (27.5-29.9 kg/m² ) or obese-III (≥30.0 kg/m² ). SROH was assessed using responses to the question, "How do you rate your oral health, including your teeth and gums?" rated on a 5-point scale. SROH was categorised as "good" (reported as "fair," "good" or "very good") or "poor" or "very poor." Age- and sex-stratified associations between BMI categories and poor SROH were assessed using ordinal logistic regression analysis with sampling weights.

RESULTS

The age-adjusted odds ratio (OR) for poor SROH according to BMI levels was lowest in the overweight group in both men and women. In men, the OR for poor SROH was 2.03 (99% confidence interval [CI], 1.72-2.39) in the underweight group, 1.17 (99% CI, 1.17-1.25) in the normal group, 1.05 (99% CI, 0.98-1.13) in the obese-I group, 1.08 (99% CI, 0.98-1.18) in the obese-II group and 1.36 (99% CI, 1.20-1.55) in the obese-III group. In women, the OR was 1.18 (99% CI, 1.07-1.31) in the underweight group, 1.01 (99% CI, 0.95-1.07) in the normal group, 1.07(99% CI, 0.99-1.16) in the obese-I group, 1.16 (99% CI, 1.04-1.30) in the obese-II group and 1.39 (99% CI, 1.20-1.62) in the obese-III group. From the restricted cubic spline models in both sexes, BMI showed a J-shaped association with poor and very poor SROH in men and women. In a stratified analysis by age group and sex, men and older women in the underweight group had poorer SROH than those in overweight group.

CONCLUSION

In a nationally representative sample of Korean adults, there was a J-shaped association between BMI and poor SROH, with the highest risk in the underweight group amongst men and in the obese-III group amongst women. Furthermore, in men and women over 65 years of age, underweight and obesity were associated with poorer SROH.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

Predictors of self-rated oral health in Canadian Indigenous adults

OBJECTIVES

The purpose of this study was to: (1) compare oral health indicators between Indigenous adults and the general population and (2) examine the predictors of poor self-rated oral health in the Indigenous population.

METHODS

Data from the 2017-2018 cycle of the Canadian Community Health Survey was used and included 943 Indigenous and 20,011 non-Indigenous adults. Independent variables included demographic information, lifestyle behaviours, dental concerns and care utilization, and transportation access. The dependent variable was self-rated oral health. A logistic regression was performed to determine predictors of poor self-rated oral health.

RESULTS

More than half of the Indigenous sample were aged between 35 and 64 years (57.3%); 57.8% were female. Compared to the general population, the Indigenous group were significantly more likely to have no partner, have less post-secondary education, and have an income of less than $40,000. Almost a fifth of the Indigenous sample self-rated their oral health as poor (18.5%) compared to 11.5% in the general population. Indigenous participants reported significantly poorer general health, had poorer oral care practices, and lifestyle behaviours than the general population (all p < .001). Indigenous adults having poor self-rated oral health was predicted by poorer general health, being a smoker, male, bleeding gums, persistent pain, feeling uncomfortable eating food, avoiding foods, and not seeking regular dental care.

CONCLUSIONS

There are many predictors of poor self-rated oral health, many of which are preventable. Providing culturally adapted oral health care may improve the likelihood of Indigeneous adults visiting the dentist for preventative care.

Association Between Tobacco Smoking, Dental Status and Self-perceived Oral Health in Elderly Adults in Colombia

Tobacco smoking is responsible for several health problems, including mouth diseases. The aim of the present study was to establish the association between smoking and dental status and self-perceived oral health in a large group of elderly Colombian adults. Analysis of 18,937 survey records of participants aged ≥ 60 years old was conducted. Information regarding age, sex, skin color, socioeconomic level, education, marital status, denture use, partial tooth loss or edentulism, Geriatric Oral Health Assessment Index (GOHAI) and tobacco smoking was retrieved from the database. A descriptive analysis and multivariate logistic regression analysis were performed. Half of the participants were edentulous in the maxilla while mandibular teeth were more frequently retained in more than 60% of the participants. After adjusting for sex and age, smoking consistently increased the odds of partial or complete edentulism in the maxilla (OR 1.05; 95% CI 1.02-1.09) and mandible (OR 1.04; 95% CI 1.00-1.08). Nonetheless, the increase in the odds in the mandible was not statistically significant. The habit of smoking was associated with increased tooth loss that in the long-term may result in poor oral health affecting the quality of life of elderly people.

Self-rated oral health and frailty index among older Americans

OBJECTIVE

To assess the association between self-rated oral health and frailty index among older American adults aged 60 years and over.

MATERIALS AND METHODS

Data from the National Health and Nutrition and Examination Survey from 2011 to 2014 were used. Self-rated oral health was assessed based on a single question "rate the health of your teeth and gum". A frailty index of 49-items covering multiple systems was created. Age, gender, ethnicity, poverty-income ratio, education, poor nutritional intake and smoking were used as covariates. Weighted negative binomial regression was used to test the association between self-rated oral health and frailty index adjusting for the covariates.

RESULTS

A dose response relationship was observed between self-rated oral health and frailty index. The rate ratios (RR) of frailty index were 1.03 (95% CI 0.95-1.13), 1.15 (95% CI 1.05-1.25), 1.30 (95% CI 1.17-1.45) and 1.41(95% CI 1.28-1.54) for participants who rated their oral health very good, good, fair or poor, respectively, compared with those who rated their oral health excellent after adjusting for covariates.

CONCLUSION

Poorer self-rated oral health is associated with higher rates of frailty index. This highlights the importance of oral health as a predictor of frailty and the adequacy of using self-rated oral health in health surveys and clinical practices when conducting a comprehensive clinical oral examination is not feasible.

Social capital and self-reported oral health at baseline of the brazilian longitudinal study of aging

OBJECTIVES

This cross-sectional study aimed to estimate the association between the structural and cognitive dimensions of social capital and self-reported oral health.

METHODS

This study conducted individual assessments of 9,365 individuals aged 50 years or older from Brazil. Four individual variables based on structural and cognitive dimensions of social capital were assessed. We used hierarchical Poisson regression models to estimate the prevalence ratio of self-reported oral health with individual structural and cognitive social capital variables adjusted for associated factors.

RESULTS

Cognitive social capital was associated with self-reported oral health. Individuals who reported lack of neighbourhood trust and not having friends presented 14% (RP: 1.14; 95% CI: 1.07-1.21) and 9% (RP: 1.09; 95% CI: 1.01-1.19), respectively, higher prevalence of poor self-reported oral health, relative to those who trust in their neighbourhood and reported having friends.

CONCLUSION

The cognitive dimension of social capital may be linked with self-reported oral health. Therefore, social capital can be stimulated in the context of social policies as its encouragement can be an efficient tool for improving individuals' health and, consequently, the oral health of the older people.

The relationship of aging, complete tooth loss, and having a dental visit in the last 12 months

OBJECTIVES

To evaluate the extent to which dental health care visits in the past year differed among older adults with and without edentulism.

MATERIAL AND METHODS

We conducted a cross-sectional study using the 2017 Medical Expenditure Panel Survey among participants aged ≥50 years (n = 10,480, weighted = 112,116,641). Two self-reported outcome variables were used: loss of all teeth from upper and lower jaws (yes/no) and dental visit in the last 12 months (yes/no). Logistic models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS

Overall, 11.4% of the non-institutionalized U.S. population aged ≥50 years were edentulous; the prevalence was higher in those with advanced age. Adherence to annual oral health visits was 16% among those with edentulism, 52% among those without. The prevalence of dental care visits in the past year was higher among those with advanced age without edentulism, but for those with edentulism, the odds of visiting a dental care provider was lower in all age groups compared to those 50-59 years ((60-69 years): aOR: 0.58, CI:0.36-0.95; (70-79 years): aOR: 0.51, CI: 0.30-0.88; (≥ 80 years): aOR: 0.45, CI: 0.26-0.80)).

CONCLUSION

Although the prevalence of edentulism was higher in those with advanced age, oral health visits during the last 12 months were less frequent in older adults with edentulism. Interventions to improve adherence to dental care recommendations in the growing aging population are warranted.