The relationship between cigarette smoking and perceived dental treatment needs in the United States, 1988–1994

Smoking, Serum Albumin and 25-hydroxy Vitamin D Levels, and Bone Mineral Density Are Associated with Tooth Loss in Patients with Rheumatoid Arthritis

Objectives This study investigated factors associated with tooth loss in patients with rheumatoid arthritis (RA). Methods A total of 429 patients with RA were enrolled in the study. We examined tooth loss and clinical data. Patients were classified into two groups: a group with tooth loss (tooth loss-positive group), and a group without tooth loss (tooth loss-negative group). Patients were included in the tooth loss-positive group if they had fewer remaining teeth than the number defined by the Ministry of Health, Labour and Welfare in Japan to be the normal number teeth for that age and sex. Factors associated with tooth loss were analyzed by comparing the tooth loss-positive and loss-negative groups. Results The frequency of patients with tooth loss was 39.6%. The factors associated with tooth loss were smoking [odds ratio (OR) 1.638; 95% confidence interval (CI) 1.165-2.302], serum levels of albumin (OR 0.325; 95% CI 0.149-0.707) and 25-hydroxy vitamin D (OR 0.947; 95% CI 0.915-0.980), and total hip T score (OR 0.713; 95% CI 0.535-0.950). Conclusion This study revealed that tooth loss is associated with smoking, serum levels of albumin and 25-hydroxy vitamin D, and the total hip T score in patients with RA. Our findings may help prevent tooth loss in patients with RA.

Health Behaviors and Self-Reported Oral Health among Centenarians in Nanjing, China: A Cross-Sectional Study

The role of health behaviors in oral health conditions in individuals of extremely old age remains understudied. This study included 185 participants aged 100 years or older from the Nanjing Centenarians Study (NCS) to examine the associations between health behaviors and oral health and investigate the potential moderating role of education and living arrangements in such relationships. The oral health status as an outcome included the self-reported oral health status and edentulous status. Health behavior variables included smoking, eating fruits, eating vegetables, participating in leisure activities, and practicing oral hygiene behaviors. Sociodemographic characteristics and health status were considered as confounders. Descriptive statistics, ordinal regression, and logistic regression models were used to address the research questions. Results showed that better oral health was reported by centenarians who were non-smokers, participated in more leisure activities, and practiced higher frequency of oral hygiene behaviors. Those who ate fruits daily and practiced more frequently oral hygiene behaviors were more likely to be dentate. The positive association of oral hygiene behaviors was stronger for centenarians who were formally educated and co-resided with family members. The results suggest that effective interventions should consider health behaviors and living arrangements in this growing population to improve their oral health status.

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.

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

Smoking has been identified as the second greatest risk factor for global death and disability and has impacts on the oral cavity from aesthetic changes to fatal diseases such as oral cancer. The paper presents a secondary analysis of the National Adult Dental Health Survey (2009). The analysis used descriptive statistics, bivariate analyses and logistic regression models to report the self-reported oral health status and dental attendance of smokers and non-smokers in England. Of the 9,657 participants, 21% reported they were currently smoking. When compared with smokers; non-smokers were more likely to report ‘good oral health’ (75% versus 57% respectively, p<0.05). Smokers were twice as likely to attend the dentist symptomatically (OR = 2.27, CI = 2.02–2.55) compared with non-smoker regardless the deprivation status. Smokers were more likely to attend symptomatically in the most deprived quintiles (OR = 1.99, CI = 1.57–2.52) and perceive they had poorer oral health (OR = 1.77, CI = 1.42–2.20). The present research is consistent with earlier sub-national research and should be considered when planning early diagnosis and management strategies for smoking-related conditions, considering the potential impact dental teams might have on smoking rates.

Children, sealants, and guardians who smoke: Trends in NHANES 2001-2002 to 2010-2012

OBJECTIVE

There are many factors influencing dental behavior. The relationship of smokers who smoked inside the home toward preventive care (measured as dental sealant placement) of the children living in their homes is examined in this study.

METHODS

Data from the National Health and Nutrition Examination Surveys in 2001-2002 and in 2011-2012 were analyzed. Data included variables to someone smoking inside the home, dental sealant placement in children ages 6-less than 20 years, and sociodemographics which were obtained from a dental examination and a home interview.

RESULTS

There were 3,352 eligible participants in 2001-2002 and 2,374 in 2011-2012. The unadjusted odds ratio for not having dental sealants when there was someone who smoked inside the home as compared with not having dental sealants when there was no one who smoked inside the home was 1.57 (95%CI: 1.17, 2.10) in 2001-2002. The unadjusted odds ratio was 1.56 (95% CI: 1.20, 2.03) in 2011-2012. When the data were adjusted for age, sex, race/ethnicity, insurance, and income to poverty ratio, the 2001-2002 adjusted odds ratio was 1.31 (95%CI: 0.97, 1.78). The adjusted odds ratio in 2011-2012 was 1.41 (95% CI:1.01, 1.95).

CONCLUSIONS

Children who lived in homes in which someone smoked inside the home were more likely to not have dental sealants compared with children who lived in homes in which no one smoked inside the home. These results are important for understanding the factors related to access to dental care issues for children.

Prevalence and predictors for periodontitis among adults in China, 2010

Background

Although the interrelationship between poor oral health and chronic diseases is well established, few related studies are available in China. In this study, the prevalence of severe periodontitis and its association with chronic diseases among adults in China have been explored.

Design

During China's 2010 Chronic Disease and Risk Factor Surveillance (CCDRFS) survey among adults aged 18 and older, 3 out of 162 surveillance points and the entire sample from each point (600×3=1,800 subjects) were selected as pilot study sites in which oral examination was performed. Basic demographic information, chronic diseases status, and results of oral examination were collected from 2010 CCDRFS data. A standard oral examination was conducted by trained staff. Periodontitis was defined as moderate (4–5 mm pockets) or severe (≥6 mm pockets). Chronic disease status was determined by using standard methods and criteria. Multivariate logistic analysis was used to identify the independent association of various factors with severe periodontitis.

Results

Of 1,800 subjects, 1,728 subjects (96%) provided complete information. The prevalence of severe periodontitis was 1.9% (32/1,728) (95% CI=1.2–2.5). In multivariate model, participants with diabetes were 2.4 times (OR=2.4, 95% CI=1.1–5.6) more likely to have severe periodontitis. Being male was significantly associated with severe periodontitis (OR=3.5, 95% CI=1.6–7.7). Living in a rural area was related to an increased chance of having severe periodontitis (OR=2.1, 95% CI=1.0– 4.9). Attainment of at least 6 years of education was inversely associated with severe periodontitis (OR=0.3, 95% CI=0.1–0.8).

Conclusions

According to this pilot project, prevalence of severe periodontitis was low. Control measures should be particularly emphasized for high-risk groups such as less educated people (<6 years of education), people living in rural areas, men, and diabetes patients. Population-based studies, including oral examination by trained staff, are feasible and should be done in order to understand the burden of periodontitis and to provide an effective response to this key oral health issue.

Smoking-cessation e-referrals: a national dental practice-based research network randomized controlled trial

BACKGROUND

Tobacco use is still the leading preventable cause of death and morbidity in the U.S. Web-assisted tobacco interventions are an effective but underutilized tool in assisting smokers with quitting. The dental visit is an excellent opportunity to assist smokers in quitting by referring them to these tobacco-cessation online programs.

PURPOSE

The study purpose was to test two patient referral methods-paper referrals (information prescriptions) versus paper plus e-referrals-to a web-assisted smoking-cessation induction system.

DESIGN

RCT that used implementation research methods.

PARTICIPANTS/SETTING

A total of 100 community-based dental practices were enrolled and 1814 smokers were referred to the web-assisted tobacco induction system.

INTERVENTION

The study intervention was a proactive e-referral of smokers to a web-assisted tobacco induction system called Decide2Quit.org, and the control group used paper referrals (information prescriptions) to refer smokers to the Decide2Quit.org.

MAIN OUTCOME MEASUREMENTS

The outcome measurements were the referral numbers, Decide2Quit registration numbers, and the smokers' quit rate. Data were collected in 2010-2011 and analyses were completed in 2012.

RESULTS

Although total referrals from intervention practices was lower than control, subsequent proportions of registrations among smokers referred to Decide2Quit.org were nearly fourfold higher (adjusted mean percentages: 29.5% vs 7.6%, p<0.01) in intervention compared with control practices. Subsequent rates of cessation among referred smokers were threefold higher (adjusted mean percentages: 3.0% vs 0.8%, p=0.03) in intervention practices as compared with control.

CONCLUSIONS

Intervention practices using the e-referral system had higher smoker registration numbers and higher quit smoking rates than the control practices. This study finds that e-referrals are effective in getting smokers to the web-assisted smoking-cessation induction system and in assisting with quitting that more than compensates for any additional effort that e-referrals require on the part of the practitioner.

CLINICAL TRIAL REGISTRATION

DPBRN Hygienists Internet Quality Improvement in Tobacco Cessation (HiQuit); NCT01108432.

Sociodemographic and health-related risk factors associated with tooth loss among adults in Rhode Island

Introduction

Oral health is an integral component of overall health and well-being. Very little Rhode Island state-level information exists on the determinants of tooth loss. The objective of this study was to systematically identify sociodemographic characteristics, health behaviors, health conditions and disabilities, and dental insurance coverage associated with tooth loss among noninstitutionalized adults in Rhode Island.

Methods

We analyzed Rhode Island’s 2008 and 2010 Behavioral Risk Factor Surveillance System survey data in 2011. The survey had 4 response categories for tooth loss: none, 1 to 5, 6 or more but not all, and all. We used multinomial logistic regression models to assess the relationship between 4 risk factor domains and tooth loss.

Results

An estimated 57.6% of Rhode Island adults had all their teeth, 28.9% had 1 to 5 missing teeth, 8.9% had 6 to 31 missing teeth, and 4.6% were edentulous. Respondents who had low income, low education, unhealthy behaviors (ie, were former or current smokers and did not engage in physical activity), chronic conditions (ie, diabetes and obesity) or disabilities, and no dental insurance coverage were more likely to have fewer teeth compared with their referent groups. However, the association of these variables with tooth loss was not uniform by age group.

Conclusion

Adults who report risky health behaviors or impaired health may be considered target subpopulations for prevention of tooth loss and promotion of good oral health.

The role of tobacco use on dental care and oral disease severity within community dental clinics in Japan

Background

To examine facilitators of dental smoking intervention practices in Japan, where smokeless tobacco is rarely used, we evaluated the characteristics of dental care for smokers.

Methods

Community dentists volunteered to record the treated disease or encounter with patients that was principally responsible for their dental care on the survey day. Patients were classified into groups receiving gingival/periodontal treatment (GPT), caries/endodontic treatment (CET), prosthetic treatment (PRT), periodical check-up/orthodontic treatment (POT), or other encounters/treatments. Potential effect of dentist clustering was adjusted by incorporating the complex survey design into the analysis.

Results

Data of 2835 current smokers (CS) and 6850 non-smokers (NS) from 753 clinics were analysed. Distribution of treatments significantly differed between CS and NS (P = 0.001). In ad hoc multiple comparisons for each treatment, CS were significantly higher than NS for CET (47.1% vs. 43.6%, P = 0.002), and lower for POT (1.6% vs. 2.7%, P = 0.001), whereas GPT and PRT proportions were equivalent by smoking. When stage of disease progression was compared in the GPT subpopulation, CS were more likely received treatment for advanced stage disease than NS in the age groups of 40–59 years (24.9% vs. 15.3%, P = 0.001) and more than 60 years (40.8% vs. 22.1%, P < 0.001). However, the difference was less apparent in the entire population (9.7% vs. 6.0%), and CS were not predominant among patients receiving GPT for advanced stage disease (37.6%).

Conclusions

The association of smoking with type of dental care of CET and GPT severity would warrant the need for dental professionals to engage their patients smoking within clinical practice. The detrimental effects of smoking in dental care for smokers, as evidenced by the distribution of treatment and encounter and stage of treated disease, may not be clearly realized by dental professionals, unless the smoking status of all patients is identified.

Necessity and readiness for smoking cessation intervention in dental clinics in Japan

BACKGROUND

The necessity and readiness for smoking cessation intervention in dental clinics was assessed by investigating smoking status and stage of behavior change in patients and the attitudes of dentists toward the effects of smoking on their patients, respectively.

METHODS

A self-administered questionnaire was mailed to 1022 dentists randomly selected from the Japanese Dental Association database. The questionnaire survey consisted of 1 section for dentists and 1 for patients aged 20 years or older and was scheduled to be completed at the dentists' clinics on a designated day in February 2008.

RESULTS

The response rate to the questionnaire was 78.2% from among target dental clinics and 73.7% and 74.7% for patient and dentist questionnaires, respectively. Data from 11,370 patients and 739 dentists were analyzed. The overall smoking prevalence among the patients (25.1%) was similar to that reported by the National Health and Nutrition Examination Survey, and young female patients had a markedly higher smoking prevalence. More than 70% of patients who smoked were interested in quitting. Although the prevalence of current smoking among dentists (27.1%) was significantly higher than that reported among Japanese physicians (15.0%), approximately 70% of dentists were concerned about the effects of smoking on patient health and prohibited smoking inside their clinic.

CONCLUSIONS

Many smokers who were interested in quitting, particularly young women, visited dental clinics, and most dentists believed that smoking was harmful for their patients. These results indicate that smoking cessation intervention in dental settings is necessary and that dentists are ready to provide such interventions.

Does smoking increase risk for caries? a cross-sectional study in an Italian military academy

BACKGROUND/AIMS

Traditionally, tobacco is considered as part of the military culture. A cross-sectional survey was designed to clarify if smoking habit increases the caries risk in a sample of Italian adults attending a Military Academy.

METHODS

Clinical examinations including dental caries and presence of bleeding at probing were carried out following WHO criteria. Related socio-behavioural factors were collected. Four calibrated examiners observed 763 subjects (men = 722; 94.6% and women = 41; 5.4%).

RESULTS

One of the 763 subjects did not declare the smoking status and was excluded from the analysis. Hundred twenty-six (16.5%) subjects claimed to have never smoked, 200 (26.3%) were coded as light smokers and 436 (57.2%) as heavy tobacco users. Statistically significant linear trend across the educational level (p = 0.03), self-satisfaction with the appearance of teeth and gums (p = 0.04) and dental check-up in the past 6 months (p = 0.02) was found among the 3 subgroups. Almost the entire sample showed caries experience (84.1%). Mean DS ranged from 0.6 in the nonsmokers subgroup to 1.1 in the heavy smokers. Differences among means were statistically significant for DS, DMFS and Significant Caries Index (p = 0.01, 0.04 and 0.03, respectively). The zero-inflated regression model showed that caries severity was significantly associated with smoking habit (p = 0.02), dental check-up in the past 6 months (p = 0.01), self-satisfaction with the appearance of teeth and gums (p < 0.01) and healthy gums (p = 0.04).

CONCLUSION

Heavy smokers attending a Military Academy showed a higher prevalence of caries, confirming a correlation between the disease and tobacco use.

Trends in oral health by poverty status as measured by Healthy People 2010 objectives

OBJECTIVES

Poverty is a significant social determinant for oral health, yet Healthy People 2010 (HP 2010) does not monitor changes in oral health status by poverty. We assessed recent trends for six HP 2010 oral health objectives by poverty status.

METHODS

We used data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys to analyze trends for HP 2010 age-specific objectives relating to caries experience, untreated tooth decay, dental sealants, periodontal disease, tooth retention, and complete tooth loss by poverty status.

RESULTS

Dental caries significantly increased from 19% to 24% for children aged 2-4 years, but when stratified by poverty, caries only increased significantly for non-poor 2- to 4-year-old children (10% to 15%) (Objective 21-1a). The largest percentage point increase in dental caries was for non-poor boys (9% to 18%). The use of dental sealants continues to grow in the U.S. The largest percentage point increase in sealant use (Objective 21-8) between the two survey periods was for all poor children aged 8 years (3% to 21%). Among adults aged 35-44 years, periodontal disease significantly declined in the U.S. from 22% to 16% (Objective 21-5b) and more adults retained all of their natural teeth (30% to 38%) (Objective 21-3). However, the increase in tooth retention was significant only for non-poor adults, particularly non-poor men (34% to 48%).

CONCLUSIONS

Overall, the oral health status of Americans as measured by HP 2010 objectives mostly showed improvement or remained unchanged between 1998-1994 and 1999-2004. However, some changes in oral health status for some traditionally low-risk groups, such as non-poor children, may be reversing improvements in oral health that have consistently been observed in previous decades. These results suggest that poverty status is an important factor for planning and monitoring future national oral health goals.

Socio-demographics of adult orthodontic visits in the United States

INTRODUCTION

Population-based studies in orthodontics have focused on differences between normative and perceived needs. However, information from national data on the prevalence of orthodontic visits and their associated factors in adults in the United States is scarce. We examined the demographic profile of likely adult users of orthodontic services and whether there is racial and ethnic disparity in orthodontic visits.

METHODS

We analyzed data from the Medical Expenditure Panel Survey, 2000-2004.

RESULTS

Overall, about 1% of the population reported an orthodontic visit. Subjects who made a general dental visit during the current year were significantly more likely to also have an orthodontic visit. Single adults, women, people between 18 and 30 years of age, and those from high-income families were more likely to report an orthodontic visit. There were no indications of racial and ethnic disparity for either black or Hispanic adults compared with white adults after adjusting for other covariates.

CONCLUSIONS

Substantial racial and ethnic disparity in adult orthodontic usage was not identified. Adults (ages 18-30 years), women, those with higher incomes, and single adults had significantly higher odds of reporting an orthodontic visit. However, additional studies specifically evaluating the association of treatment need among low-income families are required to evaluate whether these adults face significant barriers in accessing orthodontic care.

Dental management of patients with obstructive pulmonary diseases

Many dental patients have obstructive pulmonary disease, such as chronic bronchitis, emphysema, and bronchial asthma. These diseases have different etiologies but may have overlapping signs and symptoms. Diagnosis and treatment are becoming more sophisticated so that morbidity and mortality are improving. Most dental patients with these morbidity and mortality are improving. Most dental patients with these disease can be treated safely with only minor adjustments to procedures. Cigarette smoking is a common risk factor that dental health care providers can address with a simple program called the five A's.