Influence of oral health literacy on dissatisfaction with oral health among older people

Interdental cleaning and periodontal status among older Koreans: Findings from KNHANES VII

OBJECTIVE

To assess the association between the usage of interdental cleaning and periodontal status among older people in Korea.

BACKGROUND

In order to maintain oral health in older people, it is very important to use interdental cleaning devices. However, there is a lack of research on periodontal status and interdental cleaning device use in older people.

METHODS

This study used data collected from the 7th National Health Nutrition Survey (KNHANES VII: 2016-2018). A total of 3426 older people adults aged 65 years or older were selected from 16 489 participants. Data on sociodemographic status (sex, age, level of education, income, residential area), personal health practice (subjective health status, smoking, physical activity, hypertension, and diabetes mellitus), oral health practice (subjective oral health status, tooth brushing frequency, dental visits, and chewing problem), the number of teeth and periodontitis were collected. Periodontitis was defined as having a World Health Organisation community periodontal index (CPI) code greater than or equal to three, and severe periodontitis was defined as a CPI code 4. Participants having a CPI code of 3 or 4 were considered to have periodontal disease in this study. Logistic regression analysis investigated the association between interdental cleaning devices usage and periodontitis controlling the confounding factors.

RESULTS

Those who do not use dental floss had a higher rate of periodontal disease (AOR = 1.47, 95% confidence interval [CI]: 1.05 to 2.1). However, there were no significant differences by interdental brush use. In those with 20 or more teeth, non-users of dental floss had a higher risk of periodontitis in all models. Conversely, in those with fewer than 20 teeth, no significant differences were observed.

CONCLUSIONS

Older people with mostly intact dentitions have better periodontal health if they clean between their teeth.

Validation of an Arabic version of the short form of the health literacy in dentistry scale: a cross-sectional study

BACKGROUND

The Arabic version of the short form of the Health Literacy in Dentistry scale (HeLD) had not yet been developed in previously published studies. This study aims to test the reliability and validity of an Arabic version of the short form of the HeLD questionnaire.

METHODS

The short version of HeLD was translated into Arabic and the psychometric properties were evaluated in a sample of 1,889 female students in their first year of secondary school. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC), and internal consistency reliability was assessed using Cronbach's alpha. Content validity was investigated by creating a correlation matrix between the individual items of the HeLD-14, and criterion validity was determined using Pearson's correlation between the HeLD-14 score and an overall oral health rating. Sensitivity analysis was assessed by testing the associations of the HeLD-14 score with oral health-related behaviours and residential area.

RESULTS

The Arabic version of HeLD-14 (A-HeLD-14) had acceptable ICC (0.54) and excellent internal consistency (Cronbach's alpha: 0.92). The correlations between the items of the A-HeLD-14 varied from 0.3 to 0.9. The A-HeLD-14 showed a statistically significant correlation with the overall oral health rating (r = 0.37, p < 0.001). The median A-HeLD-14 score was significantly higher in participants who brushed their teeth frequently (51.31), visited the dentist regularly (52.00), consumed fresh fruit frequently (51) and consumed soda or energy drinks infrequently (51.00) than participants who brushed their teeth infrequently (41.50), visited the dentist irregularly (49.00), consumed fresh fruit infrequently (47) and consumed soda or energy drinks frequently (48.00).

CONCLUSION

The A-HeLD-14 instrument demonstrates sufficient validity, reliability, and sensitivity for measuring oral health literacy among the Arabic-speaking population.

Oral Health Literacy and Tooth Loss and Replacement in Older Adults at a University Dental Clinic in Colombia

BACKGROUND

Oral health literacy (OHL) is the ability of individuals to obtain, process, and understand oral health information and services, allowing them to make appropriate oral health decisions. The association between OHL and tooth loss and replacement have not been well understood.

OBJECTIVES

We aimed to determine the association between OHL and tooth loss and replacement in a Colombia population.

METHODS

A cross-sectional study of 384 older adults age 65 to 89 years from Pasto, Colombia was carried out. The number of lost and replaced teeth was assessed intraorally; sociodemographic and prosthetic characteristics were collected, and the Health Literacy in Dentistry questionnaire was used to evaluate OHL. Generalized linear models were estimated to assess associations between independent variables (including OHL) and the number of lost and replaced teeth.

KEY RESULTS

There were 224 (58.3%) men and 160 (41.7%) women. The mean (standard deviation [SD]) number of lost and replaced teeth was 27.78 (4.03) and 12.53 (9.89), respectively. One hundred fifty five (40.4%) individuals had full removable dental protheses, 122 (31.8%) partial removable dental protheses, 68 (17.7%) fixed prosthetics, and 36 (9.4%) dental implants. OHL was 33.29 (6.59) and significantly positively associated with the number of replaced teeth (β = 0.65, 95% confidence interval [CI]: 0.52-0.78, p < .001), but not with lost teeth.

CONCLUSIONS

OHL may foster individuals' capabilities to replace lost teeth, although we did not find it associated with reduced tooth loss, likely as tooth loss was highly common in this older population. [HLRP: Health Literacy Research and Practice. 2024;8(1):e21-e28.].

Oral health literacy and its associated factors among nurses: A cross-sectional study

AIMS AND OBJECTIVES

To investigate the oral health literacy (OHL) of nurses and explore the factors affecting their OHL.

BACKGROUND

OHL is important for improving the oral health outcomes. Nurses' OHL may affect the oral health of themselves, families, and patients. Few studies have examined the OHL and its related factors among nurses.

DESIGN

A cross-sectional design following the STROBE guideline.

METHODS

A total of 449 nurses were recruited from tertiary hospitals in the minority areas of southwest China. The participants completed an online questionnaire, which contained questions related to the OHL, sociodemographic factors, general health, oral health and related behaviours, oral health knowledge, attitudes, and oral health-related quality of life. OHL was measured using the validated Chinese version of the short-form Health Literacy of Dentistry (HeLD-14) scale. Descriptive statistics, the Mann-Whitney U test, Spearman's correlation, and multiple linear regression analysis were used to analyse the data.

RESULTS

The median HeLD-14 score (p25-p75) was 50.0 (44.0-54.0). The regression model for OHL was found to be significant. The factors that influenced OHL included oral health knowledge, oral health attitudes, self-reported oral health, annual household income, and dental flossing; these factors accounted for 13.9% of the variance in OHL.

CONCLUSIONS

The nurse' OHL has room for improvement. Nurses' OHL could be improved by enriching their oral health knowledge, promoting their positive oral health attitudes, increasing their household income, and helping them build correct oral health behaviours.

RELEVANCE TO CLINICAL PRACTICE

The findings of the study could be used to make a case for changing nursing curricula. Oral health knowledge curriculum or programmes targeted towards nurses should be developed to improve their OHL.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

The impact of oral health literacy on dental anxiety and utilization of oral health services among dental patients: a cross sectional study

BACKGROUND

Low oral health literacy levels and deficient oral health knowledge jeopardize the communication between dentists and patients in different communities. This study aimed to examine the impact and association of oral health literacy with patients' levels of dental anxiety and their utilization of dental health services.

METHODS

This cross-sectional study was conducted at the Misr International University (MIU) dental clinics. The study utilized a structured, interview led questionnaire that was administered by second year dental students, over the period of two successive academic years 2018-2019 and 2019-2020. A total of 440 student interviewed a convenience sample of 440 dental patients: including 269 females (61.1%) and 171 males (38.9%). The questionnaire consisted of four sections; a demographic section, a modified Arabic Rapid Estimate of Adult Literacy (ARELAD-30) Tool that measures the ability of the participants to read 30 commonly used dental terms. This questionnaire was modified by the authors to measure the participants' knowledge by asking them to choose the most accurate meaning for each word based on their previous knowledge. Scoring was dependent on the participant's immediate correct pronunciation, as well as comprehension of each word. The Arabic Modified Dental Anxiety Scale (AMDAS) was used to measure the level of dental anxiety, and the dental health service utilization was measured using the Utilization of oral health services questionnaire.

RESULTS

One quarter (24.1%) of the participants read the 30 items of the A-REALD correctly. The average percentage of correct responses to the meaning of the dental terms was 71.2%. There was no statistically significant association between A-REALD and knowledge scores (Spearman's Correlation coefficient ρ = -0.008, p-value = 0.872). There was a statistically significant inverse correlation between age and MDAS (Correlation coefficient ρ = -0.146, p-value = 0.002). A-REALD scores were inversely correlated with time since last visit (Regression coefficient = -0.027, p-value = 0.036, with 95% CI: -0.052 - -0.002).

CONCLUSION

Within the limitations of this study, it can be concluded that oral health literacy is significantly associated to dental health services utilization, while, dental anxiety is related to other variables, such as age and gender.

Defining the Connotations of Oral Health Literacy Using the Conceptual Composition Method

Due to advancements in research, the concept of oral health literacy (OHL) has become rich in connotations, with over 250 definitions present in the literature and government and organizational reports. The diversity of OHL definitions and connotations not only produces conflicting results but also limits the production of accurate OHL measurement and assessment tools while simultaneously hindering the construction of health literacy intervention policies. To clarify the connotations of OHL and establish a scientific basis for evaluation, we conducted a systematic review, searching and analyzing the literature related to the conceptual connotations of OHL. Additionally, we extracted basic, methodological, and OHL conceptual connotation information from the literature. With reference to the review framework, we classified the conceptual connotations of OHL into antecedents of OHL, the core of OHL, mediators, and outcomes of OHL. The comprehensive conceptual connotations of OHL were obtained through a systematic review and concept mapping based on the related literature. Our analysis revealed that the antecedents of OHL can be classified in two categories: personal factors and external factors. The core conceptual connotations of OHL include three core dimensions (with 16 subdimensions): (1) basic skills-literacy, reading comprehension, numeracy, hearing, oral expression, communication, and knowledge; (2) information-related abilities-information acquisition, information understanding, information communication, information evaluation, information utilization, and information decision-making; and (3) oral health maintenance abilities-interpersonal skills, self-regulation, and goal achievement. The mediator of these connotations is oral health behaviors, with oral health being the result of OHL. This study further clarifies the conceptual connotations of OHL, serving as a reference for future OHL-related studies.

Health literacy dimensions among public health service users with chronic diseases in Piracicaba, Brazil, 2019

Aim: This study analyzes factors associated with dimensions of health literacy (HL) functional, communicative and critical among public health service users with chronic non-communicable diseases. Methods: A cross-sectional analytical research was carried out in Piracicaba, São Paulo, Brazil, with adults and older adults attending Family Health Units (FHU). Data were collected by oral exam (CPOD and CPI) and a questionnaire on systemic conditions, sociodemographic factors, health behaviors and HLS (HLS-14). The outcomes consisted of functional, communicative, and critical HL dimensions dichotomized by median (high and low), which were analyzed by chi-square test (p<0.05) to find associations with the variables studied. Results: The study sample comprised 238 FHU users with 62.7 (± 10.55) mean age, of which 47.5% (n=113) showed high functional HL, 50.0% (n=119) high communicative HL, and 46.2% (n=110) high critical HL. High functional HL was associated with men (p<0.05). Functional and communicative HL were associated with having higher education (p<0.001 and p=0.018, respectively). High communicative and critical HL were associated with regular use of dental and medical services (p<0.05). Individuals with low functional HL were more likely to present poor tooth brushing (p=0.020). High HL (in all three dimensions) was associated with regular flossing and having more teeth (p<0.05). Conclusion: Functional, communicative and critical HL were associated with health behaviors and clinical outcomes, whereas the functional dimension was also associated with sociodemographic factors. HL dimensions allowed to differentiate health-related factors.

Gender differences in the association between oral health literacy and oral health-related quality of life in older adults

BACKGROUND

Poor oral health affects quality of life; oral health literacy studies are increasing as it plays an essential role in promoting oral health. However, little is known regarding the gender differences in oral health literacy and oral health-related quality of life (OHRQoL) among older adults. This study aimed to explore the gender differences in oral health literacy and OHRQoL among community-dwelling older adults in Taiwan.

METHODS

A cross-sectional study design with convenience sampling was undertaken to recruit participants at two community service centres. Data were collected using a structured survey consisted of the demographic characteristics, instrumental activities of daily living, nutrition assessment, oral health literacy and OHRQoL. The logistic regression was used to examine the gender differences in the relationship between oral health literacy and OHRQoL.

RESULTS

A total of 202 participants completed the survey. Of which 56.4% (n = 114) were female. Logistic regression analyses showed that after controlling for age, instrumental activities of daily living, nutrition, education level, and average monthly income, better oral health literacy was associated with better oral health quality of life (p = 0.006) in men.

CONCLUSIONS

The relationship between oral health literacy and OHRQoL was only significant for men. No significant relationship between women's oral health literacy and their OHRQoL. However, good OHRQoL is an integral part of overall health, but it is affected by differences in oral health and the accessibility of healthcare services. We suggest that gender-specific oral health literacy education should be offered through community health-education programs.

Differences in health literacy level of patients from public and private hospitals: a cross-sectional study in Turkey

OBJECTIVES

Policy-making based on a health literacy approach makes it a priority to develop people-centered public health strategies and programs, particularly in the time of COVID-19 across the world. This is the first study to assess health literacy levels of patients visiting public and private hospitals in Turkey and also compares these levels with sociodemographic and health-related variables by hospital type to suggest health policies aimed at improving the health literacy skills for patients with different socio-economic backgrounds.

STUDY DESIGN

This is a cross-sectional study.

METHODS

The study was conducted on 948 outpatients from both hospital types in 2018. Health literacy was assessed using the validated Turkish version of the European Health Literacy Survey Questionnaire with 47 items. The level of health literacy and sociodemographic factors influencing it were analyzed using correlation and binary logistic regression tests. Patients from private hospital had better health literacy index score compared with the public hospital.

RESULTS

The health-related variables, such as self-reported health and the presence of long-term illness, and sociodemographic characteristics, including education, age, and gender, were associated with health literacy for both public and private hospitals. Age and education were important predictors, whereas gender, long-term disease condition, self-reported health, and perceived income status were statistically significant variables for adequate health literacy in both hospital types.

CONCLUSIONS

Participants from private hospital had better health literacy than that of public hospital. These findings could be used to help health policy makers to improve the current health literacy policy for patients and develop strategies by stakeholders for reducing barriers to obtaining health-related information.

Validation of the Chinese version of the Short-Form Health Literacy in Dentistry (HeLD) scale

OBJECTIVES

As an important part of health literacy, oral health literacy has been adapted to dental practice and research. The 14-item short version of the Health Literacy in Dentistry (HeLD) scale demonstrated excellent reliability, validity and precision when tested among English-speaking populations. However, an appropriate and reliable assessment of this scale in other language contexts remains lacking. The reliability and validity of the Chinese version of HeLD (HeLD-C) for the Chinese population must therefore be examined.

METHODS

The short version of HeLD was translated into Chinese, and one item was deleted because of its unsuitability for the Chinese healthcare system. The psychometric properties of HeLD-C were evaluated in a sample of 404 Chinese participants aged from 19 to 72 years. The item selection analyses were performed by comparing the difference of each item between the high- and low-score groups. The internal consistency reliability was assessed using the Cronbach's alpha coefficient. Construct validity was assessed using exploratory structural equation modelling. For the criterion validity, correlations between the HeLD-C and the criterion validity scales, including the eHealth Literacy Scale (eHEALS), oral hygiene maintenance habits, and oral health status were tested using Pearson's correlation.

RESULTS

Results of item selection reveal significant differences among all items between the high- and low-score groups (Ps < .001). The internal consistency reliability of HeLD-C was measured using Cronbach's α (0.92), whereas its construct validity was measured using χ² [df] (3.30), comparative fit index (0.95), Tucker-Lewis index (0.94), root mean square error of approximation (0.08), and standardized root mean square residual (0.05). The criterion validity analyses show that HeLD-C is correlated with the criterion validity scales, including eHEALS, oral hygiene maintenance habits and oral health status (Ps < .001).

CONCLUSIONS

Chinese version of HeLD is a reliable and valid instrument for measuring the oral health literacy of the Chinese adult population.

Association Between Oral Health Literacy and Number of Remaining Teeth Among the Thai Elderly: A Cross-Sectional Study

Purpose

Limited oral health literacy is associated with poor oral health status. This study aimed to determine the association between oral health literacy (OHL) and the number of remaining teeth (NRT) among Thailand’s older population.

Patients and Methods

This cross-sectional study was conducted between July 1, 2020 and September 30, 2020 at the Subdistrict Health Promoting Hospitals in Panare, Pattani, Thailand. A total of 361 independent-living older adults, male and female, participated in the study. OHL data were obtained using the Thai version of Health Literacy in Dentistry (HeLD‐Th) questionnaire. Trained interviewers performed face-to-face interviews for oral health-related behavior information. The NRT was collected through intraoral examination by a trained examiner. Data were analyzed using SPSS version 22. Mann–Whitney U-tests, chi-square tests, and binary logistic regression analysis were performed. A multivariate logistic regression model was developed to test associations between OHL and NRT and other potential covariates. All analyses were two-sided with a 95% confidence interval.

Results

There were significant associations between limited OHL and fewer than 20 remaining teeth (odds ratio [OR]=1.986, P = 0.018), older age (OR=1.743, P = 0.023), and lower educational levels (OR=2.365, P = 0.007).

Conclusion

The significance of this evidence is that OHL influences NRT among older Thai people who have lower education levels. Therefore, OHL intervention is an essential strategy for better oral health-related behaviors to reduce tooth loss and to improve the oral health status of Thai older adults.

Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus®

BACKGROUND

Clinical trials and laboratory studies from around the world have shown that GC Tooth Mousse Plus® (TMP) is effective in protecting teeth from tooth decay and erosion, buffering dental plaque pH, remineralising white spot lesions and reducing dentine hypersensitivity. However, no other study has assessed the experiences of oral health, before, during and after individuals becoming regular users of TMP. The aim of this study was to identify how participants' oral health status changed after introducing TMP into their oral hygiene routine.

METHODS

A qualitative study using Charmaz's grounded theory methodology was conducted. Fifteen purposively sampled regular users of TMP were interviewed. Transcripts were analysed after each interview. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation.

RESULTS

Participants described their experiences of oral health and disease, before, during and after introducing TMP into their daily oral hygiene routine, together with the historical, biological, financial, psychosocial, and habitual dimensions of their experiences. Before becoming a regular user of TMP, participants described themselves as having a damaged mouth with vulnerable teeth, dry mouth, and sensitivity. Various aspects of participants' histories were relevant, such as, family history and history of oral disease. Having a damaged mouth with vulnerable teeth, dry mouth and sensitivity was explained by those elements. Despite some initial barriers, once being prescribed TMP by a dental professional, a three-fold process of change was initiated: starting a new oral hygiene routine, persevering daily, and experiencing reinforcing outcomes. This process led to a fundamental lifestyle change. Participants transitioned from having a damaged mouth with vulnerable teeth to having a comfortable mouth with strong teeth; at the same time participants felt empowered by this newly found status of being able to keep their teeth for life. Barriers and facilitators for incorporating TMP on daily oral hygiene routine were also identified.

CONCLUSIONS

Participants valued having a comfortable mouth with strong teeth, which did not require repeated restorations. Seeing concrete results in their mouths and experiencing a more comfortable mouth boosted adherence to daily applications of TMP, which was maintained over time.

The impact of oral health on prognosis of older multimorbid inpatients: the 6-month follow up MPI oral health study (MPIOH)

PURPOSE

There is clear evidence for an association between oral health and systemic illnesses, geriatric syndromes, and mortality. Frail and multimorbid older people often suffer from insufficient oral health care, but standardized dental examinations are not routinely performed in clinical settings. The aim of this study was to verify the practicability of in-hospital oral health examinations and to identify their association with patients' prognosis as assessed by means of the Comprehensive Geriatric Assessment (CGA)-based Multidimensional Prognostic Index (MPI).

METHODS

One hundred hospitalized patients aged 65 years and older (mean age 76.9 years (SD 6.4); 58.2% male, 41.8% female) underwent a CGA-based MPI calculation at discharge with subdivision into three mortality risk groups (MPI-1, low risk, score 0-0.33; MPI-2, moderate risk, score 0.34-0.66; MPI-3, high risk, score 0.67-1). To identify the current oral health status and the Oral Health-related Quality of Life (OHRQoL), three oral health examinations were performed. Information on survival, the incidence of oral diseases, dental appointments, and treatments up to 6 months after discharge were collected.

RESULTS

All oral health examinations were feasible during hospitalization and were associated with MPI prognosis, even though they were not associated with 6-month mortality. The MPI could not predict the use of dental health care or treatment, as, irrespective of MPI and oral health examinations, dental services were underutilized during follow up.

CONCLUSION

Besides MPI evaluation, oral health examinations should be implemented into an inhospital course to improve clinical decision-making as well as secondary and tertiary prevention of oral health- and related systemic diseases.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register: DRKS00013607 (07.02.2019, retrospectively registered).