The Self-Reported Oral Health Status and Dental Attendance of Smokers and Non-Smokers in England

Delivering smoking cessation interventions in NHS primary dental care - lessons from the ENHANCE-D trial

Introduction Smoking is a major contributor to health inequalities in the UK. The ENHANCE-D trial is evaluating three smoking cessation interventions (nicotine replacement therapy [NRT], electronic cigarettes [ECs] or 'very brief advice') delivered in NHS primary dental care. This qualitative study aimed to provide insight into the factors that could influence the adoption of the interventions in these settings.Methods Interviews were conducted at two timepoints. Purposive maximum variation sampling was used to recruit and interview a total of 24 dental patients, 12 dental professionals and three NHS dental commissioners. Thematic analysis was carried out using normalisation process theory as an analytical framework.Results Dental settings were perceived as an appropriate location to deliver smoking cessation interventions. Patients had several motivating and demotivating factors regarding use of NRTs or ECs; they often had negative preconceptions. Financial considerations were major influencers for both patients and dental teams. The time pressures for dental practices were identified as a major barrier. Some practical issues, such as procurement and stock supply, would need to be considered if the ENHANCE-D interventions were to be implemented in routine practice.Conclusion Primary dental care teams are well-placed to deliver smoking cessation interventions. However, a number of facilitators and deterrents have been identified and strategic changes are needed for successful implementation.

Trends and socioeconomic inequalities in the dental attendance of adult smokers in Scotland from 2009 to 2019, a repeated cross-sectional study

BACKGROUND

Smoking continues to be the single largest cause of preventable disease and death and a major contributor to health inequalities. Dental professionals are well placed to offer behavioural support in combination with pharmacotherapy to increase smoking cessation rates across the population. We aimed to assess the trends and socioeconomic inequalities in the dental attendance of adult smokers in Scotland from 2009 to 2019 and examine the potential population reach of dental settings for smoking cessation interventions.

METHODS

A secondary analysis was conducted of combined Scottish Health Surveys (SHeS) from 2009/11, 2013/15 and 2017/19. 'Recent' dental attendance (within the past two years) was the focus and descriptive analysis examined attendance of self-reported smokers compared to non-smokers and stratified by the area-based Scottish Index of Multiple Deprivation (SIMD) and individual socioeconomic measures (income, education, and occupation). Generalised linear models were used to model recent attendance in non-smokers relative to smokers adjusted by the socioeconomic measures, for each of the survey cohorts separately. Absolute differences and risk ratios were calculated with 95% Confidence Intervals (CI).

RESULTS

Recent dental attendance was generally high and increased in both smokers (70-76%) and non-smokers (84-87%) from 2009/11 to 2017/19 and increased across all SIMD groups. After adjustment for sociodemographic variables, the adjusted Risk Difference (aRD) for recent attendance between non-smokers and smokers was 8.9% (95% CI 4.6%, 13.2%) by 2017/19. Within smokers, recent attendance was 7-9% lower in those living in the most deprived areas compared to those living in the least deprived areas over the three surveys.

CONCLUSIONS

SHeS data from 2009 to 2019 demonstrated that a high and increasing proportion of smokers in the population attend the dentist, albeit slightly less frequently than non-smokers. There were large inequalities in the dental attendance of smokers, to a lesser extent in non-smokers, and these persisted over time. Dental settings provide a good potential opportunity to deliver population-level smoking cessation interventions, but smokers in the most deprived groups and older age groups may be harder to reach. Consideration should be given to ensure that these groups are given appropriate proportionate support to take up preventive interventions.

Association between smoking habits and dental care utilization and cost using administrative claims database and specific medical check-up data

BACKGROUND

This study aims to evaluate the association between smoking habits and dental care utilization and cost in individuals registered with the Japan Health Insurance Association, Osaka branch.

METHODS

We used the administrative claims database and specific medical check-up data and included 226,359 participants, who visited dental institutions, underwent dental examinations, and underwent specific medical checkups, with smoking data from April 2016 to March 2017. We calculated propensity scores with age, gender, exercise, eating habits, alcohol intake, and sleep. We also compared dental care utilization with the total cost of each procedure.

RESULTS

According to propensity score matching, 62,692 participants were selected for each group. Compared to non-smokers, smokers were younger, and a higher proportion were men. Smokers tended to skip breakfast, have dinner just before bed, and drink alcohol. After adjusting for potential confounding factors with propensity score matching, the mean annual dental cost among smokers was significantly higher than non-smokers. The prevalence of pulpitis, missing teeth, and apical periodontitis were higher among smokers than non-smokers, while inlay detachment, caries, and dentine hypersensitivity were higher among non-smokers.

CONCLUSION

This study suggests that smokers have higher dental cost consisted of progressive dental caries, missing teeth, and uncontrolled acute inflammation that necessitated the use of medications. It is suggested that smokers tend to visit the dentist after their symptoms become severe.

Factors influencing oral cancer screening preferences in patients attending Tertiary Care University Oral Health Clinic

BACKGROUND

Understanding factors that influence patients' preferences towards oral cancer (OC) screening is imperative to provide high-quality evidence-based OC screening interventions that can be targeted for population-level uptake. This study determined adult patients' knowledge and awareness of OC, and how health behaviours influenced their preferences towards OC screening.

METHODS

This cross-sectional study used a 42-point questionnaire, between February and May 2020 using a combination of in-person and telephone interviews. Chi-square test and multiple logistic regression analysis were applied to confounding factors that returned statistical significance against OC knowledge and awareness. Significance of P < 0.05 was accepted.

RESULTS

Sixty-eight (38.6%) participants out of a total 176 had good knowledge of OC and 89 (50.6%) had good awareness. A total of 31.8% reported preference for OC screening by a general dental practitioner (GDP) over a general medical practitioner (GMP). Majority (72.7%) reported acceptance of OC screening at their next GDP visit. Ages 56-70 (OR = 0.357, 95% CI) and previous smokers (OR = 0.336, 95% CI) significantly influenced screening preferences. Knowledge of risk factors did not significantly influence OC screening preferences (χ²  = 3.178, P = 0.075).

CONCLUSIONS

Significant gaps in OC knowledge, screening and role of GDPs exist with smoking history and age influencing OC screening preferences.

Self-Rated Oral Health and Associated Factors among an Adult Population in Rural India-An Epidemiological Study

BACKGROUND

To determine the perception of oral health status and its associated factors among adults living in rural areas in Karnataka state, India.

METHODS

A cross-sectional study was conducted among adults in the age group of 35-54 years old residing in villages in a southern state in India. The main outcome measure was poor self-rated oral health (SROH) among adults in rural India.

RESULTS

About 873 adults participated in the study. The prevalence of poor SROH was 15.2%. Adults of age 40-44 years, females, those in lower socioeconomic conditions, and those with high caries experience (DMFT ≥ 4) and periodontal disease were associated with poor SROH. Those who had visited a dentist in the previous one year were 1.9 times more likely to report poor oral health.

CONCLUSIONS

Nearly 15% of rural people reported poor oral health. Socioeconomic conditions, sex, age, smoking, and dental visiting were associated with poor SROH. People's perception of poor oral health was associated with severe periodontitis and DMFT ≥ 4. A dose-response relationship was observed between experience with dental caries and poor SROH.

Oral cancer knowledge and screening behavior among smokers and non-smokers in rural communities

BACKGROUND

Research suggests having an oral and pharyngeal cancer (OPC) examination for early diagnosis can increase survival rate. However, the OPC screening rate is low in certain populations. To improve OPC screening rate, this study identified factors that are associated with having an OPC examination.

METHODS

Participants with landlines and aged 25 years and older were recruited from six northern Florida counties. Bivariate and logistic regressions were used to predict the outcome of whether the participants had ever had an OPC examination as well as whether participants had ever heard of an OPC examination.

RESULTS

Of 2260 participants with a mean age of 55.9 ± 15.0 years, the majority of participants never smoked (53.4%), self-identified as Whites (70.6%), and had some college or 2-year degree education (30.3%). Smokers were significantly less likely to have ever heard of an OPC examination than those who never smoked. Significant interaction between smoking status and race, and smoking status and social support interaction were found. Whites who never smoked were more likely to have had an OPC examination than non-Whites who never smoked. Former and current smokers with greater social support were more likely to have had an OPC examination than those with lower social support.

CONCLUSION

The findings from this study inform the need to enhance the awareness of having an OPC examination among smokers and to reduce barriers for racial minority populations to receive an OPC examination. Future research is warranted to develop interventions to target certain populations to improve the rate of OPC examination.

Factors Affecting Dental Service Utilisation in Indonesia: A Population-Based Multilevel Analysis

This study aimed to examine the prevalence of dental service utilisation in Indonesia and its association with social determinants at individual and community levels. Cross-sectional data from the 2014 Indonesian Family Life Survey (IFLS-5) was analysed. Individual independent variables included age, sex, marital status, educational attainment, economic status, health insurance, dental pain, self-reported mouth ulcers, self-rated health status, unmet healthcare needs and smoking status, while community independent variables included cognitive, structural social capital and residential area. Multilevel logistic regressions were performed to explore the associations between independent variables at different levels and the outcome of dental service utilisation. Of the total sample of 16,860 adults aged 15 years or older in our study, around 86.4% never visited a dentist. Dental service utilisation was associated with older age, female, currently not married, higher education level and economic status, health insurance, dental pain, self-reported mouth ulcers, met healthcare needs, never smoking, living in urban areas and communities with high structural social capital. Both individual and broader social determinants influenced dental service utilisation in Indonesia. These factors should be considered in the formulation of oral health policies and programmes aiming to improve dental service utilisation in the country.

Self-Perception of Periodontal Health and Associated Factors: A Cross-Sectional Population-Based Study

The aim of this cross-sectional study was to explore sociodemographic, behavioral, and clinical factors associated with self-awareness of periodontal health. Data were collected from a representative sample of 736 adults (25–75 years old) in a city of Northern Italy who self-assessed gingival bleeding, oral malodor, and tooth mobility in a questionnaire and who underwent clinical periodontal examination and organoleptic evaluation. Approximately 50% of the subjects were aware of their actual gingival health status and oral odor. The logistic regression analysis revealed that females presented higher odds of correctly perceiving their gingival conditions and mouth odor, while those who were older and smokers had a greater probability of being less objective in reporting them. Tooth type and position in the dental arches were positively associated with self-perception of tooth mobility. These findings reflected a low level of self-awareness that may influence oral care-seeking behavior. Subjects may be unconcerned about their periodontal health condition or lack enough knowledge to be aware of it. This points to the need for planning strategies to improve education and knowledge about periodontal health, which, by enhancing self-perception of periodontal symptoms, could help everyone to seek treatment in the initial stage of the disease.

Understanding the association between self-reported poor oral health and exposure to adverse childhood experiences: a retrospective study

Background

Adverse childhood experiences, including physical, sexual or emotional abuse, can have detrimental impacts on child and adult health. However, little research has explored the impact that such early life experiences have on oral health. This study examines whether experiencing adverse childhood experiences before the age of 18 years is associated with self-reported poor dental health in later life.

Methods

Using stratified random probability sampling, a household survey (N = 5307; age range 18–69 years) was conducted in the South of England (Hertfordshire, Luton and Northamptonshire). Data were collected at participants’ homes using face-to-face interviews. Measures included exposure to nine adverse childhood experiences, and two dental outcomes: tooth loss (> 8 teeth lost due to dental caries or damage) and missing or filled teeth (direct or indirect restorations; > 12 missing or filled teeth).

Results

Strong associations were found between exposure to childhood adversity and poor dental health. The prevalence of tooth loss was significantly higher (8.3%) in those with 4+ adverse childhood experiences compared to those who had experienced none (5.0%; p < 0.05). A similar relationship was found for levels of missing or filled teeth (13.4%, 4+ adverse childhood experiences; 8.1%, none; p < 0.001). Exposure to 4+ adverse childhood experiences was associated with a higher level of tooth loss and restorations at any age, compared to individuals who had not experienced adversity. Demographically adjusted means for tooth loss increased with adverse childhood experience count in all age groups, rising from 1.0% (18–29 years) and 13.0% (60–69 years) in those with none, to 3.0% and 26.0%, respectively in those reporting 4+.

Conclusions

Exposure to childhood adversity could be an important predictive factor for poor dental health. As oral health is an important part of a child’s overall health status, approaches that seek to improve dental health across the life-course should start with safe and nurturing childhoods free from abuse and neglect. Given the growing role that dental professionals have in identifying violence and abuse, it seems appropriate to raise awareness in the field of dentistry of the potential for individuals to have suffered adverse childhood experiences, and the mechanisms linking childhood adversity to poor dental health.

Risk factors for tooth loss in adult Japanese dental patients: 8020 Promotion Foundation Study

AIM

The assessment of the risk of tooth loss in patients visiting a dental clinic is important for managing their oral health. In the present study, we examined the risk factors for tooth loss among dental patients.

METHODS

Data from the 8020 Promotion Foundation Study on the Health Promotion Effects of Dental Care were used in the present study. The study involved 2743 patients who visited a dental clinic in Japan and completed a questionnaire and oral health examination at baseline and at the 2-year follow up. Tooth- and person-level risk factors for tooth loss during 2 years were subjected to a multilevel multivariate logistic regression analysis.

RESULTS

In both the person- and tooth-level analyses, age, smoking habit, reason for dental visit, economic status, number of remaining teeth, and periodontal status were significantly associated with tooth loss. In the tooth-level analysis, tooth type, tooth status, and periodontal status were significantly related to tooth loss. Persons who visited a dental clinic for periodic maintenance had a significantly lower risk of tooth loss than those who visited only to receive dental treatment.

CONCLUSIONS

Various tooth-level factors and modifiable factors, such as smoking cessation and periodic maintenance, are important for the suppression of tooth loss in dental patients.

Heightened olfactory dysfunction and oral irritation among chronic smokers and heightened propylthiouracil (PROP) bitterness among menthol smokers

Chronic cigarette smoking may influence chemosensory function, which in turn, may affect cigarette usage. Because menthol in cigarettes can attenuate nicotine bitterness, choice of menthol/nonmenthol cigarettes may be influenced by ability to perceive bitterness. We examined chemosensory function of chronic smokers, hypothesizing they would show altered function in comparison to non-smokers and by menthol cigarette preference. In laboratory-based measures, chronic smokers (N = 135; 84 menthol smokers) self-reported their chemosensory function and participated in smell (identification task with perceived intensity) and taste (quinine and NaCl intensity on tongue-tip and whole mouth) testing. A taste genetics probe (propylthiouracil (PROP) bitterness) also was assessed. Self-reported and measured chemosensory function were compared with nationally-representative 2013-2014 National Health and Nutrition Examination Survey (NHANES) data generated with similar measures. The taste measures also were compared between smokers and age- and sex-matched non-smokers from a laboratory database. Frequencies of self-reported smell and taste alterations among smokers exceeded NHANES prevalence estimates for non-smokers. The rate of measured smell dysfunction also exceeded NHANES prevalence for hyposmia. Compared to non-smokers, smokers reported elevated tongue-tip and whole mouth intensities from 1 M NaCl, with no significant differences in whole mouth quinine or 0.32 M NaCl. Inconsistent with previous hypotheses, smokers were not more likely to report depressed PROP bitterness than non-smokers. However, as expected, menthol smokers reported greater PROP bitterness than non-menthol smokers. In conclusion, chemosensory alterations were more frequent among chronic smokers, including hyposmia and heightened intensity from NaCl at an oral-irritant concentration. PROP supertasters were most likely to prefer mentholated cigarettes.

Oral Cancer Screening among Smokers and Nonsmokers

Aims and Objectives:

The aim of visual systematic screening is early identification of oral cancer (OC) precursor lesion. OC mortality improves when cancer is identified at early stages. This is important in patients whose lifestyle choices render them at higher risk of developing OC. This study described the prevalence of OC screening among smokers and nonsmokers in Kuwait and ascertained demographic predictors.

Materials and Methods:

This cross-sectional study utilized a self-administered online survey in English and Arabic through Survey Monkey^® and disseminated using the social networking app “WhatsApp.” The survey included 21 questions on demographics, smoking status, and knowledge of OC. Screening questions were adopted from the Maryland Cancer Screening and Risk Behavior Survey. Data were analyzed using the computer software “Statistical Package for Social Sciences, SPSS version 24.0” (IBM Corp, Armonk, NY, USA).

Results:

The study included 404 Kuwaiti respondents, 311 (77%) nonsmokers and 93 (23%) smokers. Prevalence of OC screening was 7.2, 7.7% among nonsmokers and 5.4% in smokers. Only 36.6% were aware of OC, with more nonsmokers (38.9%) than smokers (29%). Logistic regression revealed twice more males likely to go for screening than females and with the likelihood of those being in the age group of 25–44 years four times more (P < 0.012) than other age groups.

Conclusion:

There was low prevalence of screening and poor awareness of OC among sampled. Increased efforts are needed by health professionals to spread awareness and improve knowledge on OC and demand the inclusion of screening during their routine and opportunistic oral examinations.

Clinical Oral Health Recommended Care and Oral Health Self-Report, NHANES, 2013-2014

PURPOSE

The purpose of this study was to determine the concordance of self-reported responses to oral health questions versus clinically evaluated recommended need for oral healthcare by calibrated dentists to determine usefulness of the questions for epidemiological studies. We additionally examined other factors associated with concordant self-reports versus clinical evaluations.

MATERIALS AND METHODS

We used a cross-sectional study design with 4,205 participants, ages 30 years and above, who had complete oral health self-perception data and dental referral data in the NHANES 2013-14. Calibrated dentists completed clinical oral healthcare assessments. The assessments were dichotomized to (1) recommendation for immediate care and (2) routine oral health care. Self-reported oral health needs were measured with 6 items (an overall oral health self-perception question, oral pain within the previous year, impact on job/school, suspected periodontal disease, tooth appearance, and tooth mobility). The key item of interest was the overall oral health self-perception question.

RESULTS

Concordance with clinically evaluated recommended need for oral healthcare varied from 52.0% (oral pain) to 65.4% (overall oral health self-perception). Many subgroup differences were observed.

CONCLUSIONS

The overall self-perception of oral health and the clinical evaluation of oral healthcare need were substantially concordant; other self-reported measures were moderately concordant. This is useful information and points to the need for a minimum set of measures that can provide actionable information and capture the need for clinical dental care.

Nicotine is a risk factor for dental caries: An in vivo study

Background/purpose

Streptococcus mutans is an important pathogen in the development of dental caries. Many studies have focused on the relationship between nicotine and S. mutans in vitro. The aim of this study was to investigate the effect of nicotine on the growth of S. mutans and its cariogenic potential in vivo.

Materials and methods

Sixteen male Specific-pathogen-free Wistar rats were divided into 2 groups (nicotine-treated and nicotine-untreated group) and infected with S. mutans. The S. mutans suspension was treated with 1 mg/mL nicotine in the nicotine-treated group. The Keyes method was used to evaluate sulcal caries of rats, and dental plaque on molar teeth was observed by scanning electron microscopy (SEM).

Results

Incidence of sulcal caries was higher in nicotine-treated group compared to nicotine-untreated group (42.7 ± 1.7 vs 37.3 ± 4.9, P = 0.009). Severity of caries increased with nicotine treatment. The slightly dentinal caries scores and moderate dentinal caries scores were higher in the presence of nicotine (P < 0.001). Increased number of S. mutans cells attached to dental surface was observed under SEM in the nicotine-treated group.

Conclusion

Nicotine would promote the attachment of S. mutans to dental surface, and further increase the incidence and severity of dental caries. Therefore, nicotine might be a risk factor for smoking-induced caries.

Screening and early detection of oral cancer: current controversies

Some evidence suggests that the early detection of oral cancer (OC) during surveillance might improve survival rates. In addition to this, interventions aimed at enhancing public awareness and knowledge of signs, symptoms and risk factors of OC are thought to decrease the burden of disease. Nevertheless, there is much controversy with regard to the cost-effectiveness of population-based strategies for OC screening. Here, we present and briefly discuss timely findings that have put under scrutiny the applicability of approaches targeted at the early identification of patients with OC.

Regular Dental Visits: Influence on Health-Related Quality of Life in 1,607 Patients with Oral Squamous Cell Carcinoma

Background

The incidence of oral squamous cell carcinoma (OSCC) is in the top 10 of all cancer entities. Regular oral examinations by dentists play an important role in oral cancer prevention.

Methods

Patients with OSCC (n = 1,607) and physicians (n = 1,489) completed questionnaires during the DÖSAK Rehab Study. The psychosocial and functional factors collected in these questionnaires were assessed in the present study. We compared patients who visited their dentist at least once a year (group A) with those who visited their dentist less than once a year (group B).

Results

Patients in group A had significantly better health-related quality of life after tumor treatment than patients in group B. Patients in group A also had a smaller tumor size and less lymph node metastasis and lost fewer teeth during the treatment. This resulted in better prosthetic rehabilitation and better psychological status after tumor treatment.

Conclusions

Dentists play an important role in the early recognition of oral cancer. This study should encourage dentists to take a more active role in oral cancer prevention.

Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

Objective

This study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England.

Methods

Routine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008–2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients’ individual characteristics (demography, smoking, payment status) and contextual experience (deprivation based on area of residence), with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments.

Results

Data on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (<18 years) and older adults (≥65 years) received preventive care in the form of ‘instruction and advice’, compared with 46% of working age adults (18–64 years); p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001): ‘partial dentures’ (7%); ‘scale and polish’ (3.7%); ‘tooth extraction’ (3%; p = 0.001), and ‘instruction and advice’ (3%; p = 0.001). Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive ‘instruction and advice’ than non-smokers (OR 4.124; 95% CI: 3.088–5.508; p = 0.01). A further new finding from the multilevel models was a significant difference in treatment related to area of residence; adults from the most deprived quintile were more likely to receive ‘tooth extraction’ when compared with least deprived, and less likely to receive preventive ‘instruction and advice’ (p = 0.01).

Conclusion

This is the first study to model patient management data from a state-funded dental service and show that individual and contextual factors predict common treatments received. Implications of this research include the importance of making provision for our aging population and ensuring that preventative care is available to all. Further research is required to explain the interaction of organisational and system policies, practitioner and patient perspectives on care and, thus, inform effective commissioning and provision of dental services.

Awareness about the effects of tobacco consumption on oral health and the possibility of smoking behavior among male Saudi schoolchildren

OBJECTIVE

To investigate an association between the awareness about the effects of tobacco consumption on oral health and the likelihood of smoking among male schoolchildren.

MATERIALS AND METHODS

A cross sectional study was conducted using a multistage random sampling technique. The participants (ages 15-19 years) were recruited from male public high schools in Greater Dammam in Saudi Arabia. A pretested questionnaire inquired participants' awareness about the effects of smoking on oral health. SPSS (Released 2013, IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) was used to calculate unadjusted and adjusted odds ratio (OR) and 95% confidence interval (CI). Multiple logistic regression and interaction analyses were performed to identify the factors associated with the probability of smoking behavior among children.

RESULTS

More than 69.9% (n = 277) of participants were aware of the adverse effects of tobacco consumption on oral health which included poor oral health, bad taste and breath, periodontal disease, dental caries, oral ulcers, and oral cancers. The odds of smoking were 22%-47% lower among schoolchildren who were aware of the consequences of smoking on oral health than those who were unaware of these complications. The students who believed that smoking can cause oral ulcers and negatively affects oral health had a lower probability of smoking (OR: 0.414; CI: 0.201-0.50) and (OR: 0.433; CI: 0.194-0.965), respectively in comparison with those who thought that smoking had no such negative impacts.

CONCLUSIONS

Schoolchildren with increased awareness of smoking effects on oral health were less likely to smoke. Educating students about the complications of smoking on oral health should be the part of smoking cessation programs and policies.