Demonstrating successful aging using the International Collaborative Study for Oral Health Outcomes

Use of dental services among middle-aged adults: predisposing, enabling and need variables

OBJECTIVES

To examine if making a visit, number of visits and services varied by predisposing (gender, perceived health competence, education, previous relief of pain visit), enabling (dental anxiety, income, social support) and need (perceived need, number of teeth and oral pain) characteristics.

METHODS

Dental visiting and services data from a sample of middle-aged South Australian adults were collected from 61% of participants at 12-months (n = 603) and 59% after 24-months (n = 583). Visiting over 2-years, mean visits and mean services were analysed by log binomial and Poison regression using the Andersen and Newman model.

RESULTS

The percentage having a dental visit over 2-years was lower for males than females, prevalence ratio (PR, 95% CI) 0.91 (0.84, 0.99), and for higher than lower dental anxiety, PR = 0.78 (0.62, 0.98). Number of visits was associated with higher than lower income, rate ratio (RR, 95%CI) 1.20 (1.02, 1.41) but lower for those with higher social support, RR = 0.86 (0.74, 0.99). Services were lower for those with higher perceived health competence, RR = 0.72 (0.56, 0.92) but higher for those with perceived needs, RR = 1.22 (1.01, 1.46).

CONCLUSIONS

While need and cost factors predict dental service use, psychosocial variables such as health competence and social support also need to be considered.

Rehabilitation of lost teeth related to maintenance of cognitive function

OBJECTIVE

As the era of aging comes, cognitive impairment (CI) is increasing. The impact of rehabilitation of lost tooth on CI remains unclear. This study aimed to investigate whether non-rehabilitated lost teeth (NRLT) is associated with CI among Korean elders.

METHODS

A total of 280 elders comprising of 140 cases and 140 age-sex-matched controls were included in this cross-sectional study. CI was assessed using the Mini-Mental Status Examination (MMSE). NRLT was evaluated using panoramic radiograph and oral examination. NRLT was categorized into low (≤4) and high (≥5). Age, sex, education, drinking, smoking, exercise, obesity, hypertension, subclinical atherosclerosis, glucose, cholesterol, depression, and denture-wearing were considered as confounders. Conditional multivariate logistic regression analysis was applied to assess the adjusted association.

RESULTS

NRLT was associated with increased CI after controlling for confounders (odds ratio [OR] = 1.06, 95% confidence interval [95% CFI]: 1.00-1.13). However, lost teeth were not associated with CI. Those with high NRLT (≥5) compared to those with low NRLT (≤4) was more likely to have CI by 2.7 times (OR = 2.74, 95% CFI = 1.28-5.86).

CONCLUSION

Our data showed that NRLT was independently associated with CI. Hence, rehabilitation of the lost teeth could be important for the maintenance of cognitive function.

Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004–2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005–2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006–2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults’ overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

Tooth loss and periodontitis in older individuals: results from the Swedish National Study on Aging and Care

BACKGROUND

Due to the increasing number of older people, there is a need for studies focused on this population. The aims of the present study are to assess oral and systemic conditions in individuals aged 60 to 95 years with access to dental insurance.

METHODS

Probing depths (PDs), tooth loss, alveolar bone levels, and systemic health were studied among a representative cohort of older individuals.

RESULTS

A total of 1,147 individuals in young-old (aged 60 or 67 years), old (aged 72 or 78 years), and old-old (aged ≥81 years) age groups were enrolled, including 200 individuals who were edentulous, in this study. Annual dental care was received by 82% of dentate individuals. Systemic diseases were common (diabetes: 5.8%; cardiovascular diseases: 20.7%; obesity: 71.2%; elevated C-reactive protein [CRP]: 98.4%). Serum CRP values were unrelated to periodontal conditions. Rates of periodontitis, defined as ≥30% of sites with a distance from cemento-enamel junction to bone of ≥5 mm, were 11.2% in women in the young-old age group and 44.9% in men in the old-old age group. Individuals in older age groups had a higher likelihood of periodontitis defined by bone loss and cutoff levels of PD ≥5 mm (odds ratio: 1.8; 95% confidence interval: 1.2 to 2.5; P <0.01). A total of 7% of individuals in the old-old age group had ≥20 teeth and no periodontitis. Systemic diseases, dental use, or smoking were not explanatory, whereas age and sex were explanatory for periodontitis.

CONCLUSIONS

The prevalence of periodontitis increased with age. Sex seems to be the dominant explanatory factor for periodontitis in older individuals. Despite frequent dental visits, overall oral health in the oldest age cohort was poor.

Impact of rehabilitation with metal-ceramic restorations on oral health-related quality of life

Dental ceramics present excellent ability to reproduce the natural teeth regarding esthetic and biomechanics. Recently, due to the advancement of ceramic technology, metal-free restorations were developed. However, the traditional metal-ceramic restorations still present the requirements of high strength, long survival in the oral environment and favorable aesthetics. In this context, it is essential to know the specificity of each ceramic system available in order to apply it properly to various clinical situations. This report describes an integrated rehabilitation using metal-ceramic restorations of a patient at 50 years of age, who presented edentulous spaces, and previous unsatisfactory composite and amalgam restorations, and indirect metallic restorations, leading to compromised quality of life in both functional and psychosocial aspects. The impact on quality of life was measured using a generic instrument, OHIP-14, validated for the World Health Organization, which covers both the biological and the psychosocial dimensions. This instrument was applied to the patient before and after treatment. The patient had an overall OHIP-14 score of 28 before the treatment and after treatment the score decreased to 0, showing that dental and oral health conditions are factors that do impact on the quality of life. Rehabilitation has provided functional and aesthetic restorations, harmony of the stomatognathic system and improvement of life quality.

Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability

OBJECTIVE

To analyse whether cognitive function and functional ability are related to oral health among community-dwelling older people over the age of 80 years.

BACKGROUND

This cross-sectional study is based on the Kungsholmen Elders Oral Health Survey (KEOHS). The study included oral examinations carried out in two local clinics by standardised examiners and interviews using structured questionnaires.

MATERIALS AND METHODS

Altogether 159 individuals were included in this study. Coronal caries and root caries were assessed using the National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) index and functional ability was assessed by a global measure of self-reported changes.

RESULTS

Older adults with a low MMSE score (< or = 23) tended to have a higher risk of coronal caries than those with higher scores. Participants with mild cognitive decline (MMSE = 24-26) and with a decrease in functional ability had a significantly higher risk of root caries. These associations changed little when adjusted by the covariates. In addition, people with a low MMSE (0-23) had a four times higher risk of not using dental services regularly. This result was unchanged after adjusting for the variables studied.

CONCLUSIONS

This study revealed associations between the cognitive and functional status of the individual and aspects of oral health, that may contribute to a deeper understanding of the background of oral health status in older adults.

The self-assessed oral health status of individuals from White, Indian, Chinese and Black Caribbean communities in South-east England

OBJECTIVES

To determine the level of self-assessed oral symptoms and the impact of such symptoms among individuals from four ethnic groups resident in South-east England and the relationship between self-assessed oral health status, age, gender, employment status, educational level and ethnicity.

METHOD

Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups.

MEASURES

Subjective Oral Health Status Indicators (SOHSI).

PARTICIPANTS

Individuals were recruited through community groups. All participants self-classified their ethnicity. Only completed questionnaires from participants categorising themselves as White, Black Caribbean, Chinese or Indian were included in the data analysis.

FINDINGS

Univariate statistical analysis revealed significant differences between ethnic groups in all but one of the SOHSI scales. Age and ethnicity (in particular membership of the Chinese community) emerged as significant predictors of SOHSI scale scores.

CONCLUSIONS

Within the limitations imposed by convenience sampling, it has been found that differences exist among four ethnic groups in the UK in their reporting of self-assessed oral health status. Ethnicity and age, in particular, predict the reporting of self-assessed oral symptoms and the impact of such symptoms.