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Ju X, Jamieson LM, Mejia GC, Mittinty MN. Effect of oral health literacy on self-reported tooth loss: A multiple mediation analysis. Community Dent Oral Epidemiol 2021; 50:445-452. [PMID: 34561880 DOI: 10.1111/cdoe.12699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aims to investigate the mediating pathways of oral health literacy (OHL) and oral health-related behaviours on the relationship between education and self-reported tooth loss among Australian adults. METHODS Data used for studying the effects of mediating pathways are from the National Dental Telephone Interview Survey 2013, a random sample survey of Australian adults aged 18+ years. To study the mediating effects, we use counterfactual-based analysis. To decompose the effect of multiple mediator's alternate, to natural effect, methods such as interventional effects have been proposed. In this paper, we use these approaches to decompose the effect between education, OHL and oral health-related behaviours on self-reported tooth loss. Sensitivity analysis was performed for unmeasured confounding with multiple mediators. RESULTS Data were available for 2936 Australian adults. The prevalence of persons with ≥12 self-reported tooth loss was approximately 15%. The average total causal effect from the low education group was nearly 150%, and the interventional indirect effect through OHL and the dependence of oral health-related behaviours on OHL to more than 12 missing teeth were 20% and 120%, respectively, higher than in the high education group. Sensitivity analysis indicated if the difference in the prevalence of unmeasured confounder is as big as 6% the direct effect and the indirect effect remains as observed. CONCLUSIONS An additional two-fifths reduction on having more than 12 missing teeth for Australian adults with lower education level could be achieved if the proportion of lower OHL was decreased and optimal dental behaviours were increased.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Gloria C Mejia
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, Australia.,SA Aboriginal Chronic Disease Consortium, Wardliparingga, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Murthy N Mittinty
- School of Public Health, The University of Adelaide, Adelaide, Australia
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Ju X, Hedges J, Garvey G, Smith M, Canfell K, Jamieson L. Poor self-rated oral health associated with poorer general health among Indigenous Australians. BMC Public Health 2021; 21:424. [PMID: 33648472 PMCID: PMC7919297 DOI: 10.1186/s12889-021-10426-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
Background Oral diseases negatively impact general health, affecting physical, psychological, social and emotional wellbeing, and ability to give back to community. The relationship between poor oral health, and general health and wellbeing among Indigenous Australians has not been documented. Working in partnership with seven Indigenous communities in South Australia, this study aimed to: 1) quantify self-rated oral health and health-related quality of life and; 2) investigate associations between poor self-rated oral health and general health among Indigenous Australian adults. Methods Data was collected from a large convenience sample of Indigenous Australians aged 18+ years from Feb 2018 to Jan 2019. General health-related quality of life, as the main outcome variable, was measured by calculating disutility scores with the five individual EQ-5D dimensions (EuroQol instrument: EQ-5D-5L), then classified as ‘no problem’ and ‘at least one problem’. Self-reported oral health, as the main explanatory, was dichotomised into ‘fair or poor’ and ‘excellent, very good or good’. Multivariable log-Poisson regression models were used to estimate associations between poor self-rated oral health and general health by calculating mean rate ratios (MRR) for disutility scores and prevalence ratios (PR) for individual dimensions, after adjusting for social-demographic characteristics and health-related behaviours. Results Data were available for 1011 Indigenous South Australian adults. The prevalence of ‘fair or poor’ self-rated oral health was 33.5%. The mean utility score was 0.82 (95% CI: 0.81–0.83). Compared with those rating their oral health as ‘excellent or very good or good’, those who rated their oral health as ‘fair or poor’ had a mean disutility score that was 1.6 (95% CI: 1.1–2.2) times higher, and the prevalence of at least one problem ranged from 90 to 160% higher for individual EQ-5D dimensions. Conclusions Fair or poor self-rated oral health among Indigenous persons in South Australia was associated with poor general health as measured by EQ-5D-5L disutility. The relationship was especially evident with respect to mobility, self-care and anxiety/depression. The findings emphasise the importance of oral health as predictors of general health among Indigenous Australians. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10426-3.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, 5005, Australia.
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, 5005, Australia
| | - Gail Garvey
- Menzies School of Health Research, Darwin, Australia
| | - Megan Smith
- Cancer Council of NSW, Woolloomooloo, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Karen Canfell
- Cancer Council of NSW, Woolloomooloo, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, 5005, Australia
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Singh KA, Brennan DS. Use of dental services among middle-aged adults: predisposing, enabling and need variables. Aust Dent J 2021; 66:270-277. [PMID: 33521979 DOI: 10.1111/adj.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- K A Singh
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - D S Brennan
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Lindmark U, Ernsth Bravell M, Johansson L, Finkel D. Oral health is essential for quality of life in older adults: A Swedish National Quality Register Study. Gerodontology 2020; 38:191-198. [PMID: 33258183 PMCID: PMC8247009 DOI: 10.1111/ger.12514] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/08/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine the relationship between QoL and oral health from two Swedish national quality registries (NQRs). BACKGROUND Oral health plays an important part in general health, which might also affect QoL. No studies have examined the relationships between QoL and oral health in late adulthood based on aggregated data from Swedish NQRs. MATERIAL AND METHODS Four NQRs incorporated the EQ-5D, which assesses 5 aspects of QoL: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Items from the Revised Oral Assessment Guide, obtained from the NQR Senior Alert, were used to identify older adults at risk for oral health issues. RESULTS A total of 510 individuals had data on all relevant variables. Analyses indicated significantly higher QoL for individuals without risk of oral health problems (M = -0.15 (SD = 1.01)), compared to those with risk (M = -0.75 (SD = 1.52)). Logistic regression analysis showed that lower QoL (OR = 0.69 (0.49, 0.97)), mental status (OR = 0.37 (0.19, 0.71)), lower self-rated health (OR = 0.59 (0.42, 0.85)) and higher age (OR = 1.07 (1.01, 1.13)) were significantly related to risk of oral health problems. Higher BMI (OR = 1.13 (0.99, 1.30)), living alone (OR = 2.37 (0.93, 6.06)) and more years of education (OR = 1.15 (1.01, 1.31)) were associated with higher risk of oral health problems. CONCLUSIONS Oral health is a significant component of quality of life in late adulthood. NQRs are of value for healthy ageing research in populations that may be underrepresented in research studies.
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Affiliation(s)
- Ulrika Lindmark
- Department of Health Sciences, Karlstad University, Karlstad, Sweden.,Center of Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Aging Research Network - Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Marie Ernsth Bravell
- Aging Research Network - Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Institution of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Linda Johansson
- Aging Research Network - Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Institution of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Deborah Finkel
- Aging Research Network - Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Institution of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Psychology, Indiana University Southeast, New Albany, IN, USA
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Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis. J Am Dent Assoc 2019; 150:1027-1039.e7. [PMID: 31761016 DOI: 10.1016/j.adaj.2019.07.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome. TYPES OF STUDIES REVIEWED Through electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies' methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS Twelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, -2.77; 95% confidence interval, -4.56 to -0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low. CONCLUSIONS AND PRACTICAL IMPLICATIONS Better-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS.
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Rosing K, Christensen LB, Øzhayat EB. Associations between tooth loss, prostheses and self-reported oral health, general health, socioeconomic position and satisfaction with life. J Oral Rehabil 2019; 46:1047-1054. [PMID: 31206793 DOI: 10.1111/joor.12836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 06/07/2019] [Accepted: 06/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate whether the location of tooth loss and prosthesis are associated with self-reported oral health, general health, socioeconomic position and satisfaction with life. METHODS From the Copenhagen Aging and Midlife Biobank (CAMB) investigation, 1517 persons had their oral status ranked (full dentition, fixed prosthesis in the masticatory zone, tooth loss in the masticatory zone, fixed prosthesis in the aesthetic zone, removable prosthesis, tooth loss in the aesthetic zone). Self-reported oral health, general health, socioeconomic position and satisfaction with life were obtained. Information on gender, normative socioeconomic position, frequency of seeing a dentist, acute dental treatment within the last 5 years and general diseases was also recorded. RESULTS Patients with tooth loss in the aesthetic zone and removable prosthesis showed high odds ratios for reporting poor rather than good oral health compared to patients having a full dentition. Having a removable prosthesis was further associated with rating socioeconomic position as low rather than high (odds ratio = 27.7 [95% CI: 5.07; 151.6]) compared to a full dentition after controlling for normative socioeconomic position and gender. In the bivariate analyses, a tendency towards poorer general health and poorer satisfaction with life was found with worse oral status, meanwhile the multiple regression analyses did not show significant associations between oral status and general health and satisfaction with life. CONCLUSIONS Missing teeth and having prostheses are associated with worse self-reported oral health compared to having a full dentition. Removable dental prosthesis may be associated with a worse self-perception of socioeconomic status.
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Affiliation(s)
- Kasper Rosing
- Section of Community Dentistry, Department of Odontology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Lisa Bøge Christensen
- Section of Community Dentistry, Department of Odontology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Esben Boeskov Øzhayat
- Section of Oral Rehabilitation, Department of Odontology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Matsuyama Y, Tsakos G, Listl S, Aida J, Watt R. Impact of Dental Diseases on Quality-Adjusted Life Expectancy in US Adults. J Dent Res 2019; 98:510-516. [DOI: 10.1177/0022034519833353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Comparing the burden of dental conditions to other health outcomes provides useful insight for public policy. We aimed to estimate quality-adjusted life expectancy (QALE) loss due to dental conditions in the US adult population. Social inequalities in QALE loss by dental conditions were also examined. Data from 3 cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES waves 2001 to 2002, 2003 to 2004, and 2011 to 2012) were pooled and analyzed. The average age of study participants ( n = 9,445) was 48.4 y. Disutility scores were derived from self-rated health and the numbers of physically unhealthy days, mentally unhealthy days, and days with activity limitation, employing a previously published algorithm. The associations between the disutility scores and the numbers of decayed teeth, missing teeth, and periodontitis were examined by multiple linear regression stratified by age groups (20–39, 40–59, and ≥60 y), adjusted for other covariates (age, sex, wave fixed effect, educational attainment, smoking, and diabetes). The QALE loss due to dental conditions at the age of 20 was estimated using life tables. Decayed and missing teeth, but not periodontitis, were associated with a larger disutility score. The coefficient for decayed teeth was larger among the older population, whereas that of missing teeth was smaller among them. The estimated QALE loss was 0.43 y (95% confidence interval [CI], 0.28–0.59), which reached 5.3% of QALE loss (8.15 y; 95% CI, 8.03–8.27) due to overall morbidity. There were clear social gradients in QALE loss by dental conditions across the life course, and people with high school or less education had 0.32 y larger QALE loss in total compared with people with college or more education. This study suggests that improvements in people’s dental health may yield substantial gains in population health and well-being. The necessity of more comprehensive public health strategies is highlighted.
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Affiliation(s)
- Y. Matsuyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Japan
- Japan Society for the Promotion of Science, Chiyoda-ku, Japan
- Department of Epidemiology and Public Health, University College London, London, UK
| | - G. Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - S. Listl
- Department of Dentistry-Chair for Quality and Safety of Oral Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Conservative Dentistry–Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - R.G. Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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