Factors associated with having less than 20 natural teeth in rural adults: a cross-sectional study

Rural-urban disparities in the incidence and treatment intensity of periodontal disease among patients with diabetes

Background

Diabetes threatens population health, especially in rural areas. Diabetes and periodontal diseases have a bidirectional relationship. A persistence of rural-urban disparities in diabetes may indicate a rural-urban difference in periodontal disease among patients with diabetes; however, the evidence is lacking. This retrospective study aimed to investigate rural-urban discrepancies in the incidence and treatment intensity of periodontal disease among patients who were newly diagnosed with type 2 diabetes in the year 2010.

Methods

The present study was a retrospective cohort design, with two study samples: patients with type 2 diabetes and those who were further diagnosed with periodontal disease. The data sources included the 2010 Diabetes Mellitus Health Database at the patient level, the National Geographic Information Standardization Platform and the Department of Statistics, Ministry of Health and Welfare in Taiwan at the township level. Two dependent variables were a time-to-event outcome for periodontal disease among patients with type 2 diabetes and the treatment intensity measured for patients who were further diagnosed with periodontal disease. The key independent variables are two dummy variables, representing rural and suburban areas, with urban areas as the reference group. The Cox and Poisson regression models were applied for analyses.

Results

Of 68,365 qualified patients, 49% of them had periodontal disease within 10 years after patients were diagnosed with diabetes. Compared to urban patients with diabetes, rural (HR = 0.83, 95% CI: 0.75-0.91) and suburban patients (HR = 0.86, 95% CI: 0.83-0.89) had a lower incidence of periodontal disease. Among 33,612 patients with periodontal disease, rural patients received less treatment intensity of dental care (Rural: RR = 0.87, 95% CI: 0.83, 0.92; suburban: RR = 0.93, 95% CI: 0.92, 0.95) than urban patients.

Conclusion

Given the underutilization of dental care among rural patients with diabetes, a low incidence of periodontal disease indicates potentially undiagnosed periodontal disease, and low treatment intensity signals potentially unmet dental needs. Our findings provide a potential explanation for the persistence of rural-urban disparities in poor diabetes outcomes. Policy interventions to enhance the likelihood of identifying periodontal disease at the early stage for proper treatment would ease the burden of diabetes care and narrow rural-urban discrepancies in diabetes outcomes.

Rural-urban disparities in Oral Health-related Quality of Life for middle-aged and older adults with diabetes in Taiwan

Background

Public health faces a significant challenge in reducing rural-urban disparities in diabetes. Since dietary control is part of the medical regimen for diabetes management, how diabetic patients perceive the impact of oral health on their quality of life is critical. The present study aimed to compare the Oral Health-related Quality of Life (OHRQoL) between rural and urban diabetic patients.

Methods

The study design was cross-sectional. The study sample included 831 self-reported diabetic patients, extracted from the first wave of the new-cohort Taiwan Longitudinal Study on Aging survey (NC_TLSA) that comprised a nationally representative sample of community-dwelling adults aged 50 and above in Taiwan. The composite score generated from the Oral Health Impact Profile-7 (OHIP-7), which has seven questions, was used to construct two OHRQoL measures, the severity of perceived poor OHRQoL and the prevalence of poor OHRQoL. These two OHRQoL measures were treated as dichotomous variables. Multivariate logistic regression models were applied for analysis.

Results

Rural diabetic patients had a higher likelihood of experiencing the severity of perceived poor OHRQoL than those in urban areas (OR = 2.40, 95% CI: 1.30-4.40). Although rural diabetic patients also had a higher prevalence of poor OHRQoL than urban diabetic patients, the difference was not significant (OR = 1.47, 95% CI: 0.95-2.28). Social determinants, such as education, are essential factors attributed to both OHRQoL measures.

Conclusion

Overall, rural diabetes community-dwelling patients had a poorer OHRQoL than those in urban areas. Given a bidirectional relationship between oral health and diabetes, improving oral health in rural areas may be a critical avenue to improve the quality of diabetes care in rural areas.

"If I have teeth, I can smile." Experiences with tooth loss and the use of a removable dental prosthesis among people who are partially and completely edentulous in Karnataka, India

Objectives

Tooth loss is a phenomenon associated with structural and functional changes, with a negative influence on the oral and general health of an individual. Removable dental prosthesis is commonly fabricated as treatment for tooth loss. However, the perceptions and experiences of individuals during the transition from a dentate to a partially or completely edentulous state and their acceptance of the denture are largely ignored. The objective of this study was to explore the perceptions and experiences during the transition from a dentate state to being partially or completely edentulous in the Indian population.

Methods

Fifteen individuals wearing partial or complete denture prosthesis were interviewed in depth using open-ended questions. These interviews were recorded using a voice-recording device. They were then transcribed, and a coding process was applied using the thematic framework approach to qualitative analysis.

Findings

Five themes emerged, namely: (i) Transition from dentulous to partially or completely edentulous state; (ii) Varying experiences with the use of dentures; (iii) Convenience and duration of wearing dentures; (iv) Attitude of dentists towards patients’ complaints; (v) Knowledge and preference of available treatment modalities.

Conclusions

The loss of natural teeth seemed to affect the psychological, functional, and social well-being of participants. Tooth loss was believed to be a natural aging process. Costs of treatment deterred the uptake of fixed denture treatment options. However, some participants preferred removable dentures to fixed prosthesis.

The inflammation link between periodontal disease and coronary atherosclerosis in patients with acute coronary syndromes: case-control study

BACKGROUND

Coronary atherosclerosis and periodontal disease, due to their prevalence, are a serious epidemiological problem. Pathophysiological evidence points to their possible common inflammatory etiopathological background. The aim of the study was to analyze the relationship between the presence and severity of periodontitis, systemic inflammation and selected parameters of myocardial injury and heart function in patients with acute myocardial infarction.

METHODS

The study group consisted of 71 patients 54.22 (7.05)-year-old hospitalized due to acute myocardial infarction. The patients underwent a coronary angiographic examination and echocardiography. The following laboratory parameters were determined: blood morphology, high sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), fibrinogen, troponin I, creatine kinase myocardial band (CK-MB), brain natriuretic peptide (BNP), lipidogram, glucose, creatinine, glomerular filtration rate (GFR), thyroid stymulating hormone (TSH), glycated hemoglobin (HbA1c). Dental assessment of the patients was performed and the following indicators were included: the number of teeth preserved, approximal plaque index (API), bleeding on probing (BoP), pocket depth (PD), the number of bleeding periodontal pockets ≥ 4 mm in depth (NoPD ≥ 4 mm), the percentage of bleeding periodontal pockets ≥ 4 mm in depth (%PD ≥ 4 mm), clinical attachment loss (CAL). The control consisted of 40 patients 52 (± 8.43)-year-old without a history of coronary heart disease. These patients were subjected to a periodontal examination using the above parameters and classification methods. The following statistical tests were implemented: Shapiro-Wilk test, Levene's test, Mann Whitney's U analysis, Univariate Analysis of Variance (ANOVA); the post-hoc analysis was performed with the use of Tukey's honest significant difference test (HSD), Kruskal-Wallis's non-parametric test, Spearman's rank correlation, logistic regression analysis, linear regression analysis and ROC analysis.

RESULTS

The BoP (bleeding on probing) significantly correlated with fibrynogen (R-0.36; p-0.006). All indices regarding the pocket depth correlated significantly with the number of leukocytes: PD (R-0.27; p-0.02), NoPD ≥ 4 mm (R-0.28, p-0.02), %PD ≥ 4 mm (R-0.27; p-0.02). PD (R-0.28; p-0.01) and NoPD ≥ 4 mm (R-0.24; p-0.04) were also associated significantly with the level of hsCRP. The BoP is correlated closely with the levels of BNP (R-0.29, p-0.02). The multifactorial analysis showed that significant predictors of myocardial infarction are API and BoP. The analysis showed that API and BoP are important predictors of troponin levels. Linear regression analysis showed that only CAL is a significant predictor of BNP.

CONCLUSIONS

Patients with acute myocardial infarction have worse periodontal status compared to people without coronary heart disease. Greater severity of periodontitis, plaque accumulation and bleeding on probing are associated with acute myocardial infarction. Periodontitis is a risk factor for myocardial infarction and also affects the degree of post-infarction left ventricular damage, which means that there is an inflammatory link between these two diseases.

Sugary Snack Consumption and Tooth Retention among Middle-aged Thai Adults

Objectives:

This study investigated whether the habit of consuming sugary snacks was independently associated with the loss of permanent teeth.

Materials and Methods:

Eight hundred ninety-seven adults aged 35–65 from four communities in the lower regions of Southern Thailand completed a structured questionnaire interview and dental examinations. The independent variable was frequency of sweet snack consumption between meals in the previous week and coded as: never (0 days), occasionally (1–4 days), or frequently (≥5 days). The outcome was the number of permanent teeth (1–19 vs. ≥20 teeth). Multivariate logistic regression was used to examine the adjusted associations between sugary snack consumption and the number of retained teeth. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.

Results:

Approximately 23% of participants retained fewer than 20 permanent teeth. Approximately 30% of participants reported sugary snack intake most days. Fewer teeth were positively associated with high-frequency sugary snack consumption, older age, Muslim, ≤ 6 years of education, universal healthcare, infrequent tooth brushing, smoking, and alcohol consumption, but not sugar-sweetened beverages. After adjusting for sociodemographic characteristics and other potential confounders, the odds of having fewer teeth were higher among participants who frequently consumed sugary snacks (OR = 2.03, 95% CI = 1.21–3.39), but was not significantly different from those who occasionally consumed sugary snacks (OR = 0.93; 95% CI = 0.58–1.50) compared to nonsugary snack consumers.

Conclusion:

In this study, habitual sugary snack intake was associated with fewer teeth among middle-aged Thai adults. To improve oral health and prevent further tooth loss, efforts to reduce sugary snack consumption would be needed.

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis

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.

Factors Associated with Tooth Loss in Postmenopausal Women: A Community-Based Cross-Sectional Study

Many studies have indicated that menopause affects periodontal health and tooth loss. The possible mechanism might due to several hormonal changes and low bone mineral density (BMD) during the transition period. However, few studies have explored the role of oral hygiene in the number of remaining teeth (NRT) in postmenopausal women (PMW). The aim of this study was to explore the prevalence of and factors associated with NRT less than 20 in PMW. A community-based, cross-sectional study was conducted in coastal Yunlin County, Taiwan. NRT was calculated based on natural and filled teeth. BMD was detected by dual-energy X-ray absorptiometry at the collaborating hospital. Logistic regression analyses were used to identify the factors associated with NRT in rural PMW. Six hundred and ten rural PMW with mean age 65.4 years enrolled in this study. The mean NRT was 17.6 (standard deviation [SD] = 10.4), with 43.9% having <20 and 13.9% edentulous. More than half (65.9%) reported that they seldom brushed their teeth after meals, 79.2% rarely used dental floss, and 80% did not regularly undergo tooth scaling by a dentist. The majority of women had low BMD, including 48.7% with osteopenia and 20.7% with osteoporosis. After adjusting for potentially confounding variables, NRT <20 was associated with infrequent tooth scaling (odds ratio [OR] = 2.78, 95% confidence interval [CI] = 1.70–4.56) and dental floss use (OR = 2.01, 95% CI = 1.24–3.26), but not BMD. A high prevalence of NRT <20 was found among rural PMW, but poor oral hygiene rather than low BMD was the major contributing factor. It is an emerging issue for primary healthcare providers and clinicians to initiate oral hygiene promotion programs for these disadvantaged women.

Detection of dental plaque with disclosing agents in the context of preventive oral hygiene training programs

No studies have evaluated the relationship between the detection points for dental bacterial plaque (DBP or biofilm) and gender, age, socioeconomic status, body mass index (BMI), and oral health, hence the need to investigate and clarify their possible association. This study aimed to map out the occurrence of DBP, investigate and evaluate the factors affecting its localization, and design preventive interventions. The research was conducted on 588 public school children aged 4–18 years in a provincial area of Greece. The subjects’ oral health status and anthropometric characteristics were examined by a dentist (A.F.) and a dietitian (E.P.), respectively. To identify DBP, chewable double-staining disclosing tablets were used. The results of the present study indicate the following: (1) Age and socioeconomic status seem to be associated with DBP development, particularly in the oral cavity. (2) Overweight schoolchildren show more DBP on the upper posterior occlusal and upper posterior buccal surfaces compared to normal-weight children. (3) Moderate caries disease is associated with DBP detection on almost all tooth surfaces and especially on the tongue and lower anterior labial surface. (4) Severe caries disease is most strongly associated with DBP in the upper posterior palatal, lower posterior buccal, and lower posterior lingual spaces, as well as on the tongue. (5) Sex is the only variable without a significant impact on DBP detection surfaces. In conclusion, DBP identification in specific areas of the mouth seems to be influenced by age, socioeconomic level, BMI, and oral health. Gender has no influence on DBP detection points. Disclosing agents can be used in oral health prevention programs, both for more effective guidance on the use of oral hygiene tools and for their evaluation.

Periodontal complications with age

The present literature review on periodontal complications in aging focuses on the diagnosis, etiology and development of periodontal complications as a complete entity. In addition, the review also focuses on some of the common systemic diseases that either may further add to periodontal complications or, as result of anti-inflammatory treatment, limit the expression of periodontal disease. There is no evidence to suggest that clinical methods to provide periodontal therapies have been developed especially for older individuals. There is evidence that aging can be associated with periodontally healthy conditions through life and with a high level of tooth retention and function. Periodontal complications that are difficult to manage are usually associated with concurrent medical diseases and complications, or with socio-economic factors that limit the ability to provide dental care for the aging population. Currently, some systemic medical conditions are managed with anti-inflammatory medications with positive effects, while slowing the progression and expression of chronic periodontitis. The lack of data from clinical studies on how to manage periodontal complications in aging is obvious.

Relationship between dentition, anthropometric measurements, and metabolic syndrome in the elderly

Abstract Introduction Tooth loss is a health disorder of the elderly population that may lead to masticatory deficiency and nutritional risks, inducing the biochemical changes of metabolic syndrome (MS). Objective To verify the relationship among number of teeth, anthropometric measurements, and MS in a group of elderly people. Material and method The study was developed in Porto Alegre, RS, Brazil, and it was divided into three phases. The first phase collected information from the database of all project participants and the second one collected sociodemographic, anthropometric, and biochemical data. The third phase was divided into two other phases: first, oral health interviews were applied to the elderly (281 patients evaluated by telephone and 23 visited at home) and second, 45 patients were randomly selected and invited to validate the data obtained by telephone with oral clinical examinations performed by a trained dental surgeon. The sample consisted of 304 individuals. The data collected were tabulated and analyzed using statistical tests. Result Elderly women with severe tooth loss present a significantly higher risk of developing MS. Thus, the maintenance of natural teeth in the elderly is a protective factor for the syndrome. Conclusion The findings support the hypothesis that the oral health of individuals, expressed by the number of teeth, may compromise and increase the risk of MS in the elderly.

Effects of oral hygiene programme and home phone counselling for hepatitis C patients receiving antiviral treatment

AIMS

To explore the effectiveness of an oral hygiene programme combined with home phone counselling on hepatitis C patients during antiviral treatment.

BACKGROUND

Hepatitis C virus infection is the leading cause of liver diseases. Evidence indicates that the antiviral treatment for hepatitis C virus infection has been successful, albeit its many side effects, such as discomfort symptoms of oral ulcers, which, in turn, leads to discontinued treatment. Inappropriate oral hygiene may worsen the side effects and increase the risk of dropping out of the treatment.

DESIGN

A quasi-experimental pre-post-test design was used.

METHODS

The oral hygiene programme was based on a standardized protocol of oral health care combined with home phone counselling. The participants were recruited from an outpatient clinic between August 2016 and July 2017. The generalized estimating equation was used for repeated measures of oral health behaviour, oral health status and discomfort symptoms.

FINDINGS

Thirty-four participants completed this study. The findings indicated that the oral hygiene programme significantly improved tooth brushing, use of dental floss and oral comfort. The result showed that the participants' oral health status significantly improved in 3 months.

CONCLUSIONS

This pilot study supports the finding that an oral hygiene programme can reduce oral discomfort, improve oral hygiene behaviour, and enhance the oral health status of hepatitis C patients receiving treatment. This is a simple and low-cost programme, which can be performed at home easily and boosts the completion of antiviral treatment.

Misperception of Oral Health among Adults in Rural Areas: A Fundamental but Neglected Issue in Primary Healthcare

Background: Poor oral hygiene is associated with metabolic syndrome, systemic diseases, mortality and many chronic diseases. Misperception means a wrong or incorrect understanding or interpretation. Few studies have examined the subjective perception and objective condition of oral health among community adults in rural areas. Methods: This was a cross-sectional, community-based study. Participants were recruited via convenience samples from December 2015 to July 2016. One thousand six (1006) community residents participated in the project, of which 973 fulfilled the inclusion criteria. The average age was 42.8 (SD = 12.3) years, range 20–64, selected from a collaboration local hospital. Results: Most of the participants reported brushing their teeth every day, however, 72% reported seldom brushing their teeth after meals, 54% seldom used dental floss, 64% seldom received dental scaling, 29.5% had experienced a toothache within 6 months, and 30.5% demonstrated significant tooth loss. However, most of them perceived their oral health as good. Misperception of oral health was common, 21.5% among whose number of remaining teeth <25 under-assess their actual oral health. The more number of remaining teeth (p < 0.001) and regular dental check-up (p < 0.01) were positively associated with feeling good about their oral health. After adjusting for potential confounders, clinically significant findings indicated that number of remaining teeth (OR = 3.03, p < 0.001), age (OR = 0.99, p < 0.001), regular dental check-ups/scaling (OR = 1.85, p < 0.001), education (OR = 1.45, p < 0.05), and water consumption (OR = 1.38, p < 0.05) were independently associated with good perceived oral health. Conclusions: The findings showed that subjective self-perception of oral health was not matched with their objective oral condition. Excluding the unmodifiable factors, the clinical implications indicated that oral health promotion programs, particularly for adopting regular dental check-up, healthy diet and oral hygiene habits are urgent in rural areas.

Prevalence of and factors associated with fewer than 20 remaining teeth in Taiwanese adults with disabilities: a community-based cross-sectional study

OBJECTIVES

To examine the prevalence of and the factors associated with a number of remaining teeth (NRT) <20 among adults with disabilities.

DESIGN

A community-based, cross-sectional descriptive study.

SETTING

This study was part of a health promotion programme designed for community-dwelling adults with disabilities.

PARTICIPANTS

A total of 549 adults with disabilities, aged 20-80 years, living in the community in Chiayi County in Taiwan.

OUTCOME MEASURES

Various parameters, including NRT, oral health behaviours (ie, oral hygiene, dietary habits and substance use), comorbidities, disability classification and capability for performing activities of daily living, were measured. Data were statistically analysed using descriptive statistics and multivariate logistic regression analysis.

RESULTS

The mean NRT was 18.1 (SD=10.9); 44.8% of participants had NRT <20 (including 13.7% edentulous participants). Most participants had poor oral hygiene: 83.4% reported seldom using dental floss, 78% did not undergo regular 6-monthly dental check-ups and 77.4% seldom brushed their teeth after meal. After adjusting for potentially confounding variables, the intellectual disability group had a significantly higher risk of an NRT <20 than the physical disability group (OR 2.30, 95% CI 1.30 to 4.08). Additionally, the rare use of dental floss and hypertension significantly increased the possibility of an NRT <20 (OR 1.73-2.12, 95% CI 1.15 to 3.71).

CONCLUSIONS

An NRT <20 and edentulism were highly prevalent among adults with disabilities, who displayed poor oral hygiene behaviours. Adults with intellectual disabilities had a greater likelihood of having an NRT <20 than did those with physical disability. In addition to unmodifiable factors, the poor use of dental floss was significantly associated with an NRT <20.

The association between diabetes mellitus, sugar-sweetened beverages, and tooth loss in adults: Evidence from 18 states

BACKGROUND

Sugar-sweetened beverages (SSBs) are dietary sources of sugar that are factors in caries development and tooth loss. Dietary sugar also is linked to diabetes mellitus (DM). There is limited research related to SSBs and tooth loss in people with DM. The authors investigated the association between SSBs and tooth loss as it related to the presence or absence of DM.

METHODS

The authors used a cross-sectional design with data reported by adults (18 years and older) who responded to the 2012 Behavior Risk Factor Surveillance System questionnaire, which was used in 18 states (N = 95,897; 14,043 who had DM and 81,854 who did not have DM). The authors conducted χ² and logistic regression analyses to determine associations related to DM status.

RESULTS

Overall, 12.3% of the survey respondents had DM, 15.5% had 6 or more teeth extracted, and 22.6% reported that they consumed 1 or more SSB daily. In the adjusted analyses, among adults who had DM, those who consumed at least 2 SSBs daily were more likely to have had 6 or more teeth extracted than those who reported that they did not consume SSBs (adjusted odds ratio, 2.35; 95% confidence interval, 1.37 to 4.01; P = .0018). Among adults who did not have DM, those who consumed more than 1 but fewer than 2 SSBs per day were more likely to have had at least 6 teeth extracted (adjusted odds ratio, 1.46; 95% confidence interval, 1.21 to 1.77; P < .0001).

CONCLUSIONS

The authors found that, among adults with DM, consuming 2 or more SSBs per day was associated with having had 6 or more teeth extracted.

PRACTICAL IMPLICATIONS

Dietary sugar is a concern for oral and systemic health; however, a strong, independent relationship between the number of teeth extracted and a single source of dietary sugar is not adequate to explain the complexity of tooth loss. Clinicians should use broadly worded dietary messages when discussing caries assessment with patients.

Relationship between Metabolic Syndrome and Number of Teeth in Japan

The 2004 Japanese National Health and Nutrition Survey collected data on several measures, including self-reported dental health. In addition, this was the first nationwide survey to focus on metabolic syndrome (MetS) in Japan. Therefore, the authors used this nationwide data set to assess the relationship between number of teeth present and MetS. Anonymized data were available with permission from the Ministry of Health, Labour and Welfare of Japan. Data from 3,195 men and women aged 35 to 99 y were examined, and logistic regression analyses were used to evaluate the association between number of teeth and MetS. Moreover, the authors performed an analysis of covariance to compare the mean number of teeth between those with and those without MetS, after adjusting for confounders. In comparison with those having ≥28 teeth, those with fewer remaining teeth demonstrated significantly higher odds of having MetS. Specifically, those having 1 to 9 teeth had higher odds of having MetS than those with more teeth and were more than twice as likely to be affected than those with ≥28 teeth. Furthermore, individuals with MetS in the age groups of 45 to 54, 55 to 64, and 65 to 74 y had significantly fewer teeth than those without MetS in the same age groups. These results suggest that the number of teeth present is associated with the prevalence of MetS in the Japanese population. Knowledge Transfer Statement: The results of this study can be used by clinicians when they examine patients with periodontal disease or extensive tooth loss to refer for a general medical examination.