Comparison of adult oral health in Australia, the USA, Germany and the UK

Using machine learning to study the association of sociodemographic indicators, biomarkers, and oral condition in older adults in Colombia

BACKGROUND

Chronic health conditions and socioeconomic problems that affect the well-being and life expectancy of older adults are common. The objective of this cross-sectional study was to analyze the association between sociodemographic variables, oral conditions, and general health and the biomarkers of older adults using machine learning (ML).

METHODS

A total of 15,068 surveys from the national study of Health, Well-Being and Aging (Salud, Bienestar y Envejecimiento) data set were used for this secondary analysis. Of these, 3,128 people provided blood samples for the analysis of blood biomarkers. Sociodemographic, oral health, and general health variables were analyzed using ML and logistic regression.

RESULTS

The results of clustering analysis showed that dyslipidemia was associated with poor oral condition, lower socioeconomic status, being female, and low education. The self-perception of oral health in older adults was not associated with the presence of teeth, blood biomarkers, or socioeconomic variables. However, the necessity of replacing a dental prosthesis was associated with the lowest self-perception of oral health. Edentulism was associated with being female, increased age, and smoking.

CONCLUSIONS

Socioeconomic and educational disparities, sex, and smoking are important factors for tooth loss and suboptimal blood biomarkers in older adults. ML is a powerful tool for identifying potential variables that may aid in the prevention of systemic and oral diseases in older adults, which would improve geriatric dentistry.

PRACTICAL IMPLICATIONS

These findings can help the academic community identify critical sociodemographic and clinical factors that influence the process of healthy aging and serve as a useful guide to enhance health care policies and geriatric oral health care services.

Oral health of the 65+ age group in Israel-2020

Background

In 2019, a reform of dental services for older adults was implemented in Israel to improve access and reduce barriers that stood in their way. The reform stipulated that preventive and restorative dentistry would be included in the basket of services of the National Health Insurance Law. The current study was conducted by the Myers-JDC-Brookdale Institute (MJB) and the Division of Dental Health of Israel’s Ministry of Health to examine the dental status and patterns of utilizations of dental services among the 65+ age group. This paper reports on the dental status of the 65+ age group in comparison with the same population two decades earlier.

Goals

To describe the dental status of Israel’s 65+ age group, and to identify the population at risk of dental morbidity.

Methodology

Telephone interviews were conducted with a representative sample of 512 older adults aged 65+, from February to April 2020.

Main findings

Some two-thirds of the 65+ age group assessed their oral health as good or very good. Twenty-four percent did not have natural teeth, while the rest had 19 teeth on average. Ten percent had not lost any teeth. In the 65–74 age group, 19% had no natural teeth and the rest had 20 teeth on average. In contrast, in the 85+ age group, 38% were edentulous and the rest had 13 teeth on average. Of the older adults who found it difficult to cover their monthly expenses, 39% were edentulous—twice the percentage of those who did manage to cover their monthly expenses (19%). Of the 65+ age group 44% had dentures—37% in the 65–74 age group, and 66% in the 85+ age group. Approximately 40% of the 65+ age group saw a dentist for preventive check-ups. The rest did not, mainly due to lack of awareness of the importance of doing so.

Conclusions and recommendations

The perceived status of oral health among the 65+ age group is currently better than it was 22 years ago. However, despite the improvement in oral health and health behavior, there are still barriers to the utilization of dental services. The main barriers are a lack of awareness of the importance of proper health behavior, and the cost of care for people with financial difficulty. This study provides decision-makers with data on the status of oral health, the utilization of dental services and the geographical disparities. The findings will help policy makers evaluate the effectiveness of the reform and fine tuning it in the future. Policies should be instated to increase awareness of constituencies and their access to the services, in addition to the entitlements the reform granted.

Distribution of Australian dental practices in relation to the ageing population

OBJECTIVE

The purpose of this study was to analyse and map the distribution of the ageing population, by sociodemographic profiling, in private and public dental practices in Australia.

BACKGROUND

The rapid increase in the aged population in Australia requires a comprehensive approach to ensure accessibility to geriatric dental services. However, the availability of dental services for the older people requires further investigation of the demographic distribution of need.

MATERIALS AND METHODS

Dental practices were located and mapped against the ageing population data. The address for each dental practice in Australia was compiled from online access sources. Australian socioeconomic data were integrated with dental practices, clinic locations and older populations using Geographic Information System (GIS) technology.

RESULTS

There was an uneven distribution of dental practices across Australia's States and Territories (NT and ACT). Tasmania had the highest ratio of private practices to the older population (1:1000) and the highest percentages of this ageing cohort (32%, 61%) that lived more than 5 km from private and public dental practices respectively. Higher percentages of dental practices were located in areas of lower socioeconomic status in Tasmania, Queensland and South Australia (47%, 42% and 38%) respectively, however, these areas were associated with higher ageing population densities.

CONCLUSION

There is a geographic maldistribution of dental practices in relation to the spatial distribution of Australia's older population, with the inequity most pronounced in the most disadvantaged areas. This inequality requires a National approach to match dental services to the population that they serve.

For preventive medicine to include oral health care, the dental profession, licensing agencies, payers, and the public must effect change

Dentistry is represented to the US public in large part by the various professional associations, which speak for the interests of general and specialized dentists, mostly in private proprietary practice. Unfortunately, the interests of dental professional associations may often be in conflict with those of the public. To resolve this continued disparity, it behooves the dental leadership to become more involved with the overall health care system than continuing to enhance the economic interests of the profession without sufficient regard for the world-wide burden of unmet dental needs. An assessment of policy failures is provided with some recommendations for greater involvement of organized dentistry in the integration of oral and general health care. Dentistry must recommit itself to being a health profession rather focusing on the business aspects of health care. Another aspect to be considered is a reorganization of the American Dental Association to better represent the oral health care workforce.

Long-term effects of Class II orthodontic treatment on oral health

AIM

To investigate the long-term (≥15 years) benefit of orthodontic Class II treatment (Tx) on oral health (OH).

SUBJECTS AND METHODS

All patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who underwent Class II correction (Herbst-multibracket Tx, end of active Tx ≥ 15 years ago) and agreed to participate in a recall (clinical examination, interview, impressions, and photographs) were included. Records after active Tx were used to assess the long-term OH effects. Data were compared to corresponding population-representative age-cohorts as well as to untreated Class I controls without orthodontic Tx need during adolescence.

RESULTS

Of 152 treated Class II patients, 75 could be located and agreed to participate at 33.7 ± 3.0 years of age (pre-Tx age: 14.0 ± 2.7 years). The majority (70.8%) were fully satisfied with their teeth and with their masticatory system. The Decayed, Missing, Filled Teeth Index (DMFT) was 7.1 ± 4.8 and, thus, almost identical to that of the untreated Class I controls (7.9 ± 3.6). In contrast, the DMFT in the population-representative age-cohort was 56% higher. The determined mean Community Periodontal Index (CPI) maximum score (1.6 ± 0.6) was also comparable to the untreated Class I controls (1.7 ± 0.9) but in the corresponding population-representative age-cohort it was 19-44% higher. The extent of lower incisor gingival recessions did not differ significantly between the treated Class II participants and the untreated Class I controls (0.1 ± 0.2 vs. 0.0 ± 0.1 mm).

CONCLUSION

Patients with orthodontically treated severe Class II malocclusions had a lower risk for oral health impairment than the general population. The risk corresponded to that of untreated Class I controls (without orthodontic Tx need during adolescence).

Widespread Volumetric Brain Changes following Tooth Loss in Female Mice

Tooth loss is associated with altered sensory, motor, cognitive and emotional functions. These changes vary highly in the population and are accompanied by structural and functional changes in brain regions mediating these functions. It is unclear to what extent this variability in behavior and function is caused by genetic and/or environmental determinants and which brain regions undergo structural plasticity that mediates these changes. Thus, the overall goal of our research program is to identify genetic variants that control structural and functional plasticity following tooth loss. As a step toward this goal, here our aim was to determine whether structural magnetic resonance imaging (sMRI) is sensitive to detect quantifiable volumetric differences in the brains of mice of different genetic background receiving tooth extraction or sham operation. We used 67 adult female mice of 7 strains, comprising the A/J (A) and C57BL/6J (B) strains and a randomly selected sample of 5 of the 23 AXB-BXA strains (AXB1, AXB4, AXB24, BXA14, BXA24) that were produced from the A and B parental mice by recombinations and inbreeding. This panel of 25 inbred strains of genetically diverse inbred strains of mice is used for mapping chromosomal intervals throughout the genome that harbor candidate genes controlling the phenotypic variance of any trait under study. Under general anesthesia, 39 mice received extraction of 3 right maxillary molar teeth and 28 mice received sham operation. On post-extraction day 21, post-mortem whole-brain high-resolution sMRI was used to quantify the volume of 160 brain regions. Compared to sham operation, tooth extraction was associated with a significantly reduced regional and voxel-wise volumes of cortical brain regions involved in processing somatosensory, motor, cognitive and emotional functions, and increased volumes in subcortical sensorimotor and temporal limbic forebrain regions including the amygdala. Additionally, comparison of the 10 BXA14 and 21 BXA24 mice revealed significant volumetric differences between the two strains in several brain regions. These findings highlight the utility of high-resolution sMRI for studying tooth loss-induced structural brain plasticity in mice, and provide a foundation for further phenotyping structural brain changes following tooth loss in the full AXB-BXA panel to facilitate mapping genes that control brain plasticity following orofacial injury.

Austin Powers bites back: a cross sectional comparison of US and English national oral health surveys

OBJECTIVE

To compare oral health in the US and England and to assess levels of educational and income related oral health inequalities between both countries.

DESIGN

Cross sectional analysis of US and English national surveys.

SETTING

Non-institutionalised adults living in their own homes.

PARTICIPANTS

Oral health measures and socioeconomic indicators were assessed in nationally representative samples: the Adult Dental Health Survey 2009 for England, and the US National Health and Nutrition Examination Survey 2005-08. Adults aged ≥25 years were included in analyses with samples of 8719 (England) and 9786 (US) for analyses by education, and 7184 (England) and 9094 (US) for analyses by income.

MAIN OUTCOME MEASURES

Number of missing teeth, self rated oral health, and oral impacts on daily life were outcomes. Educational attainment and household income were used as socioeconomic indicators. Age standardised estimates of oral health were compared between countries and across educational and income groups. Regression models were fitted, and relative and absolute inequalities were measured using the relative index of inequality (RII) and the slope index of inequality (SII).

RESULTS

The mean number of missing teeth was significantly higher in the US (7.31 (standard error 0.15)) than in England (6.97 (0.09)), while oral impacts were higher in England. There was evidence of significant social gradients in oral health in both countries, although differences in oral health by socioeconomic position varied according to the oral health measure used. Consistently higher RII and SII values were found in the US than in England, particularly for self rated oral health. RII estimates for self rated oral health by education were 3.67 (95% confidence interval 3.23 to 4.17) in the US and 1.83 (1.59 to 2.11) in England. In turn, SII values were 42.55 (38.14 to 46.96) in the US and 18.43 (14.01 to 22.85) in England.

CONCLUSIONS

The oral health of US citizens is not better than the English, and there are consistently wider educational and income oral health inequalities in the US compared with England.

Relationship between decayed teeth and metabolic syndrome: data from 4716 middle-aged male Japanese employees

Background

Epidemiological findings regarding the relationship between decayed teeth (DT) and metabolic syndrome (MetS) are scarce. We evaluated the relationship of DT with MetS, obesity, and MetS components in early middle-aged male Japanese employees.

Methods

We cross-sectionally analyzed dental and medical health checkup results from a total of 4716 participants aged 42 or 46 years. Logistic regression models were employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for age, breakfast consumption frequency, drinking habits, smoking status, and physical activity.

Results

Significant differences in the prevalence of MetS, obesity determined by body mass index, and the components of MetS between participating men with and without DT were detected (all P < 0.01). The adjusted OR of MetS was 1.41 (95% CI, 1.14–1.74) for those with 1 or 2 DT, and 1.66 (95% CI, 1.28–2.16) for those with ≥3 DT (P for trend = 0.01), and this significant relationship was observed even in those without periodontal pocket formation (P for trend = 0.03) or missing teeth (P for trend = 0.02). DT was significantly related to overweight/obesity and the MetS components of hypertension, dyslipidemia, and hyperglycemia, with adjusted ORs of 1.35 (95% CI, 1.19–1.53), 1.22 (95% CI, 1.07–1.39), 1.18 (95% CI, 1.03–1.34), and 1.33 (95% CI, 1.13–1.56), respectively. In addition, even in non-overweight/non-obese men, DT was found to be related to dyslipidemia and hyperglycemia, though with marginal significance (P < 0.05).

Conclusions

Our findings suggest that having DT is related to MetS in early middle-aged Japanese men directly and through obesity and is independent of health behaviors, periodontal condition, and tooth loss.

Geriatric slim implants for complete denture wearers: clinical aspects and perspectives

Background

Advances made in prevention have helped postpone complete edentulism in older patients. However, in the elderly, the physiological state reduces patients’ ability to adapt to oral rehabilitation and degrades the patient’s oral condition. Consequently, elderly edentulous subjects avoid many types of foods, which can lead to substantial nutritional consequences. Complete dentures retained by implants are, currently, the treatment of reference in prosthodontic mandibular rehabilitation. Indeed, the mandibular symphysis generally tolerates implantation, even when the mandible is strongly resorbed. However, in the elderly, implant rehabilitation is compromised by the complexity of the surgical protocol and possible postoperative complications. In this context, the use of geriatric “slim implants” (GSI) offers an interesting alternative.

Methods

In the present study, the surgical and prosthetic procedures for the use of GSI in a French dental hospital are presented. The objective was the stabilization of a complete mandibular denture in an elderly person, with the immediate implantation of four GSI.

Results

The operating procedure was found to be less invasive, less expensive, simpler, and more efficient than the conventional procedure.

Conclusion

The result strongly suggests that this protocol could be used systematically to treat complete edentulism in very elderly patients. Long-term monitoring and the evaluation of the reliability of this type of rehabilitation should be undertaken.

Analysis of a Payments Database Reveals Trends in Dental Treatment Provision

Use of fluoride has led to dramatic improvements in oral health; however, the impact of these improvements on the volume and mix of treatment provided in dental systems is largely unknown. The use of administrative data to analyze trends in treatment provision gives ‘real-life’ insight into the impact of changing levels of oral health on oral health services. The first aim of this study was to determine the extent to which useful data on temporal treatment patterns could be extracted from a public insurance database. The second aim, contingent on the first, was to investigate whether increased tooth retention and decreases in caries were reflected in the volume and types of treatment provided to adults within a public social insurance scheme between 1997 and 2008. Data were retrieved from the Dental Treatment Benefit Scheme databases, and new datasets were generated to analyze the distribution of treatments and mean treatments provided to 1,271,937 adults over the 12-year period. Provision of restorations, extractions, and dentures decreased, and the ratio of preventive/diagnostic to invasive treatments per dentist increased, which supports reported improvements in oral health. In conclusion, this paper illustrates the decline in invasive treatments, and increase in preventive treatments that accompanied improvements in oral health.

Is dental erosion really a problem?

Dental erosion is the non-carious dental substance loss induced by direct impact of exogenous or endogenous acids. It results in a loss of dental hard tissue, which can be serious in some groups, such as those with eating disorders, in patients with gastroesophageal reflux disease, and also in persons consuming high amounts of acidic drinks and foodstuffs. For these persons, erosion can impair their well-being, due to changes in appearance and/or loss of function of the teeth, e.g., the occurrence of hypersensitivity of teeth if the dentin is exposed. If erosion reaches an advanced stage, time- and money-consuming therapies may be necessary. The therapy, in turn, poses a challenge for the dentist, particularly if the defects are diagnosed at an advanced stage. While initial and moderate defects can mostly be treated non- or minimally invasively, severe defects often require complex therapeutic strategies, which often entail extensive loss of dental hard tissue due to preparatory measures. A major goal should therefore be to diagnose dental erosion at an early stage, to avoid functional and esthetic impairments as well as pain sensations and to ensure longevity of the dentition.

A comparison of periodontal status in the two regional, population-based studies of SHIP and INVEST

OBJECTIVES

To compare the prevalence of periodontal disease between two randomly selected population-based studies (the Oral Infections and Vascular Disease Epidemiology Study (INVEST) and the Study of Health in Pomerania (SHIP)) and address relevant methodological issues.

METHODS

Comparison was restricted to 55- to 81-year olds. Attachment loss (AL), probing depth (PD) and tooth count were assessed in INVEST (full-mouth, six sites) and SHIP (half-mouth, four sites). Subjects were classified according to the CDC/AAP case definition. Recording protocols were standardized. Mixed linear or logistic models were used to compare INVEST with SHIP.

RESULTS

Mean half-mouth AL was lower in INVEST versus SHIP (INVEST: 2.9 mm versus SHIP: 4.0 mm, p < 0.05). Findings were similar across multiple periodontal disease definitions. After equalization of recording protocols and adjustment for periodontal risk factors, mean AL and PD were 1.2 and 0.3 mm lower in INVEST versus SHIP (p < 0.001). The odds for severe periodontitis (CDC/AAP) was 0.2-fold in INVEST versus SHIP (p < 0.001). Confounding effects of age, gender, race/ethnicity, education and use of interdental care devices were highest as indicated by change-in-estimate for study.

CONCLUSION

Implementation of the proposed method for comparison of epidemiological studies revealed that periodontitis was less prevalent in INVEST compared with SHIP, even after extensive risk-factor adjustment.

Oral health in the adult population of Skåne, Sweden: a clinical study

OBJECTIVE

The aim of this study was to describe the oral health in the adult population of Skåne by clinical factors with special reference to age, gender, ethnicity and education.

MATERIALS AND METHODS

Clinical examinations were performed on 451 randomly selected individuals, 20-89 years old, living in Skåne, Sweden. The clinical examination included a radiographic examination and a questionnaire. Clinical variables were put into cross-tabulations along with age, gender, educational level and ethnicity.

RESULTS

For all of the described clinical variables, except caries, the frequency increased with age. There were no differences in the clinical variables due to gender. The frequencies of missing teeth, caries, periodontal conditions and DMFT were higher among those with a lower educational level. More missing teeth, worse periodontal conditions, more apical destructions and less dental fillings were found in individuals who were not born in Sweden.

CONCLUSIONS

The oral health in the adult population of Skåne was overall good, with low frequencies of oral disease and a large number of remaining teeth up to a high age. The patients' oral health status, as determined by a dentist's clinical examination, differed due to age, educational level and ethnicity, but not due to gender.

Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers

BACKGROUND AND OBJECTIVE

The prevalence of malnutrition increases with age because of many factors. Edentulousness leads to the avoidance of many types of foods. The aim of this study was to determine whether elderly complete denture wearers have a higher risk of malnutrition than dentate controls.

MATERIAL AND METHODS

A Mini-Nutritional Assessment (MNA) and a 3-day dietary record were compiled for a group of fully dentates (21 women and 29 men; mean age 70.1 ± 6.1) and for a group of complete denture wearers (31 women and 16 men; mean age 70.1 ± 8.1). Socio-demographic data and scores on the General Oral Health Assessment Index (GOHAI) questionnaire were collected.

RESULTS

Inter-group comparison of MNA scores showed that more subjects in the edentulous group (21.3%) risked malnutrition than in the dentate group (0%). The variability of the MNA could be explained for 22% by dental status, 7% by loneliness and 4% by the GOHAI score (regression analysis). Both groups had insufficient energy intakes and deficits in vitamins and micronutrients; moreover, edentulous subjects had lower intakes than dentate subjects.

CONCLUSION

The use of conventional dentures increases the risk of malnutrition in the elderly.

Diversity of dental patterns: application on different ages using the Brazilian National Oral Health Survey

Methods of individual identification using human remains are widely used in forensic anthropology; however, there are few studies that use statistical methods in order to obtain a correct definition of parameters. The objectives of the study were to verify the diversity of dental patterns in the Brazilian population and analyse its application on different ages. Data from the Brazilian National Oral Health Survey were used to verify the presence and absence of dental treatment among 35,613 individuals of several age groups: 15-19, 35-44 and 65-74. Information referring to every dental element was described: higid (H), decayed (D), filled (F), missing (M) and prosthesis (P). Coincidences that were observed in pairs of homologous teeth were analysed according to clinical situation, gender and age. Ordinary findings (presented in more than 10% of pairs) and extraordinary ones (presented in less than 10% of pairs) were described. Total and conditional diversity estimates were performed. Among adolescents, H were the most frequent teeth, and the first molar teeth were the ones presenting less frequency of H. Among adults, the frequency of M teeth among females ranged from 15.17% to 71.59%, and among males they ranged from 9.00% to 87.20%. Among the elderly, M teeth were observed in the largest frequency, and anterior teeth presented fewer losses than posterior ones. M was the condition that most coincided with both sides in the elderly. In adults, some pairs of teeth presented H, but mostly pairs of teeth presented as M. Among adolescents, there was more concordance of the H component. Among male and female adolescents, we observed extraordinary findings in DMFP dental conditions in most of the teeth. Among adults, the less frequent dental condition was P, which was found in several teeth. The extraordinary findings among elderly male teeth were codes H, D, F and P; among females, they were H, D, F and P codes. The high prevalence of healthy teeth in adolescents and a high rate of edentulism in the elderly interfered with the analysis performed. However, when an estimation of diversity that corrects those distortions was used, all of the groups presented satisfactory results that were homogeneous in the performed analysis.

National survey of the incidence of missing anterior teeth: potential use in bite mark analysis in the Brazilian context

Bite mark analysis in forensic dentistry presupposes that the human dentition is unique and that its characteristics can be transferred precisely to several materials. The aim of the present study was to register the frequency of missing anterior teeth in the Brazilian adult population, discussing its potential importance in bite mark analysis. Data from the Brazilian Oral Health Survey were used; 13,431 male and female individuals aged 35 to 44 were examined according to the criteria of the World Health Organization. The analysis of Poisson regression was performed in order to calculate the rating ratios and the respective confidence interval at 95%. A total of 13,431 adults participated in the study. Among male individuals, 2063 (47.00%) were dentate and 2036 (46.40%) had at least one missing tooth. Only 254 (5.83%) were totally edentulous. A significant number of males and females presented 6 missing teeth in the same dental arch, revealing the poor state of oral health of adult Brazilians. Missing teeth were more frequent in the upper dental arch than in the lower arch. In the upper dental arch, the incisor group (central and lateral) was missing the most. In the lower dental arch, however, a certain lack of homogeneity was observed among the different dental groups as regards missing teeth. White individuals presented a smaller proportion of missing teeth compared to the other ethnic groups. Females were 1.61 (CI 1.50-1.73) times more likely than males to present missing teeth. The absence of upper teeth and the presence of lower teeth were observed in 16.10% of the individuals. Further research should also include an analysis of different age groups. This would increase the potential of applying this kind of information to bite mark analysis.