Changes in oral health inequalities in adults in Chile

A rural teledentistry care experience: a geriatric approach to assessing oral health status and treatment needs in older adults from a Mapuche community in Chile

Background

Limited attention has been given to oral health challenges faced by older Indigenous populations, especially in rural settings, where disparities exist. This study aims to assess oral health in a rural Mapuche community in southern Chile, utilizing geriatric technology support, and exploring the connection between geriatric health and oral well-being to fill a gap in this context.

Methods

A cross-sectional study was conducted involving 76 independent older adults from a rural Mapuche community who required dental care. Assessments were in a remote care setting gathering extensive data including comprehensive geriatric assessments, medical and dental conditions using a geriatric teledentistry platform (TEGO®). Statistical analysis involved descriptive analysis, logistic regression, and both multiple correspondence analysis and k-means cluster analysis.

Results

The sample comprised individuals with limited formal education and a high degree of vulnerability. Geriatric assessments unveiled cognitive deterioration, frailty, depression risk, and multimorbidity. A distribution of the DMFT index, number of remaining teeth, number of occluding pairs, number of teeth with restorative needs and other relevant clinical findings was conducted based on sociodemographic, and medical-geriatric-dental characteristics, and additionally, a Multinomial Logistic Regression Analysis of Dentition Variables in Relation to Geriatric Assessments was performed. The dental burden was substantial, with an average DMFT index of 25.96 (SD 4.38), high prevalence of non-functional dentition (89.3%), periodontal disease (83%), xerostomia (63.2%) and oral mucosal lesions (31.5%). Age, lower education, depression, daily medication number and sugary consumption frequency were associated with a decreased average number of teeth (p < 0.05). Multiple correspondence analysis and k-means cluster analysis identified 4 clusters, with the edentulous and functional dentition groups being the most distinct.

Conclusion

This study uncovers a substantial dental burden and intricate medical-geriatric conditions interlinked among Indigenous older adults in a rural Chilean Mapuche community. The implementation of a geriatric technological ecosystem in the community enabled the resolution of less complex oral health issues and facilitated remote consultations with specialists, reducing the necessity for travel to health centers. This underscores the need for innovative dental public health initiatives to address health disparities and improve the overall well-being of older Indigenous adults.

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.

Inequalities in dental services use by older adults in Chile according to eligibility for a national dental programme

OBJECTIVES

The objectives of this study were to determine the prevalence and trends in dental service use among Chilean older adults (60+ years) between 2006 and 2017; to assess the association between socioeconomic factors and dental service use and type (public/private) in 2017 and whether these differ by eligibility to a national dental programme (GES-60).

METHODS

This study involved secondary data analysis of five nationally representative cross-sectional surveys between 2006 and 2017. Trends were assessed for use of dental services and types of services used among 60-79-year-olds. Logistic regression models examined the association between use of dental services in 2017 and socioeconomic variables (income and education), accounting for covariates (age, gender, residence, ethnicity, cohabiting status, employment and disability). Estimated marginal means and odds ratios (ORs) were calculated to assess the association between socioeconomic variables and the outcomes by GES-60 eligibility.

RESULTS

Across surveys, the average prevalence of use of dental services in the last 3 months was 5.0%. There was a slight increase in dental visits between 2006 and 2017. This trend was higher among GES-60 eligible individuals using public dental services. Inequalities were observed in regression analyses. Compared to the poorest quintile and those with no formal education respectively, the ORs were 2.36 (95% confidence interval (CI) 1.79-5.68) for the richest quintile and ranged from 2.91 (95% CI 1.49-5.68) to 6.43 (3.26-12.68) for each higher level of educational attainment. Inequalities were wider among GES-60 non-eligible than GES-60 eligible older adults for both outcomes.

CONCLUSIONS

Socioeconomic inequalities were present among older adults regardless of GES-60 eligibility. However, these inequalities were more pronounced among non-eligible individuals. Our findings suggest a limited impact of GES-60 only among eligible older adults. Policies considering the needs of the whole older adult population are likely to have a stronger impact.

Diabetes, periodontitis, and cardiovascular disease: towards equity in diabetes care

Type 2 diabetes and its associated cardiovascular risk is an escalating epidemic that represents a significant public health burden due to increased morbidity and mortality, disproportionately affecting disadvantaged communities. Poor glycaemic control exacerbates this burden by increasing retinal, renal, and cardiac damage and raising healthcare costs. This predicament underscores the urgent need for research into cost-effective approaches to preventing diabetes complications. An important but often overlooked strategy to improve metabolic control in diabetic patients is the treatment of periodontitis. Our aim is to assess whether the inclusion of periodontitis treatment in diabetes management strategies can effectively improve metabolic control, and to advocate for its inclusion from an equity perspective. We conducted a comprehensive review of the literature from 2000 to 2023. We analyzed the pathophysiological links between periodontitis, diabetes, and atherosclerotic cardiovascular disease, all of which have inflammation as a central component. We also examined the inequalities in health care spending in this context. Our findings suggest that incorporating routine screening and treatment of periodontitis into national health programs, with coordinated efforts between physicians and dentists, is a cost-effective measure to improve metabolic control, reduce complications and improve the overall quality of life of people with diabetes.

Inequalities by sex on remaining teeth in adults: A decomposition analysis

OBJECTIVE

To identify which social determinants of health explain the gap in the remaining teeth between men and women.

METHODS

A secondary analysis of data from the Chilean National Health Survey (CNHS) 2016-2017 was performed on the number of remaining teeth in adults. The explanatory variables were organized into structural and intermediate social determinants of health according to the WHO framework. The contribution of both groups and the contribution of each individual explanatory variable to the remaining teeth gap was estimated using the Blinder-Oaxaca decomposition analysis.

RESULTS

The predicted average number of remaining teeth for men was 23.4 and 21.0 for women, thus a mean difference of 2.4 teeth. 49.8% of the inequality between men and women was due to the different distribution (endowments) of the predictors in the model. Among them, structural determinants of health, namely education level (15.8%) and employment status (17.8%), contributed the most. Intermediate determinants had no relevant contribution to explain the gap.

CONCLUSIONS

Results revealed that the difference in the mean number of remaining teeth between men and women was mainly explained by two structural determinants: education level and employment status. The lack of explanatory power of intermediate determinants and the large explanatory power of structural determinants means that tackling oral health inequity in Chile requires strong political commitment. The role of intersectoral and intersectional public policies to address gender inequalities in oral health in Chile is discussed.

Tooth Loss and Caries Experience of Elderly Chileans in the Context of the COVID-19 Pandemic in Five Regions of Chile

Risk factors associated with tooth loss have been studied; however, the current status of the epidemiological profiles and the impact of the pandemic on the oral health of the elderly is still unknown. This study aims to determine the experience of caries and tooth loss among elderly Chilean citizens in five regions and to identify the risk factors associated with tooth loss. The sample includes 135 participants over 60 years old assessed during COVID-19 lockdown. Sociodemographic variables such as education and RSH (Social Registry of Households) were obtained through a teledentistry platform called TEGO. The history of chronic diseases such as diabetes, obesity, depression and dental caries reported by DMFT index scores were incorporated. The statistical analysis included Adjusted Odds Ratios (ORs) to assess risk factors associated with the lack of functional dentition. Multivariate hypothesis testing was used to compare the mean equality of DMFT and its components between regions (p-value < 0.05). Individuals with RSH ≤ 40% were at higher risk of having no functional dentition with OR 4.56 (95% CI: 1.71, 12.17). The only mean difference between regions was the filled tooth component. Tooth loss was associated with multidimensional lower income, where the elderly belonging to the 40% most vulnerable population had a higher prevalence of non-functional dentition. This study highlights the importance of implementing a National Oral Health Policy that focuses on oral health promotion and minimally invasive dentistry for the most vulnerable population.