Validity of self-reported number of teeth and oral health variables

Evaluation of oral health in 148 patients with systemic sclerosis-data from a prospective interdisciplinary monocentric cohort

In daily rheumatology practice, systemic sclerosis is primarily regarded as a potentially life-threatening disease characterized by fibrosis of various organs. Therefore, other manifestations, such as orofacial involvement, are often not of primary concern. Furthermore, due to its rarity, the disease might not be well known by dentists, which contrasts with the increased risk of various problems in the oral cavity. Periodontitis in particular is a known risk factor for morbidity and mortality and is associated with various systemic diseases. The risk of periodontitis appears to be increased in patients with systemic sclerosis, but little is known about the gender-specific differences. This study aims to elucidate the health-conscious behaviour of patients, their dental care and the risk of periodontitis with regard to gender-specific differences. This descriptive study of the Interdisciplinary Centre of Rheumatic Diseases (INDIRA) in collaboration with the Department of Orthodontics at the University Hospital of Tuebingen, Germany, examined the data of 148 patients with systemic sclerosis with regard to their oral health using a questionnaire and evaluating the risk of periodontitis with the DG Paro self-assessment score in this cohort. Among the participating patients, 90% reported regular visits to the dentist and good dental care. Nevertheless, more than half of the patients had missing teeth and problems opening their mouths. Sicca symptoms in the oral cavity were also common (40%). The risk of periodontitis among female participants was high (around 60%), and even higher among male study participants (around 80%). Gingival bleeding as a surrogate parameter for periodontitis was associated with salivary flow and the modified Rodnan skin score (mRSS). Despite a high awareness of dental health, we observed a high risk of periodontitis, especially in male patients with systemic sclerosis. In addition, the association between xerostomia and missing teeth as well as gingival bleeding and mRSS may indicate an increased risk in patients with a more progressive disease. We would therefore recommend regular dental consultations and careful oral hygiene for patients with systemic sclerosis in addition to the-more organ-focused-regular examinations of patients.

Reduced number of teeth with and without dental prostheses and low frequency of laughter in older adults: Mediation by poor oral function

PURPOSE

Laughter is expected to have health-protective effects, but the potential link between tooth loss and laughter remains unclear. Therefore, this study aimed to examine the association between tooth loss and a low frequency of laughter among older adults in Japan, to elucidate whether this association could be mitigated by dental prostheses, and to evaluate the magnitude of the association mediated by poor oral function.

METHODS

We used cross-sectional data from 157,708 functionally independent participants aged ≥65 years (46.3% male) from the Japan Gerontological Evaluation Study. A modified Poisson regression model was applied to examine the association between the number of remaining teeth (≥20/10-19/0-9), dental prostheses use, and infrequent laughter (i.e., laughing never or almost never). Causal mediation analysis was performed to assess whether the association was mediated by difficulties in eating hard foods, choking, or dry mouth.

RESULTS

Among the participants, 9,129 reported infrequent laughter. Participants with ≤9 and 10-19 teeth who did not use dental prostheses had a 1.29 and 1.14 times higher likelihood of infrequent laughter than those with ≥20 teeth, respectively. Furthermore, difficulty eating hard foods, choking, and dry mouth mediated 22.8%, 0.4%, and 4.3% of the association between fewer remaining teeth and infrequent laughter, respectively. Meanwhile, we did not find evidence for the differences in infrequent laughter between participants with ≤19 teeth using dental prostheses and those with ≥20 teeth.

CONCLUSIONS

Tooth loss among individuals without dental prostheses was associated with infrequent laughter, and this association was mediated by poor oral function.

Exploring the relationship between oral health and multiple health conditions: An outcome-wide approach

PURPOSE

A growing body of evidence suggests that oral health is associated with a wide range of health outcomes; however, opinions tend to vary because of inconsistent findings. This study aimed to simultaneously examine the association between oral health status and multiple health and well-being indicators using outcome-wide epidemiology.

METHODS

Data were obtained from the Japan Gerontological Evaluation Study. Oral health status was categorized as: ≥20 teeth, 10-19 teeth with dental prosthesis, 0-9 teeth with prosthesis, 10-19 teeth without prosthesis, and 0-9 teeth without prosthesis. We examined the associations between oral health status in 2013 and 35 health and well-being outcomes in 2019, including physical/cognitive health, psychological distress, subjective health, social well-being, prosocial/altruistic behaviors, and health behaviors, using two databases (n=32,827 and 15,905).

RESULTS

Compared to individuals with ≥20 teeth, those with <20 teeth had a 10-33% higher risk of mortality and a 6-14% higher risk of functional disability six years later. Additionally, individuals with fewer than 20 teeth tended to go out less frequently and eat fewer vegetables and fruits. Furthermore, individuals with 0-9 teeth without a prosthesis were more likely to have severe functional disability (risk ratio (RR):1.17, 95% confidence interval (CI):1.05-1.31), engage in fewer intellectual activities (standardized difference: 0.17, 95% CI: 0.10-0.24), and feel more hopeless (RR: 1.21, 95% CI: 1.04-1.41).

CONCLUSIONS

The prevention of tooth loss and prosthodontic treatment may be associated with reduced mortality and functional disability, as well as maintenance of intellectual ability, frequency of going out, and improvements in dietary lifestyle.

Association between Number of Teeth and Eating out of Home: A 2019 Statistical Survey of the Japanese Representative Population

Eating out of home (EOH), with its diverse food options, can benefit those with difficulty preparing their meals, especially older adults. Oral health status may be a determinant of EOH, as food accessibility is influenced by oral health, but this association remains unclear. This cross-sectional study used merged data from two national statistical surveys conducted in 2019. Participants were individuals aged ≥ 65 years who responded to both surveys. The frequency of EOH ( Collapse

Key Words

• eating out
• older population
• oral health

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MESH Headings

• Humans
• Female
• Male
• Aged
• Japan/epidemiology
• Cross-Sectional Studies
• Oral Health/statistics & numerical data
• Aged, 80 and over
• Feeding Behavior
• Prevalence
• Meals
• Surveys and Questionnaires
• Tooth Loss/epidemiology
• Eating
• East Asian People

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Grants

• 202209053A Ministry of Health, Labour and Welfare
• JPMJSP2114 Japan Science and Technology Agency

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Affiliation(s)

Anna Kinugawa Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan
Takafumi Yamamoto Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan Preventive Dentistry, Hokkaido University Hospital, Kita 13 jo Nishi 7 Chome, Kita-ku, Sapporo 060-8586, Hokkaido, Japan Department of Health Promotion, National Institute of Public Health, 2-Chome-3-6 Minami, Wako 351-0104, Saitama, Japan
Taro Kusama Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan
Kenji Takeuchi Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan
Ken Osaka Department of International and Community Oral Health, Graduate School of Dentistry, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Miyagi, Japan

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Simplifying Oral health evaluation: a novel approach through single-item surveys

BACKGROUND

This study adopts a novel approach of using single-item surveys to simplify the assessment of oral health status and behaviors among Japanese private sector employees. We aimed to establish the validity of self-reported oral health in relation to clinical dental examinations, and to elucidate the relationship between oral diseases, health behaviors, and self-assessments. A secondary aim was to explore the association of self-rated oral health with oral health behaviors.

MATERIALS AND METHODS

Self-administered questionnaires and dental examinations were obtained from 2262 Japanese private sector employees. Workers self-rated their overall oral health status according to five choices: "very good," "good," "fair," "poor," or "bad." Self-reports were then compared with the results of clinical dental examinations, which included measuring the oral hygiene index (DI-S), the number of decayed teeth, periodontal status (Community Periodontal Index) and number of missing teeth. Convergent validity was also tested by examining the correlations of self-reported oral health status with oral health behaviors.

RESULTS

Overall, 30.8% of workers reported their oral health as "poor" or "bad." "Poor" or "bad" oral health status was significantly correlated with missing teeth, periodontitis, and decayed teeth. However, lower correlations were found for gingivitis and the oral hygiene index. Most self-reported oral health behaviors were correlated with self-rated oral health; exceptions were "tooth brushing instructions received in a dental clinic," "having a primary-care dentist," and "habitual snacking between meals."

CONCLUSIONS

Self-rated oral health provides reasonably valid data, and correlated well with clinically assessed oral health status, including dental caries, periodontal status, and tooth loss. Convergent validity was also found for oral health behaviors.

TRIAL REGISTRATION

Clinical trial registration number: UMIN000023011 (UMIN-CTR). Date of clinical trial registration: 06/07/2016.

Differences in prevalence of self-reported oral hypofunction between older adult patients with rheumatoid arthritis and the general older population: A cross-sectional study using propensity score matching

OBJECTIVE

To examine the association between rheumatoid arthritis (RA) and oral hypofunction (OHF) using propensity score matching (PSM) to adjust for differences between older adults with RA and the general older adult population.

METHODS

We conducted a cross-sectional survey among 189 older adults with RA in 2019 (mean age, 71.9 ± 3.6) and 47 178 independent older adult residents in 2016 (mean age, 71.6 ± 4.0), respectively. The questionnaire covered information on socio-demographic characteristics and OHF for both groups. Age, sex, educational level and smoking history were used to determine PSM. Prevalence ratios (PRs) and 95% confidence intervals (CIs) of self-reported OHF (fewer remaining teeth, decreased masticatory function, deterioration of swallowing function and oral dryness) were estimated using Poisson regressions.

RESULT

OHF was observed in 44.4% of patients with RA and 27.5% of residents. Before PSM, the prevalence of OHF among patients with RA was higher than that of residents (PR, 1.75; 95% CI, 1.50-2.05). After PSM, there were 189 patients with RA and residents, and the prevalence of OHF among patients with RA was still higher (PR, 1.61; 95% CI, 1.22-2.13). Poisson regression showed that the prevalence of 19 or fewer teeth (PR, 1.06; 95% CI, 0.82-1.36), difficulties eating tough foods (PR, 1.18; 95% CI, 0.90-1.55), difficulties swallowing tea or soup (PR, 1.77; 95% CI, 1.19-2.63), and dry mouth (PR, 2.79; 95% CI, 1.90-4.07) was higher among patients with RA than residents.

CONCLUSION

Compared with the general older adult population, patients with RA have a higher prevalence of self-reported OHF.

Validation of an online version of the rapid estimate of adult literacy in dentistry-30 for use by medical and dental students in Nigeria

BACKGROUND

The need for online adaptations of research instruments became more pronounced amidst the COVID-19 pandemic. This study sought to modify the REALD-30 for online application (eREALD-30) and evaluate its content validity and internal reliability among medical and dental students in Nigeria.

METHODS

The eREALD-30 required participants to identify if each of the listed words were related to dentistry by ticking either a 'yes' or 'no' response with the option to mark 'don't know' for words they were unsure about. Scores ranged from 0 to 30. Five oral health experts reviewed the eREALD-30 for cultural appropriateness, while content validity was evaluated by 10 medical and dental students. Internal reliability was assessed with 320 students recruited from 15 medical and dental schools spanning the country's six geopolitical zones. These students also completed an oral health status assessment tool. Data collection utilized an online survey platform. Validity of the eREALD-30 was determined through correlation analysis between eREALD-30 scores and the oral health status assessment tool. Furthermore, binary logistic regression analysis was employed to explore the assocations between participants' oral health status and their oral health literacy, adjusting for age, sex, and level of medical and dental education.

RESULTS

Out of the respondents, 178 (55.6%) exhibited poor oral health literacy, while 205 (64.1%) reported having good oral health status. Those with good oral health literacy demonstrated significantly higher odds of having good oral health status (OR: 1.61; 95% CI: 1.02-2.54; p = 0.04). However, individuals with good oral health literacy had increased odds of good oral health status after adjusting for confounding factors,, though this association did not retain statistical significance (AOR: 1.39; 95% CI: 0.86-2.24; p = 0.17). The eREALD-30 displayed strong internal consistency (Cronbach alpha = 0.933), indicating its reliability in assessing oral health literacy levels, alongside a high content validity score of 0.90.

CONCLUSION

The study finding suggests that the e-version of the REALD-30 was reliable and valid for use among medical and dental students in Nigeria.

Association of rotating night shift work with tooth loss and severe periodontitis among permanent employees in Japan: a cross-sectional study

Background

The modern 24/7 society demands night shift work, which is a possible risk factor for chronic diseases. This study aimed to examine the associations of rotating night shift work duration with tooth loss and severe periodontitis.

Methods

This cross-sectional study used data from a self-administered questionnaire survey conducted among 3,044 permanent employees aged 20-64 years through a Japanese web research company in 2023. The duration of rotating night shift work was assessed using a question from the Nurses' Health Study. Tooth loss was assessed based on self-reported remaining natural teeth count. Severe periodontitis was assessed using a validated screening questionnaire comprising four questions related to gum disease, loose tooth, bone loss, and bleeding gums. We employed linear regression models for tooth loss and Poisson regression models for severe periodontitis, adjusting for demographic, health and work-related variables and socioeconomic status.

Results

Among participants included, 10.9% worked in rotating night shifts for 1-5 years, while 11.0% worked in such shifts for ≥6 years. In fully adjusted models, rotating night shift work duration of 1-5 years was associated with tooth loss (beta -0.74, 95% confidence interval (CI) [-1.55 to 0.08]) and severe periodontitis (prevalence ratio 1.80, 95% CI [1.33-2.43]); however, the association with tooth loss was not statistically significant.

Conclusions

This study supports that employees who work short-term rotating night shifts may experience poor oral conditions. Further research is needed to determine whether long-term rotating night shift work is associated with deteriorated oral health.

The role of differential exposure and susceptibility to heavy drinking linking income inequalities and tooth loss: An investigation of the alcohol harm paradox using a four-way decomposition analysis

OBJECTIVES

To examine the extent to which the effect of income inequalities on tooth loss is attributable to differential exposure and susceptibility to heavy drinking in older Brazilian adults.

METHODS

We conducted a secondary analysis using data from The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016), a nationally representative sample of community-dwelling people aged 50 years and over. Causal mediation analysis based on the counterfactual outcome framework decomposed the effect of income on tooth loss mediated by heavy drinking into four components (four-way decomposition): controlled direct effect (neither mediation nor interaction), reference interaction (interaction only), mediated interaction (both mediation and interaction) and pure indirect effect (mediation only). Proportions of effect attributable to each component were calculated to estimate the differential exposure (the sum of the third and fourth components) and differential susceptibility (the sum of the second and third components) to heavy drinking.

RESULTS

The analytical sample comprised 8114 participants. After adjusting for covariates, 7.3% (95% CI: 3.8%; 10.9%) and -39.5% (95% CI: -75.8%; -3.3%) of the effects of income on tooth loss were attributable to differential exposure and susceptibility to heavy drinking, respectively, consistent with the alcohol harm paradox. When setting non-functional dentition as outcome, only the effect of differential susceptibility remained (-81.7% [95% CI: -128.2%; -35.2%]).

CONCLUSION

Our findings suggest that individuals of low-income groups appear to be more susceptible to the effects of heavy drinking on tooth loss.

Association Between Number of Missing Teeth and Hyperlipidemia: The TCLSIH Cohort Study

Background

To explore the association between the number of missing teeth and the prevalence of hyperlipidemia in a Chinese adult population.

Methods

13,932 adults were investigated in the TCLSIH cohort study. The number of missing teeth was determined at baseline through a self-reported questionnaire, and then classified into three categories: 0, 1-2, and ≥3. We defined hyperlipidemia as total cholesterol (TC) ≥ 5.17 mmol/L or triglycerides (TG) ≥ 1.7 mmol/L or low-density lipoprotein (LDL) cholesterol ≥ 3.37 mmol/L or a self-report of physician-diagnosed hyperlipidemia during follow-up visits. Cox proportional-hazards regression models were employed to assess the relationship between the number of missing teeth and incident hyperlipidemia.

Results

A total of 6756 first-incident cases of hyperlipidemia occurred during 42,048 person-years of follow-up (median follow-up, 4.2 years). After adjusted confounders, multivariable HRs and 95% CI for incident of hyperlipidemia across the categories of missing teeth were as follows: in male participants, 1.00 (reference), 1.10 (0.98, 1.22), and 1.03 (0.91, 1.16) (P for trend = 0.30); in female participants, 1.00 (reference), 1.09 (0.99, 1.19), and 1.18 (1.04, 1.33) (P for trend < 0.01).

Conclusion

The number of missing teeth is associated with an increased risk of hyperlipidemia in female participants but not in male participants. Systemic chronic inflammation may potentially mediate this association.

Association between tea types and number of teeth: a cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Previous studies have suggested that tea consumption may have a positive impact on oral health. However, the effects of different tea types on oral health remain unclear. Therefore, this study aimed to determine the association between residual teeth and consumption habits of different types of tea (green tea, black tea, oolong tea, and scented tea) in older adults.

METHODS

We conducted a secondary analysis using data from the Chinese Longitudinal Healthy Longevity Survey in 2018. In a sample of 6,387 older adults, we performed logistic regression analysis to examine the relationship between persistent tea consumption and oral health according to sex and brushing frequency. The indices for particularly healthy oral health and relative health were set at more than 20 teeth and more than 10 teeth, respectively.

RESULTS

The study included 2,725 males and 3,662 females, both aged 65 and older. Among individuals with more than 20 teeth, drinking green tea significantly improved oral health in men (adjusted odds ratio [ORs]: 1.377; 95% confidence interval [CI]: 1.082-1.752) and drinking black tea significantly improved the oral health of women (ORs: 2.349, 95%CI: 1.028-5.366). In the daily brushing group, green tea had a significant beneficial effect on increasing the number of teeth in men and black tea had a significant beneficial effect in women. Among individuals with more than 10 teeth, drinking green tea significantly improved oral health in men (ORs: 1.539; 95% CI: 1.209-1.959) and drinking green tea and scented tea significantly improved the oral health of women (ORs: 1.447, 95%CI: 1.052-1.991; ORs: 1.948, 95%CI: 1.137-3.340). In the daily brushing group, consumption of green tea and black tea had significant beneficial effects on increasing the number of teeth in men, whereas that of green tea, black tea, and scented tea had significant beneficial effects in women.

CONCLUSION

Long-term green tea consumption in males and black tea consumption in females were significantly associated with maintaining functional dentition (≥20 teeth). Similarly, long-term green tea consumption in males and green tea and scented tea consumption in females were associated with avoiding severe tooth loss (≥10 teeth). Furthermore, in the daily tooth brushing group, long-term consumption of black tea was associated with avoiding severe tooth loss in both sexes. However, tea consumption alone had no effect on oral health without good brushing habits.

Frequency of Going Outdoors and Risk of Poor Oral Health Among Older Japanese Adults: A Longitudinal Cohort From the Japan Gerontological Evaluation Study

BACKGROUND

The association between the frequency of going outdoors and the risk of poor oral health has been reported in several studies; however, the findings have been inconclusive.

METHODS

We conducted a 3-year longitudinal study of 19,972 Japanese adults aged ≥65 years who reported no poor oral condition at baseline in 2013. The respondents rated their frequency of going outdoors in three categories (≤1, 2-3, or ≥4 times/week), and the oral conditions reported in 2016 included tooth loss, chewing difficulty, swallowing difficulty, dry mouth, and composite outcomes. The associations between the frequency of going outdoors and the risk of poor oral health were examined as relative risk ratios (RRs) and 95% confidence intervals (CIs) using multivariable Poisson regression, while mediation analysis was performed to investigate indirect effects.

RESULTS

During the follow-up, 32.5% of participants developed poor oral health. In the mediation analysis, indirect effects were observed through low instrumental activities of daily living, depressive symptoms, little social network diversity, and underweight. Compared to going outdoors ≥4 times/week, the multivariable RRs of composite poor oral health conditions were 1.12 (95% CI, 1.05-1.20) for 2-3 times/week and 1.22 (95% CI, 1.07-1.39) for ≤1 time/week (P-trend < 0.001). Similar associations were observed for tooth loss, chewing difficulty, and swallowing difficulty; the corresponding RRs were 1.07 (95% CI, 0.97-1.19) and 1.36 (95% CI, 1.13-1.64) (P-trend = 0.002), 1.18 (95% CI, 1.06-1.32) and 1.30 (95% CI, 1.05-1.60) (P-trend < 0.001), and 1.15 (95% CI, 1.01-1.31) and 1.38 (95% CI, 1.08-1.77) (P-trend = 0.002), respectively.

CONCLUSION

The frequency of going outdoors was inversely associated with the risk of poor oral health through several modifiable risk factors in the older population.

Validity of self-reported number of teeth among Saudi older adults: A public health perspective

Objectives

This study aimed to evaluate the agreement between self-reported and clinically measured numbers of teeth in older adults from Almadinah Almunawwarah, KSA, and to identify factors associated with self-reporting accuracy.

Methods

This study included 337 older adults (≥60 years). Participants completed a survey assessing sociodemographic characteristics, self-rated oral and general health, and the self-reported number of teeth. Clinical examination was conducted using the 2013 criteria published by the World Health Organization. Bland-Altman plots and correlation coefficients were used to assess the agreement between self-reported and clinically measured teeth.

Results

The mean age of the study participants was 67.1 (SD = 6.5) years, and the majority were males (71.2%). The self-reported teeth count was higher than the clinically measured number, and only 47.7% (n = 161) of the sample showed complete agreement between the two measures. The mean difference between the self-reported and clinically recorded number of teeth was 0.41 teeth, and almost two-thirds of the study participants reported their number of teeth within an error margin of two teeth (p < 0.001). Both Spearman's and Pearson's correlation methods revealed a significant positive correlation between the two measures. Specifically, the Spearman's rho was 0.91, while Pearson's r coefficient was 0.96.

Conclusion

Among Saudi older adults, the self-reported number of teeth correlated with the clinically measured numbers of teeth. This suggests that self-reports can be a reliable and cost-effective method for assessing oral health in large-scale surveys, potentially guiding health policies and interventions for older adults.

Frailty mediated the association between tooth loss and mortality in the oldest old individuals: a cohort study

Introduction

Tooth loss is associated with increased mortality risk; however, the mechanism underlying this is still not clear. The objective of this study was to explore whether frailty mediates the association between tooth loss and mortality risk among the oldest old individuals.

Methods

The participants were followed up from 1998 to 2018 in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Frailty was constructed following a standard procedure. Mortality, frailty, and tooth loss were applied as the outcome, mediator, and independent variables, respectively. The Cox model was fitted, including possible confounders, for causal mediation analysis. A total effect (TE), an average causal mediation effect (ACME), an average direct effect (ADE), and a proportion mediated (PM) effect were calculated.

Results

During the 129,936 person-years at risk, 31,899 individuals with a mean age of 91.79  years were included. The TE and ADE of severe tooth loss on mortality were 0.12 (95% CI: 0.08, 0.15) and 0.09 (95% CI: 0.05, 0.13); the ACME of frailty was 0.03 (95% CI: 0.02, 0.03) with 21.56% of the TE being mediated.

Discussion

This study illustrated that tooth loss is associated with mortality, and frailty appeared to mediate the relationship. It is recommended that oral health indicators and frailty status be incorporated into routine geriatric assessments to promote optimal oral health and non-frailty status.

Health-related quality of life aspects of the 'Periodontitis prevalence in ulcerative colitis and Crohn's disease' (PPCC) cohort

AIM

To assess whether oral health problems affect disease-specific quality of life (QoL) of inflammatory bowel disease (IBD) patients, and vice versa, whether IBD affects oral-health-related QoL.

MATERIALS AND METHODS

Individuals reporting IBD and matched controls were surveyed on general anamnestic information, oral-health-related questions and the Oral Health Impact Profile (OHIP)-5. IBD patients were additionally surveyed on years since diagnosis, disease activity and severity as well as health-related QoL (Short Inflammatory Bowel Disease Questionnaire, sIBDQ). OHIP-5 and sIBDQ were defined as primary outcome parameters, and several predictors and confounders were used in adjusted univariable and multivariable regression analyses.

RESULTS

Answers from 1108 IBD patients and 3429 controls were analysed. Compared with controls, IBD patients reported significantly more frequently an oral impact on daily life and worse oral-health-related QoL, with Crohn's disease (CD) patients being more severely affected than ulcerative colitis (UC) patients. The diagnosis of UC and CD, having <20 teeth, severe periodontitis and stressful daily-life experience were associated with a higher prevalence of poor oral-health-related QoL. Among IBD patients, an impaired IBD-specific, health-related QoL was significantly associated with the diagnosis of CD and depression, IBD activity and severity, having <20 teeth, presence of oral lesions and stressful daily-life experience, while a longer time since diagnosis was significantly associated with an improved IBD-specific, health-related QoL.

CONCLUSIONS

The results of the present study indicate, for the first time, that oral health problems are associated with an impairment of IBD-specific health-related QoL, and vice versa, IBD is associated with an impaired oral health-related QoL. This emphasizes the potential advantages of including dental professionals in the multi-disciplinary treatment teams of IBD patients.

Oral frailty five-item checklist to predict adverse health outcomes in community-dwelling older adults: A Kashiwa cohort study

AIM

To enable easy assessment of oral frailty; that is, an overlapping slight decline in multifaceted oral function, in any setting, we developed the oral frailty five-item checklist (OF-5), and examined its predictive validity for increased risks of physical frailty, physical disability and mortality among community-dwelling older adults.

METHODS

This population-based cohort study randomly selected 2044 residents in Kashiwa, Japan, with no long-term care needs. Baseline data were collected in 2012, and follow-up data were collected in 2013, 2014, 2016, 2018 and 2021. The OF-5 includes five measures: fewer teeth, difficulty in chewing, difficulty in swallowing, dry mouth and low articulatory oral motor skills. Physical frailty was defined according to the Cardiovascular Health Study criteria. Physical disability and mortality determined from the long-term care insurance receipt database were followed for 9 years.

RESULTS

Of 2031 eligible participants (mean age 73.1 ± 5.6 years; 51.1% women), 39.3% individuals with ≥2 OF-5 points had significantly increased prevalence and new-onset rate of physical frailty. After adjusting for potential confounders, oral frailty, defined as ≥2 OF-5 points, was associated with increased risks of physical disability (adjusted hazard ratio 1.40; 95% confidence interval 1.14-1.72) and mortality (adjusted hazard ratio 1.44; 95% confidence interval 1.11-1.87). The highest adjusted hazard ratios were observed in older adults with coexisting physical and oral frailty.

CONCLUSIONS

The OF-5 showed strong predictive validity for physical frailty, physical disability and mortality in Japanese older adults. This assessment tool can be implemented in various settings and foster comprehensive prevention through interprofessional collaboration. Geriatr Gerontol Int 2023; 23: 651-659.

The pathways from disadvantaged socioeconomic status in childhood to edentulism in mid-to-late adulthood over the life-course

BACKGROUND

This study aimed to examine the direct and indirect pathways from childhood socioeconomic status (SES) to the prevalence of edentulism in mid-to-late age Chinese individuals using structural equation modeling (SEM).

METHODS

This study analyzed data from 17,032 mid- to-late age Chinese individuals in the 2014 and 2015 China Health and Retirement Longitudinal Study (CHARLS). Childhood SES was determined based on the parents' education and occupation, financial situation of the family, primary residence, food availability, and medical convenience. Adulthood SES was established according to educational achievements of the individuals. Edentulism is defined as the loss of all natural teeth. SEM was used to examine the statistical significance of the association between childhood SES and edentulism, mediated by childhood health, adulthood SES, and adult health.

RESULTS

Childhood SES had significant indirect (β = -0.026, p < 0.01), and total (β = -0.040, p < 0.01) effects on edentulism. It was determined that 65% of the total effect of childhood SES on edentulism was indirect, and mainly mediated by adult SES. Also, the goodness-of-fit indices of the best-fitting model were acceptable.

CONCLUSION

This study revealed that childhood health, adult health and adult SES are mediators that explain the relationship between childhood SES and edentulism. The global attention to alleviate the inequality in edentulism should focus on exploring recommendations and intervention strategies from childhood to adulthood, by considering adult SES, childhood and adult health.

Association of low occlusal force as an oral hypofunction with the prevalence of irritable bowel syndrome in Japanese adults

BACKGROUND AND AIM

We investigated whether oral-dental conditions may be associated with the prevalence of irritable bowel syndrome (IBS) in a cross-sectional study in Japan.

METHODS

Information on lifestyle and abdominal symptoms was collected, and oral-dental examinations were performed from 2013 to 2017. To investigate the association between oral-dental conditions and IBS, this study used logistic regression analyses adjusted for relevant confounding factors, such as age, sex, BMI, stress, and eating between meals.

RESULTS

The prevalence of IBS was 484 (13.4%) among 3626 participants. The mean maximum occlusal force in the IBS group was significantly lower than that in the non-IBS group (0.306 ± 0.192 kN vs. 0.329 ± 0.205 kN, P = 0.014). The maximum occlusal force of the constipation-type IBS was significantly lower than that of other types of IBS without constipation type (0.269 ± 0.164 kN vs. 0.317 ± 0.198 kN, P = 0.010). Compared with those who had high values of maximum occlusal force (≧0.265 kN), those with a low value of maximum occlusal force (<0.265 kN) had a significantly greater risk for IBS (OR, 1.426; 95% CI, 1.135-1.792; P = 0.002), by multivariate analyses, across different categories of oral-dental condition in women, not in men. Women who had lowest third occlusal force (<0.206 kN) had approximately 35% significantly greater odds of having IBS compared with those who had highest third occlusal force (≧0.386 kN).

CONCLUSIONS

Results suggest that a reduction in the maximum occlusal force increases the risk of IBS in Japanese women.

Can Frequent Toothbrushing Reduce the Risk of Cirrhosis among Patients with Nonalcoholic Fatty Liver Disease? Hints from a Registry-Based Study

INTRODUCTION

While poor oral hygiene has been previously associated with an increased risk of nonalcoholic fatty liver disease (NAFLD), its association with hepatic fibrosis remains unclear. Here, we sought to analyze if toothbrushing frequency, an easy-to-assess indicator of oral health habits, would be associated with liver stiffness measurement (LSM) by transient elastography (TE) in patients with an established diagnosis of NAFLD.

METHODS

In this registry-based study, LSM was measured in 1,156 patients with NAFLD and analyzed in relation to the self-reported daily frequency of toothbrushing. LSM values ≥12 kPa were considered indicative of cirrhosis.

RESULTS

A trend toward a stepwise decrease (cross-sectional p = 0.13) in LSM was found in patients who reported having their teeth brushed more frequently: less than once a day (10.6 ± 8.6 kPa; 13% of the study sample), once a day (9.95 ± 8.40 kPa; 40%), twice a day (9.21 ± 7.63 kPa; 43%), and after every meal (8.91 ± 5.30 kPa; 4%). Patients who brushed their teeth less than once a day had a significantly higher prevalence of LSM values ≥12 kPa (p < 0.05). In multivariable logistic regression analysis, the association of LSM values ≥12 kPa with toothbrushing habits remained statistically significant for less than once a day (odds ratio = 1.69, 95% confidence interval = 1.07-2.66, p = 0.02) with reference to twice a day or after every meal.

CONCLUSION

Among patients with NAFLD, there is an independent association between brushing teeth less than once a day and TE-established cirrhosis.

Validity of self-reported oral conditions among Brazilian older women: Do socio-economic factors matter?

OBJECTIVE

To validate the level of agreement between self-report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self-report among women aged 60 and older.

METHODS

A cross-sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF-T index) and the use of dental prostheses. The self-reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin's concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information.

RESULTS

Ninety-nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self-reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self-reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels.

CONCLUSIONS

Our findings suggest that the participants' socio-economic position might influence their self-reported number of teeth.

Social isolation, loneliness and accelerated tooth loss among Chinese older adults: A longitudinal study

OBJECTIVE

Social isolation and loneliness have been linked to numerous determinants of health and well-being. However, the effects of social isolation and loneliness on oral health remain unclear. The purpose of this study was to examine the effects of social isolation and loneliness on the number of remaining teeth and the rate of tooth loss over time among Chinese older adults.

METHODS

We used three waves of data (2011/2012, 2014 and 2018) from the Chinese Longitudinal Healthy Longevity Survey with 4268 older adults aged 65 and older who were interviewed in at least two waves. The number of remaining teeth was first evaluated at baseline and then subsequently at follow-up visits. Mixed-effects Poisson regression was used to examine the associations between social isolation, loneliness, and both the number of remaining teeth and the rate of tooth loss.

RESULTS

Social isolation was associated with fewer remaining teeth (β = -.06, 95% CI = -0.13 to 0.00, p < .05) and accelerated tooth loss (β = -.02, 95% CI = -0.02 to -0.01, p < .01) after adjusting for sociodemographic covariates, lifestyle and oral hygiene behaviours, physical and cognitive health, and loneliness. Loneliness was neither associated with the number of remaining teeth (β = .15, 95% CI = -0.01 to 0.30, p = .06) nor with the rate of tooth loss (β = -.01, 95% CI = -0.02 to 0.00, p = .16) after adjusting for all other factors.

CONCLUSIONS

This study provides strong evidence that social isolation was associated with fewer remaining teeth and accelerated tooth loss among Chinese older adults. These findings expand our knowledge about the impact of social disconnection on tooth loss. More future studies are needed to further examine the associations between social connections and oral conditions using longitudinal cohort studies and intervention studies.

Oral status and homebound status: A 6-year bidirectional exploratory prospective cohort study

OBJECTIVES

Little is known about the association between oral status and homebound status, and there is a possibility of a bidirectional relationship between them. In this exploratory prospective cohort study, we examined the association between four oral status measurements and being homebound bidirectionally.

METHODS

We used 2010-2016 panel data gathered from the Japan Gerontological Evaluation Study. All functionally independent participants aged 65 years or older (n = 26,579) were included in this study. Multiple imputation and Poisson regression were used for analyses. We adjusted for age, sex, education, comorbidity, and depressive symptoms.

RESULTS

In the fully adjusted model, the prevalence ratio (PR) of being homebound at follow-up was 1.42 for having <20 remaining teeth, 1.28 for having chewing difficulty, 0.99 for having choking experience, and 0.94 for having dry mouth at baseline. Reversely, being homebound at baseline predicted having chewing difficulty at follow-up (PR = 1.17), while no significant association was demonstrated with having <20 teeth (PR = 1.00), choking experience (PR = 1.06), and dry mouth (PR = 1.02).

CONCLUSION

Chewing difficulty and having <20 remaining teeth predicted homebound status after 6 years. Reversely, homebound status at baseline only predicted having chewing difficulty at follow-up. These findings may help to determine the oral frailty assessment measures for older people.

Does remaining teeth and dental prosthesis associate with social isolation? A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES)

OBJECTIVES

Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6-years follow-up was examined.

METHODS

Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms.

RESULTS

The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow-up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10-19 teeth and used dental prosthesis, 112 (4.2%) had 10-19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0-9 teeth and used dental prosthesis, and 168 (7.6%) had 0-9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96-1.33) for those with 10-19 teeth and OR = 1.36 (95%CI = 1.17-1.58) for those with 0-9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80-1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0-9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49-2.19] more likely to be socially isolated, whereas participants with 0-9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05-1.45] more likely to be socially isolated.

CONCLUSION

Tooth loss was the main predictor for social isolation at follow-up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss.

Development and external validation of prediction models for critical outcomes of unvaccinated COVID-19 patients based on demographics, medical conditions and dental status

Background

Multiple prediction models were developed for critical outcomes of COVID-19. However, prediction models using predictors which can be easily obtained in clinical practice and on dental status are scarce.

Aim

The study aimed to develop and externally validate prediction models for critical outcomes of COVID-19 for unvaccinated adult patients in hospital settings based on demographics, medical conditions, and dental status.

Methods

A total of 285 and 352 patients from two hospitals in the Netherlands were retrospectively included as derivation and validation cohorts. Demographics, medical conditions, and dental status were considered potential predictors. The critical outcomes (death and ICU admission) were considered endpoints. Logistic regression analyses were used to develop two models: for death alone and for critical outcomes. The performance and clinical values of the models were determined in both cohorts.

Results

Age, number of teeth, chronic kidney disease, hypertension, diabetes, and chronic obstructive pulmonary diseases were the significant independent predictors. The models showed good to excellent calibration with observed: expected (O:E) ratios of 0.98 (95%CI: 0.76 to 1.25) and 1.00 (95%CI: 0.80 to 1.24), and discrimination with shrunken area under the curve (AUC) values of 0.85 and 0.79, based on the derivation cohort. In the validation cohort, the models showed good to excellent discrimination with AUC values of 0.85 (95%CI: 0.80 to 0.90) and 0.78 (95%CI: 0.73 to 0.83), but an overestimation in calibration with O:E ratios of 0.65 (95%CI: 0.49 to 0.85) and 0.67 (95%CI: 0.52 to 0.84).

Conclusion

The performance of the models was acceptable in both derivation and validation cohorts. Number of teeth was an additive important predictor of critical outcomes of COVID-19. It is an easy-to-apply tool in hospitals for risk stratification of COVID-19 prognosis.

Association of the number of natural teeth with dietary diversity and nutritional status in older adults: A cross-sectional study in China

AIM

To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China.

MATERIALS AND METHODS

A cross-sectional analysis was conducted among community-dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self-reported number of natural teeth, participants were categorized into ≥20, 10-19, 1-9 natural teeth, and edentulous. Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate-to-severe malnutrition) among a subgroup of participants. Linear and multinomial logistic regression models were used to examine the corresponding associations.

RESULTS

Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (β_edentulous  = -0.39, 95% confidence interval [CI], -0.48, -0.30; β_{1-9 teeth}  = -0.46, 95% CI, -0.55, -0.37; β_{10-19 teeth}  = -0.36, 95% CI, -0.46, -0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1-9 and 10-19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio = 0.49, 95% CI, 0.27, 0.89).

CONCLUSIONS

Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective interventions to improve the dietary quality and nutrition status among partially and fully edentulous individuals, including those with Stage IV periodontitis.

Moderating effects of resilience and self-esteem on associations between self-reported oral health problems, quality of oral health, and mental health among adolescents and adults in Nigeria

BACKGROUND

There is an intersection between oral and mental health though the studies on these intersections are few. This study investigated associations between self-reported oral health problems, quality of oral health, and depression and general anxiety among adolescents and adults in Nigeria; and analysed the moderating effects of resilience and self-esteem on these associations.

METHODS

In this secondary analysis, data were extracted from the database of an online survey conducted among participants 13 years and older and living in Nigeria about their self-reported psychological wellbeing. The data was collected between September and October 2020. Dependent variables were self-reported presence of oral health problems (yes/no) and self-reported quality of oral health (using a five-item scale ranging from "very good" to "very poor"). Independent variables were depressive and anxiety symptoms. Moderating factors evaluated were resilience and self-esteem. Multivariable logistic regression analysis was used to determine the associations between the dependent and independent variables after adjusting for confounders (age, sex, employment status and educational status). A path analysis was conducted to determine the moderating effects of self-esteem and resilience on associations between dependent and independent variables.

RESULTS

We extracted data for 2,757 adolescents and adults aged 13 to 62 years, of which 2,062 (74.8%) reported having oral health problems and 925 (33.6%) reported poor quality of oral health. Higher levels of depressive symptoms were significantly associated with higher odds of oral health problems (AOR: 1.07; 95% CI: 1.04-1.10; p<0.001). Higher levels of depressive symptoms (AOR: 1.05; 95% CI: 1.03-1.07; p<0.001), and higher levels of anxiety symptoms (AOR: 1.07; 95% CI: 1.04-1.11; p<0.001) were significantly associated with poor quality of oral health. Resilience significantly moderated the association between anxiety symptoms and oral health problems (AOR = -0.004; 95% CI: -0.006 --0.001; p = 0.002).

CONCLUSION

Depression may be a risk indicator for self-reported oral health problems, while depression and anxiety appear to be risk indicators for self-reported poor quality of oral health. These factors could be included as confounders in future studies on oral health problems and quality of oral health among adolescents and adults in Nigeria.

Association between place of dental check-ups and work absenteeism among Japanese workers

OBJECTIVES

Dental check-ups at the workplace provide the opportunity for early detection of dental diseases. Dental check-ups during working hours could reduce the number of days of absence from work due to visits to dental clinics outside the workplace. Although health check-ups are provided to workers in Japan, dental check-ups is not mandatory. This study aimed to determine the association between the place of dental check-ups and absenteeism due to visits to the dental clinic.

METHODS

This cross-sectional study used data from an online self-reported worker survey conducted for 2 weeks in March 2017. We applied linear regression analysis with robust variance to determine the association between the place of dental check-ups and absenteeism due to dental clinic visits while adjusting for sociodemographic, health, and oral health covariates.

RESULTS

The average age of the 3930 participants was 43.3 ± 11.7 years, and 52.3% were male. The number of days of absenteeism due to dental clinic visits in the past year for those who received check-ups only at the dental clinic and at the workplace were 0.57 ± 2.67 days and 0.21 ± 1.20 days, respectively. After adjusting for covariates, it was found that those who received dental check-ups at the workplace had 0.35 (95% CI, 0.12-0.58) fewer days of absence than those who received dental check-ups at the dental clinic.

CONCLUSION

Workers who received dental check-ups at the workplace were associated with fewer days of absence due to dental visits than those who received at the dental clinic.

Periodontitis prevalence in patients with ulcerative colitis and Crohn's disease - PPCC: A case-control study

AIM

The aim of this questionnaire-based case-control study was to assess whether self-reported oral health and periodontitis in patients with ulcerative colitis (UC) and Crohn's disease (CD) differ from those in matched controls without inflammatory bowel disease (IBD).

MATERIALS AND METHODS

A survey including questions on general anamnestic information, IBD diagnosis, and oral health was distributed online. Self-perceived overall health of teeth and gums, severe periodontitis, and tooth loss were defined as outcome parameters.

RESULTS

Analyses were based on answers from 1108 patients with IBD and 3429 controls. Patients with IBD reported significantly worse oral health and more periodontal problems compared to controls. Regression analyses corrected for relevant confounders showed significantly increased odds for fair or poor self-perceived overall health of teeth and gums (odds ratio [OR] 2.147 and 2.736, respectively) and for severe periodontitis (OR 1.739 and 2.574, respectively) for patients with UC and CD compared to controls; patients with CD presented additionally 91% higher odds for having &lt;20 remaining teeth.

CONCLUSION

Patients with UC and CD have significantly increased odds for worse self-perceived oral health and severe periodontitis compared to controls, with the former being more severely affected and losing more teeth. It is strongly recommended that patients with IBD are kept under close surveillance to prevent periodontitis development and/or mitigate its progression.

Early-life adversity and edentulism among Chinese older adults

BACKGROUND

Emerging evidence indicate the relationship between ELA with oral health problems. However, most focus on single types of adversity. The association of cumulative ELA with edentulism, the final marker of disease burden for oral health, remains unclear.

METHODS

Data came from 17,610 elderly participants in the China Health and Retirement Longitudinal Study (CHARLS). In 2014, the Life History Survey Questionnaire was utilized to evaluate the experience of threat and deprivation. Information on edentulism was evaluated through self-report from the follow-up in 2013, 2015, and 2018. By controlling for age, education, hukou residence, marital status, and disease history, logistic regression analyses were used to evaluate the relationships between distinct dimensions of ELA and risk of edentulism.

RESULTS

Nearly half (49.8%) of the 17,610 older persons (mean [SD] age at baseline: 63.6 [9.4] years) reported experiencing early adversity due to threat-related ELA, and 77.9% reported having deprivation-related ELA. ELA characterised by threat was associated with edentulism in both male and female participants. Two forms of threat-related ELA exposure were linked to a 1.65-fold and 1.73-fold higher risk for edentulism in both male (95% CI 1.23, 2.21) and female participants (95% CI 1.31, 2.29), compared to no threat-related ELA exposure. Both male (95% CI 2.34, 4.24) and female participants (95% CI 2.49, 4.56) had a 3.15-fold and 3.37-fold higher risk for edentulism when exposed to three or more threat-related ELAs.

CONCLUSION

Our findings suggest that ELA marked by threat is linked to an increased risk of edentulism. The biological pathways between different dimensions of ELA and teeth loss should be clarified by future research.

Health-related quality of life in various health conditions: two consecutive surveys of older Japanese adults

PURPOSE

Measuring health-related quality of life (HRQOL) in various health conditions in different countries is important given the regional differences. This study employed large-scale nationwide data targeting older adults in Japan to estimate the HRQOL in the key health conditions that are the major causes of disability.

METHODS

Our data were derived from two survey waves (2016 and 2019 surveys) of cross-sectional data from the Japan Gerontological Evaluation Study, an ongoing nationwide study targeting functionally independent older adults in Japan. A total of 28,345 individuals from 27 of the 47 Japanese provinces were analyzed. The EuroQoL 5-dimension 5-level instrument (EQ-5D-5L) was employed to assess the HRQOL utility scores. The targeted minimum loss-based estimator with sampling weighting methods was applied to estimate the utility score in eight major health conditions, including sensory organ disease, musculoskeletal disease, oral disorders, and depressive disorders.

RESULTS

The estimated HRQOL utility score for those with the poorest health conditions in self-rated health, hearing loss, vision loss, number of remaining teeth (e.g., no teeth with no denture use), oral dysfunction, depressive symptoms, chronic low back pain, and chronic knee pain was 0.576 (95% confidence interval (CI) 0.555-0.598), 0.768 (95% CI 0.737-0.800), 0.680 (95% CI 0.662-0.699), 0.809 (95% CI 0.796-0.821), 0.776 (95% CI 0.764-0.788), 0.723 (95% CI 0.710-0.737), 0.715 (95% CI 0.690-0.739), and 0.742 (95% CI 0.722-0.763), respectively.

CONCLUSION

We successfully provided a catalog for the HRQOL utility score in key health conditions that are the leading causes of disability among older adults.

Cross-sectional study of the factors associated with the number of teeth in middle-aged and older persons with intellectual disabilities

BACKGROUND

We investigated the number of teeth in middle-aged and older individuals with intellectual disability and evaluated the related factors.

METHODS

A questionnaire survey on oral health was administered to 604 persons over 40 years old with intellectual disabilities in Aichi Prefecture, Japan. The questionnaire designed for this study included items on diagnosis of disability, severity of intellectual disability and type of residence. As oral-health-related factors, the proxy-reported number of teeth, family dentist, regular dental check-ups, problems during dental treatment and tooth-brushing frequency were evaluated. A multinomial logistic regression analysis was performed using the proxy-reported number of teeth (≥20, 10-19 or 0-9) as the dependent variable, and the odds ratios (ORs) and 95% confidence intervals (CIs) of independent variables were calculated. In addition, linear regression analysis was performed using the proxy-reported number of teeth as the dependent variable.

RESULTS

In the multivariate multinomial logistic regression analysis, age, diagnosis of disability and type of residence were significantly associated with having 10-19 versus ≥20 teeth. Participants with autism spectrum disorder had a significantly lower OR for 10-19 teeth compared with those with intellectual disability [OR (95% CI): 0.49 (0.22-1.08)]. Age, diagnosis of disability, regular dental check-ups and tooth-brushing frequency were significantly associated with having 0-9 versus ≥20teeth. Participants with Down syndrome had a significantly higher OR for 0-9 teeth compared with those with intellectual disability [OR (95% CI): 3.17 (1.09-9.23)]. The ORs for 0-9 teeth of participants who did not attend regular dental check-ups and who brushed their teeth 1 time/day compared with ≥3 times/day were significantly high, and the OR (95% CI) was 2.37 (1.06-5.30) and 4.76 (1.09-20.77), respectively. [Corrections made on 22 August 2022, after first online publication: in the previous sentence, "who attend" has been changed to "who did not attend".] In the multivariate linear regression analysis, age, diagnosis of disability and regular dental check-ups were significantly associated with the proxy-reported number of teeth. The proxy-reported number of teeth was -0.42 less with each 1-year increase in age. With autism spectrum disorder, the proxy-reported number of teeth was 0.74 more compared with intellectual disability. In Down syndrome, the proxy-reported number of teeth was -0.93 less compared with intellectual disability. The proxy-reported number of teeth was -2.12 less for those who did not have regular dental check-ups.

CONCLUSIONS

The number of teeth in middle-aged and older individuals with intellectual disability was related to age and the type of disability. Regular dental visits may be effective at preventing tooth loss in middle-aged and older persons with intellectual disability.

Differences in Oral Lesions Associated with Tobacco Smoking, E-Cigarette Use and COVID-19 Infection among Adolescents and Young People in Nigeria

COVID-19 infection is associated with oral lesions which may be exacerbated by tobacco smoking or e-cigarette use. This study assessed the oral lesions associated with the use of e-cigarettes, tobacco smoking, and COVID-19 among adolescents and young people in Nigeria. A national survey recruited 11-23-year-old participants from the 36 States of Nigeria and the Federal Capital Territory, Abuja. Data were collected using Survey Monkey^®. Binary logistic regression analysis was conducted. Statistical significance was set at p-value less than 0.05. There were 2870 participants, of which 386 (13.4%) were tobacco smokers, 167 (5.8%) e-cigarette users, and 401 (14.0%) were both e-cigarette and tobacco users; and 344 (12.0%) had ever tested positive to COVID-19. Adolescents and young people who smoked tobacco had more than twice the odds of reporting gingival inflammation, oral ulcers, dry mouth, and changes in taste than those who did not smoke. Those who used e-cigarettes had 1.5 times higher odds of reporting oral lesions. Respondents who had COVID-19 infection had higher odds of reporting gingival inflammation and lower odds of reporting dry mouth than those who did not have COVID-19 infection. These findings were significant, and may help clinicians to screen for tobacco use and COVID-19 among adolescents and young people in Nigeria.

Characteristics of Individuals in Japan Who Regularly Manage Their Oral Health by Having a Family Dentist: A Nationwide Cross-Sectional Web-Based Survey

Dental healthcare systems may differ between countries; however, having a family dentist is generally important for proper oral health management. This study aims to analyze the proportion of people in Japan who have a family dentist, and their characteristics. A nationwide web-based survey with 3556 participants (1708 men and 1848 women) showed that 45.6% of men and 54.1% of women had a family dentist (FD group). A multiple logistic regression analysis revealed that men in the FD group mostly belonged to older age groups (≥70 s, OR: 2.41), received higher household incomes (≥8000 K JPY, OR: 1.47), brushed their teeth three or more times daily (OR: 1.60), practiced habitual interdental cleaning (OR: 3.66), and fewer lived in rural areas (towns and villages, OR: 0.52). Regarding the women, the majority belonged to older age groups (60 s, OR: 1.52; ≥70 s, OR: 1.73), practiced habitual interdental cleaning (OR: 3.68), and fewer received lower household incomes (<2000 K JPY, OR: 0.61). These results suggest that despite Japan being a country with a public insurance coverage system for both men and women, having a family dentist is associated with disparities in individual socioeconomic factors, particularly age and household income.

Number of erupted teeth at the age of 12 and 24 months

Aim: To verify the validity of maternal reports on the number of deciduous teeth erupted in their children. Methods: This cross-sectional study was performed with children enrolled in a Birth Cohort at the age of 12 months in the first stage and 24 months in the second stage. At both stages, children were clinically examined, and mothers reported the number of teeth of their children. Comparison between groups was performed using the Mann-Whitney non-paired Wilcoxon test. Level of agreement between two methods were estimated by the Observed Agreement, Weighted Kappa and Intraclass Correlation coefficients. Results: A total of 125 children were examined in the first stage, with mean number of reported teeth of 6.2. In the second stage, 149 children were examined, with mean number of reported teeth of 15.9. High level of agreement, kappa values and intraclass correlation coefficients were observed for both arches in both periods (p<0.001). Conclusions: Maternal report on the number of teeth erupted in children was reliable and valid. Thus, it seems to be a useful instrument for collecting data in population-based epidemiological studies targeting young children.

Clustering of Signs and Symptoms of Oral Diseases in a Colombian Population

OBJECTIVE

The aim of this study was to estimate disease pattern clusters and co-occurrences of oral signs and symptoms in a Colombian population.

METHODS

A cross-sectional study was carried out through a telephone survey amongst 1155 people registered in the telephone directory from Pasto, Colombia. The calls were made from July to November 2019. A 14-item self-report questionnaire about signs and symptoms related to oral diseases that included sociodemographic characteristics was employed. Descriptive and multivariable analyses such as hierarchical clustering, multidimensional scaling, and generalized linear models were used to determine co-occurrences in different sex and age strata.

RESULTS

Age- and condition-specific clusters of signs and symptoms were identified, while sex differences were limited. Calculus and denture sore mouth were related in 18- to 34-year-olds; tooth loss and calculus in 35- to 54-year-olds, and teeth holes or pits (dental caries) and dental abscess in those aged 55 years and older. We found stronger associations between periodontal disease (bleeding gums) and dental caries (odds ratio [OR], 2.484; 95% confidence interval [CI], 1.812-3.405; P < .001) as well as grinding/clenching and facial tension (OR, 7.162; 95% CI, 5.227-9.814; P < .001).

CONCLUSIONS

Age-specific clustering of signs and symptoms and diagnostic patterns wer present in ths Colombian cohort.

Development and Initial Validation of the Oral Health Activities Questionnaire

Background: The purpose of this study was to introduce a new Oral Health Activities Questionnaire (OHAQ, hereinafter) that examines different activities and behaviours related to the oral hygiene regimen of each analysed subject. Methods: A sample of 658 students was analysed to determine the OHAQ scale’s basic metric characteristics. To determine the construct validity of the OHAQ, descriptive statistics and correlation analysis, as well as differences testing, were applied to groups of subjects on the basis of self-reported oral status measures. Results: The dimensions of oral health activities were determined, and the scales for their measurement were constructed. Females and males differed in the OHAQ questionnaire measures. Significant but low intercorrelations were found among the measures. In the female and male subsample, four different oral health (OH, hereinafter) types of subjects were identified, exhibiting different characteristic behaviours regarding oral health. OHAQ scales showed good discriminant validity, revealing the differences related to specific self-reported oral status measures (e.g., frequency of toothache and the number of filled teeth). Conclusions: The OHAQ represents a satisfactory measurement instrument for determining the level of OH activities and for doing quick and reliable classifications of the participating subjects according to their OH activities and behaviours. The process of further validation and advancements of the OHAQ scales and measures should be continued through a clinical examination of subjects.

The validity of self-reported number of teeth and edentulousness among Norwegian older adults, the HUNT Study

Background

Number of teeth is an established indicator of oral health and is commonly self-reported in epidemiological studies due to the costly and labor-intensive nature of clinical examinations. Although previous studies have found self-reported number of teeth to be a reasonably accurate measure, its accuracy among older adults ≥ 70 years is less explored. The aim of this study was to assess the validity of self-reported number of teeth and edentulousness in older adults and to investigate factors that may affect the accuracy of self-reports.

Methods

This study included two different samples of older adults ≥ 70 years drawn from the fourth wave of the Trøndelag Health Study (the HUNT Study), Norway. Sample 1 (n = 586) was used to evaluate the validity of self-reported number of teeth and sample 2 (n = 518) was used to evaluate self-reported edentulousness. Information on number of teeth and background variables (education, smoking, cognitive function, and self-perceived general and oral health) were self-reported in questionnaires, while clinical oral health examinations assessed number of teeth, number of teeth restored or replaced by fixed prosthodontics and edentulousness. Spearman and Pearson correlation coefficients, Bland–Altman plot, chi-square test and kappa statistics were used to assess the agreement between self-reported and clinically recorded number of teeth.

Results

The mean difference between self-reported and clinically recorded number of teeth was low (− 0.22 teeth), and more than 70% of the participants reported their number of teeth within an error of two teeth. Correlations between self-reports and clinical examinations were high for the total sample (0.86 (Spearman) and 0.91 (Pearson)). However, a lower correlation was found among participants with dementia (0.74 (Spearman) and 0.85 (Pearson)), participants having ≥ 20 teeth (0.76 (Spearman) and 0.67 (Pearson)), and participants with ≥ 5 teeth restored or replaced by fixed prosthodontics (0.75 (Spearman) and 0.77 (Pearson)). Self-reports of having teeth or being edentulous were correct in 96.3% of the cases (kappa value 0.93, p value < 0.001).

Conclusions

Among older Norwegian adults, self-reported number of teeth agreed closely with clinical tooth counts and nearly all the edentulous participants correctly reported having no teeth.

Factors Associated with Regular Dental Checkups' Discontinuation during the COVID-19 Pandemic: A Nationwide Cross-Sectional Web-Based Survey in Japan

Managing oral health through regular dental checkups (RDCs) can help prevent dental diseases. Our study aimed to investigate the proportion and characteristics of those who stopped receiving RDCs owing to the coronavirus disease 2019 (COVID-19) pandemic. A nationwide web-based survey in Japan in September 2021 (3556 participants) revealed that 62.4% of participants had habitually received RDCs before COVID-19. Of these (n = 2219), 71.5% had received RDCs since the pandemic and 28.5% had not. Multiple logistic regression analysis revealed the following characteristics of those without RDCs since the pandemic: female (male, OR: 0.58, 95%CI: 0.45−0.74), lower household income (<2000 K JPY, OR: 1.45, 95%CI: 0.94−2.23; 2000 K−< 4000 K JPY, OR: 1.46, 95%CI: 1.08−1.98), fewer teeth (20−27, OR: 0.63, 95%CI: 0.39−1.03; ≥28, OR: 0.60, 95%CI: 0.36−0.98), and no interdental cleaning habits (OR: 0.51, 95%CI: 0.41−0.63). These results suggest that the disruption to RDCs owing to the pandemic is related to individual socioeconomic factors. Additionally, these individuals have poor oral health, which may be worsened by such barriers.

Association between exposure to secondhand smoking at home and tooth loss in Japan: A cross-sectional analysis of data from the 2016 National Health and Nutrition Survey

INTRODUCTION

Tooth loss affects oral health and physical and social functions. With widespread population aging, its prevalence is increasing. Secondhand smoking is a risk factor for oral diseases; however, in Japan, there are currently no regulations restricting exposure to secondhand smoke at home. This cross-sectional study examined the association between secondhand smoking at home and tooth loss among Japanese adults.

METHODS

The study examined secondary data from the 2016 National Health and Nutrition Survey, Japan. The self-reported responses of 18812 non-smokers aged ≥20 years were analyzed. The association between exposure to secondhand smoke at home and number of teeth was examined through multiple linear regression with multiple imputation. To obtain a more normal distribution, logarithmic transformation was applied to the number of teeth that deviated substantially from a normal distribution. Adjustments were made for sex, age, occupation, household size, dental check-up within the past year, and exposure to secondhand smoke outside the home.

RESULTS

Overall, 8.4% of the respondents were exposed to secondhand smoking at home almost every day; this percentage was larger among younger respondents, who also had more teeth than the older respondents. Although the univariate linear regression did not show a positive association between exposure to secondhand smoke and tooth loss, the multivariate-adjusted analysis revealed that respondents who were exposed to secondhand smoke at home almost every day had fewer teeth (β= -0.04; 95% CI: -0.07 – -0.01).

CONCLUSIONS

The present results suggest that exposure to secondhand smoke at home increases the risk of tooth loss.

Association between number of remaining teeth and healthy aging in Japanese older people: The Ohsaki Cohort 2006 Study

Aim

Maintaining ≥20 teeth is a public health goal worldwide. Healthy aging, which includes psychological and social well‐being, as well as physical indicators, has attracted a great deal of attention with the progression of aging societies. However, no studies have examined the association between the number of remaining teeth and healthy aging. This study aimed to investigate the association between the number of remaining teeth and healthy aging.

Methods

This community‐based longitudinal cohort study included 8300 Japanese people aged ≥65 years who were free of disability and depression in the baseline survey in 2006. The participants were categorized into four groups according to the number of remaining teeth at baseline: 0–9, 10–19, 20–24 and ≥25. The primary outcome was healthy aging (defined as meeting all four of the following criteria: free of disability, free of depression, high health‐related quality of life and high life satisfaction), as assessed by a questionnaire survey carried out in 2017. Multiple logistic regression was used to calculate the corresponding odds ratios and 95% confidence intervals.

Results

During about 11 years of follow‐up, 621 (7.5%) participants attained healthy aging. Participants with ≥20 remaining teeth showed a higher healthy aging rate. Compared with participants with 0–9 teeth, the multivariate‐adjusted odds ratios (95% confidence intervals) for 10–19, 20–24 and ≥25 teeth were 0.98 (0.77–1.26), 1.28 (1.01–1.63) and 1.59 (1.24–2.03), respectively.

Conclusions

These findings suggest that maintaining ≥20 teeth was associated with healthy aging. Geriatr Gerontol Int 2022; 22: 68–74.

Assessed and perceived oral health of older people who visit the dental practice, an exploratory cross-sectional study

OBJECTIVES

To assess the oral health of older people who visit the community dental practice from both the dentists' and the patients' perspective.

MATERIALS AND METHODS

In this exploratory cross-sectional study the oral health of Dutch community dwelling older people was assessed. A representative sample of general dental practitioners was asked to randomly and prospectively select one older patient and describe this patient using a specially-developed registration form; in addition the patient was requested to complete a questionnaire. The oral health of older people was described from the perspective of the dentists and the perspective of the older people themselves based on the definition of oral health from the World Dental Federation (FDI]. Relations between oral health of older people and dentist and older patient characteristics were analysed using Spearman's rank correlation coefficient (rho) and an ordinal regression model.

RESULTS

In total, 923 dentists were asked to participate in the study; data was available for 39.4% dentist-patient pairs. Dentists assessed the oral health of older patients as good or acceptable in 51.4% of the cases while this was the case in 76.2% of older patients themselves. The assessment of the dentist gets more negative with high treatment intensity and with older patients having certain diseases and more medication, while the assessment is more positive for older patients who visit the dentist on a regular basis. Older people's assessment of their oral health gets more negative by being female and with high treatment intensity, having certain diseases and higher use of medication.

CONCLUSIONS AND CLINICAL RELEVANCE

Chronically illness as expressed by the number of diseases and the use of medication, seems to be a risk factor for poor oral health. Older patients themselves assess their oral health differently, mostly more positive, than their dentist.

Inequality and Inequity in the Use of Oral Health Services in Australian Adults

OBJECTIVE

Social determinants drive disparities in dental visiting. This study aimed to measure inequality and inequity in dental visiting among Australian adults.

METHODS

Data were obtained from the National Study of Adult Oral Health (2017 to 2018). Participants were Australian adults aged ≥30 y. The outcome of interest was dental visiting in the last 12 mo. Disparity indicators included education and income. Other sociodemographic characteristics included age, gender, Indigenous status, main language, place of birth, residential location, health card and dental insurance status, and individual's self-rated and impaired oral health. To characterize inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration indexes and the slope and relative indexes of inequality. Inequalities were depicted through concentration curves. Indirect standardization with a nonlinear model was used to measure inequity.

RESULTS

A total of 9,919 Australian adults were included. Bivariate analysis showed a gradient by education and income on dental visiting, with 48% of those with lowest educational attainment/income having not visited a dentist in the last 12 mo. The concentration curves showed pro-low education and pro-poor income inequalities. All measures of absolute and relative indices were negative, indicating that from the bottom to the top of the socioeconomic ladder (education and income), the prevalence of no dental visiting decreased: absolute and relative concentration index estimates were approximately 2.5% and 5.0%, while the slope and relative indexes of inequality estimates were 14% to 18% and 0.4%, respectively. After need standardization, the group with the highest education or income had almost 1.5-times less probability of not having a dental visit in the previous year than those with the lowest education or income.

CONCLUSION

The use of oral health services exhibited socioeconomic inequalities and inequities, disproportionately burdening disadvantaged Australian adults.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by policy makers when planning a dental labor force in relation to the capacity of supply dental services to 1) reduce the inequality and inequity in the use of oral health services and 2) meet identified oral health needs across the Australian population, which is important for preventive dental care.

Relationship between Masticatory Function and Bone Mineral Density in Community-Dwelling Elderly: A Cross-Sectional Study

The relationship between masticatory function and bone mineral density (BMD) is unclear. This cross-sectional study examined this relationship after adjusting for confounding factors. The subjects were 702 community-dwelling elderly adults (306 men, 396 women) who had been recruited for the Community-Based Healthcare Research and Education study in 2019. Objective masticatory function was assessed using the gummy jelly method. The median for each descriptive statistic was 69.0 years for age, 86.2% for the young adult mean, and 18.0 for masticatory function. Comparisons of the groups with good and poor masticatory function by sex revealed a significant difference in muscle mass and the tooth number for both sexes (p < 0.05). Men showed significant differences in age (p < 0.05) and salivary occult blood findings (p < 0.05). Multivariate analysis using propensity scores showed a significant association between masticatory function and BMD in both sexes (men: odds ratio 163.0, 95% confidence interval 1.36–19,610.55, p = 0.04; women: odds ratio 48.65, 95% confidence interval 1.52–1561.15, p = 0.03 in women). Masticatory function and BMD in the community-dwelling elderly may be related. However, other factors, including frailty and sarcopenia, may also be involved. Regular oral health care by dentists and dental hygienists may benefit this population.

Association between procrastination in childhood and the number of remaining teeth in Japanese older adults

BACKGROUND

Procrastination is associated with stress and unhealthy behaviors. The oral condition reflects the long-term history of an individual's stress exposure and oral health behaviors; however, empirical studies on the association of procrastination in childhood with remaining teeth in older age are limited. We investigated the association of procrastination in childhood with the number of remaining teeth among community-dwelling older Japanese adults.

METHODS

In total, 1616 community-dwelling senior residents of Wakuya City (Miyagi Prefecture, Japan) who were enrolled in the National Health Plan & the Medical Care System for the Elderly completed a self-administered questionnaire on the number of teeth. Procrastination was measured using a single binary question about timing of holiday homework completion in childhood. The number of remaining teeth was assessed via a questionnaire with response options of ≥20, 10-19, 1-9, and 0 teeth. Ordered logistic regression models with potential confounders (sex, age, maternal education, childhood socioeconomic status (SES), childhood maltreatment, conscientiousness trait) and mediators (adulthood SES, smoking history, alcohol use history) were estimated.

RESULTS

Forty-six percent of participants reported a higher tendency to procrastinate in childhood. The proportions of participants with ≥20, 10-19, 1-9, and 0 teeth were 39.6, 22.7, 24.0, and 13.7%, respectively. After adjusting for all covariates, a higher tendency to procrastinate in childhood was significantly associated with having fewer remaining teeth (odds ratio = 1.28; 95% confidence interval = 1.05-1.57).

CONCLUSION

A higher tendency to procrastinate in childhood was associated with having fewer remaining teeth in later life.

Relationship between Oral Health Status and Bone Mineral Density in Community-Dwelling Elderly Individuals: A Cross-Sectional Study

The relationship between oral health status and bone mineral density has been poorly elucidated. We conducted a cross-sectional study to examine the relationship between oral health status and bone mineral density with data from healthy community-dwelling elderly individuals in Ohnan-cho, Shimane Japan who were recruited in 2019 for the Shimane Center for Community-Based Health Research and Education (CoHRE) study. The study included 702 participants (306 men and 396 women). The median age, bone mineral density, and number of remaining teeth were 69.0 years, 86.2%, and 26.0, respectively. The two groups (Low teeth group and High teeth group) showed significant differences in age, hemoglobin A1c (HbA1c) level, and masticatory function in men (p < 0.05). In women, age, number of untreated teeth, and masticatory function were significantly different (p < 0.05). The odds ratio of propensity score analysis for the association between the number of remaining teeth and bone mineral density was 27.7 (95% confidence interval: 1.86–414.9, p < 0.05). The number of remaining teeth could be associated with bone mineral density in the healthy elderly women, and no significant association was observed in men. Number of remaining teeth and bone mineral density may be interrelated, and oral care by dentists/dental hygienists may play an important role in maintaining bone mineral density in elderly women.

Oral Health-Related Quality of Life of Adult Orang Asli in Jelebu, Malaysia: A Cross-Sectional Study

Aims:

This study aimed at exploring the self-perception of Orang Asli (OA) from the Temuan tribe in Jelebu by using the Global Self-rated Oral Health (GSROH) and General Oral Health Assessment Index (GOHAI).

Materials and Methods:

It was a cross-sectional study involving a two-stage sampling to select the district and villages. A total of 325 participants were selected based on convenience sampling.

Results:

Almost half of the participants rated their oral health as poor or average. The mean GOHAI score was 52.96 (±7.749), ranging from 29 to 60. The GOHAI score was statistically significantly lower for female gender (P = 0.025), lower education level (P = 0.001), and elderly (P = 0.001). The GSROH score was also statistically significant with GOHAI score (P = 0.001).

Conclusions:

A limited number of studies were conducted in this area, particularly in the vulnerable population of OA. Our study found that half of the OA living in the fringe had a poor GOHAI score. It is, therefore, suggested that potential study and intervention programs concentrate on the low GOHAI score group; the male, lower educational context, and the elderly.

Association between frequency of laughter and oral health among community-dwelling older adults: a population-based cross-sectional study in Japan

PURPOSE

Oral health has been reported to have an impact on the activities of daily life such as chewing, eating, and laughing, while psychological factors such as depression and loneliness have been reported to affect oral health. Little is known, however, about the association between laughter and oral health in older adults. This study examined the bidirectional association between the frequency of daily laughter and oral health in community-dwelling older Japanese adults.

METHODS

Our cross-sectional study employed data from the 2013 Japan Gerontological Evaluation Study's self-reported survey, which included 11,239 male and 12,799 female community-dwelling independent individuals aged 65 years or older. We defined the oral health status by the number of remaining teeth. The association between the self-reported frequency of laughter (almost every day, 1-5 days per week, 1-3 days per month, or almost never) and oral health was examined using logistic regression analysis.

RESULTS

The participants with 10 or more teeth were significantly more likely to laugh compared with the edentulous participants, after adjusting for all covariates. Compared with those who almost never laughed, those who laughed 1-5 days per week were significantly less likely to be edentulous. After stratifying by sex, similar results were found only in the men for both analyses.

CONCLUSION

There was a significant bidirectional association between frequency of laughter and oral health that was independent of socioeconomic and lifestyle factors among older adults.