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Chi DL, Guinn S, Shands ME, Nemawarkar D, Hill CM, Mayhle M, Do TT, Li S, Panchal S. Socioeconomic vulnerability and access to community water fluoridation in Washington. J Am Dent Assoc 2024; 155:747-754.e2. [PMID: 39007792 DOI: 10.1016/j.adaj.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The aim of the authors was to determine whether socioeconomic vulnerability is associated with community water fluoridation (CWF). METHODS The authors used US Census Bureau data to create 4 county-level vulnerability markers (percentages non-White, Hispanic or Latino, below the federal poverty threshold, education below high school), obtained county-level CWF data from the Washington State Department of Health, and evaluated associations using Spearman rank correlation coefficient and the Kruskal-Wallis rank sum test. The authors then interviewed 122 community members in Washington (December 2022-March 2023) and analyzed the interview data inductively. RESULTS A higher percentage of non-White people at the county level was associated with a significantly higher level of CWF (Spearman rank correlation coefficient, 0.55; 95% CI, 0.29 to 0.82; P < .001), whereas county-level poverty was associated with significantly lower CWF (Spearman rank correlation coefficient, -0.36; 95% CI, -0.70 to -0.03; P = .02). High school completion was not associated with county-level CWF. Significantly larger proportions of Hispanics and Latinos lived in counties with higher CWF (P < .05). From the interviews, more participants thought tap water was healthy than unhealthy, but 41% had mixed feelings. Similarly, more participants thought CWF was acceptable than unacceptable, with 35% reporting mixed feelings. Negative views about tap water and CWF were more common among non-White participants. CONCLUSIONS People in racially and ethnically diverse communities in Washington appear to have greater access to CWF, whereas those in lower-income communities have poorer access. PRACTICAL IMPLICATIONS CWF is an important population-level strategy to prevent caries. Additional work is needed to improve access to CWF, especially for people from low-income communities.
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Aldosari M, Archer HR, Almutairi FT, Alzuhair SH, Aldosari MA, Kennedy E. Utilization of dental care and dentate status in diabetic and nondiabetic patients across US states: An analysis using the 2020 Behavioral Risk Factor Surveillance System. J Public Health Dent 2024; 84:187-197. [PMID: 38599647 DOI: 10.1111/jphd.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/15/2024] [Accepted: 03/08/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE This study examines the differences, by state, in dental care utilization and tooth retention between adults with and without diabetes mellitus (DM). METHODS We conducted a secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System, an annual, state-based, random telephone survey of noninstitutionalized US civilian adults. The predictor variable was DM status. The outcome variables were time since the last dental appointment and tooth loss. We utilized multiple multinomial logistic regression models followed by postestimation procedures to determine state-level adjusted proportions for dental visits within the last year and complete teeth retention among DM and non-DM adults. RESULTS Among adults with DM, 60.0% reported dentist visits within a year of survey participation, while 53.6% had complete tooth retention. As education and income levels increased, dental attendance and tooth retention increased among adults with DM. Most Southern states had a higher prevalence of DM, a lower proportion of dentist visits, and worse tooth retention among DM adults. Nationally, DM individuals were 4.3 percentage points less likely to visit a dentist and were 7 percent less likely to have complete teeth retention than non-DM adults. Compared with the national average, 25/50 states had greater disparities in dental visits between DM and non-DM adults, and 27/50 states had greater disparities in tooth loss between DM and non-DM adults. CONCLUSION State-level variations indicate geographical and dental coverage influences on DM and dental outcomes. There is a need for state-specific interventions to improve dental access and outcomes for adults with DM.
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Affiliation(s)
- Muath Aldosari
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Hannah R Archer
- Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Saud H Alzuhair
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | - Erinne Kennedy
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- College of Dental Medicine, Kansas City University, Joplin, Missouri, USA
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Reis LADOD, Miranda SS, Fonseca BRD, Pereira M, Natividade MDS, Aragão E, Lara TP, Nery JS. Association between racial iniquities and oral health status: a systematic review. CIENCIA & SAUDE COLETIVA 2024; 29:e04882023. [PMID: 38451644 DOI: 10.1590/1413-81232024293.04882023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/28/2023] [Indexed: 03/08/2024] Open
Abstract
The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.
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Affiliation(s)
- Laila Araújo de Oliveira Dos Reis
- Faculdade de Odontologia, Universidade Federal da Bahia (UFBA). R. Augusto Viana s/n, Palácio da Reitoria, Canela. 40110-909 Salvador BA Brasil.
| | | | - Bruna Rebouças da Fonseca
- Faculdade de Odontologia, Universidade Federal da Bahia (UFBA). R. Augusto Viana s/n, Palácio da Reitoria, Canela. 40110-909 Salvador BA Brasil.
| | | | | | - Erika Aragão
- Instituto de Saúde Coletiva, UFBA. Salvador BA Brasil
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de Souza VGL, Herkrath FJ, Garnelo L, Gomes AC, Lemos UM, Parente RCP, Herkrath APCDQ. Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey. PLoS One 2022; 17:e0277845. [PMID: 36413557 PMCID: PMC9681076 DOI: 10.1371/journal.pone.0277845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tooth loss is an oral health condition with high prevalence and negative impact on quality of life. It is the result of the history of oral diseases and their treatment as well as provision of dental care and access to dental services. Socioeconomic characteristics are determinants of tooth loss and living in rural areas is also a risk factor for its incidence. OBJECTIVE To identify contextual and individual factors associated with self-reported tooth loss among adults and elderly people living in rural riverside areas. METHODS A cross-sectional household-based survey was conducted in 2019 with rural riverside communities on the left bank of the Rio Negro River, Manaus, Amazonas. These communities are covered by a fluvial health team and two riverside health teams. Interviews were conducted in a representative random sample of dwellers aged ≥ 18 years, using electronic forms to obtain information on oral health conditions, demographic and socioeconomic characteristics, and use of and access to health services. The outcome was self-reported tooth loss. After the descriptive analysis of the data, a multilevel Poisson regression analysis was performed to estimate the prevalence ratio for the outcome. Variables with p-value ≤0.20 in the bivariate analyses were included in the multiple analysis considering the hierarchy between individual and contextual variables in the multilevel model. Variables with p-value ≤0.10 were kept in the final model and the significance level adopted was 0.05. RESULTS 603 individuals from 357 households were assessed (mean age 44.1 years). The average number of missing teeth was 11.2 (±11.6); 27.4% of individuals had lost more than 20 teeth (non-functional dentition) and 12.1% were completely edentulous. Contextual characteristic of primary healthcare offered was associated with the outcome. The tooth loss was lower in territories covered by riverside health teams. At individual level, tooth loss was greater in older individuals who had experienced dental pain over the past six months and whose sugar consumption was high. Black or brown individuals, individuals whose household income was higher, those who were on the Bolsa Família cash transfer program, those who consulted a dentist over the past year, and those who reported satisfaction with their teeth/oral health reported less tooth loss. CONCLUSION Tooth loss was associated with contextual territorial factors related to the healthcare service and individual demographic, behavioral, socioeconomic, and service-related characteristics as well as self-perceived oral health conditions. The findings suggest that actions focused on the oral health of these populations involve not only changes in the healthcare service organization, but also intersectoral policies that contribute to reducing social inequalities.
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Affiliation(s)
| | - Fernando José Herkrath
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- Superior School of Health Siences, State University of Amazonas, Manaus, Amazonas, Brazil
| | - Luiza Garnelo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
| | - Andréia Coelho Gomes
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
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Semprini J, Wehby G. Impact of Medicaid dental coverage expansion on self-reported tooth loss in low-income adults. J Am Dent Assoc 2022; 153:839-847. [PMID: 35513904 PMCID: PMC9427673 DOI: 10.1016/j.adaj.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/08/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Low-income adults delay oral health care due to cost more than any other health care service. These delays lead to caries, periodontal disease, and tooth loss. Expanding Medicaid dental coverage has increased dental visits, but the potential impact on previously unmet oral health needs is not well understood. METHODS In this analysis, the authors estimated the association between Medicaid dental expansion and tooth loss. Data on self-reported tooth loss among adults below 138% federal poverty guideline were obtained from the Behavioral Risk Factor Surveillance System. A difference-in-differences regression was estimated. Additional analyses stratified according to age and separated extensive and limited dental benefits. RESULTS Expanding Medicaid dental coverage is associated with increased probability of total tooth loss of 1 percentage point in the total sample, representing a 20% relative increase from the pre-expansion rate. This increase was concentrated in states offering extensive dental benefits and was largest (2.5-percentage-point greater likelihood) among adults aged 55 through 64 years for whom both extensive and limited dental benefits were associated with total tooth loss. CONCLUSIONS Medicaid expansion with extensive dental benefits was associated with increased total tooth loss among low-income adults. This finding suggests that greater access to oral health care addressed previously unmet oral health needs for this population. PRACTICAL IMPLICATIONS As public dental coverage continues to expand, dental care professionals may find themselves treating a greater number of patients with substantial, previously unmet, oral health needs. Additional research to understand the long-term effects of Medicaid dental insurance for adults on their oral health is needed.
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Affiliation(s)
- Jason Semprini
- University of Iowa, College of Public Health, Department of Health Management and Policy, Iowa City, IA, USA
- University of Iowa, College of Dentistry, Iowa City, IA, USA
| | - George Wehby
- University of Iowa, College of Public Health, Department of Health Management and Policy, Iowa City, IA, USA
- University of Iowa, College of Dentistry, Iowa City, IA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Escontrías OA. The opioid epidemic and oral health inequities: Two parallel public health crises in historically underrepresented and racial/ethnic (HURE) groups. J Dent Educ 2022; 86:1249-1253. [PMID: 36165251 DOI: 10.1002/jdd.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Omar A Escontrías
- Office of Policy and Education Research, American Dental Education Association, Washington, D.C., USA
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Pitchika V, Jordan RA, Norderyd O, Rolander B, Welk A, Völzke H, Holtfreter B, Kocher T. Factors influencing tooth loss in European populations. J Clin Periodontol 2022; 49:642-653. [PMID: 35569026 DOI: 10.1111/jcpe.13642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 03/19/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to identify the factors influencing the changes in the number of teeth present and the number of healthy or filled surfaces between two time points. MATERIALS AND METHODS Repeated cross-sectional data from population-based studies, namely the German Oral Health Studies (DMS-III vs. DMS-V), the Studies of Health in Pomerania (SHIP-START-0 vs. SHIP-TREND-0), and the Jönköping study (2003 vs. 2013), were analysed. Oaxaca decomposition models were constructed for the outcomes (number of teeth, number of healthy surfaces, and number of filled surfaces). RESULTS The number of teeth increased between examinations (DMS: +2.26 [adults], +4.92 [seniors], SHIP: +1.67, Jönköping: +0.96). Improvements in education and dental awareness brought a positive change in all outcomes. An increase in powered toothbrushing and inter-dental cleaning had a great impact in DMS (adults: +0.25 tooth, +0.78 healthy surface, +0.38 filled surface; seniors: +1.19 teeth, 5.79 healthy surfaces, +0.48 filled surface). Inter-dental cleaning decreased by 4% between SHIP-START-0 and SHIP-TREND-0, which negatively affected the outcomes. CONCLUSIONS From this study, it can be concluded that education may be the most important factor having a direct and indirect effect on the outcomes. However, for better oral health, powered toothbrushing and inter-dental cleaning should not be neglected.
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Affiliation(s)
- Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | | | - Ola Norderyd
- Department of Periodontology, The Institute for Postgraduate Dental Education, Region Jönköping County, Jönköping, Sweden.,Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Bo Rolander
- Futurum, Academy for Health and Care, Region Jönköping County and Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Alexander Welk
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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Lee H, Kim D, Jung A, Chae W. Ethnicity, Social, and Clinical Risk Factors to Tooth Loss among Older Adults in the U.S., NHANES 2011-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2382. [PMID: 35206567 PMCID: PMC8875070 DOI: 10.3390/ijerph19042382] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many older adults suffer from poor oral health, including tooth loss, and disparities among racial/ethnic and socially disadvantaged populations continue to exist. METHODS Data were obtained from the National Health and Nutrition Examination Survey among the adult population in the U.S. The prevalence of edentulism and multiple regression models were conducted on 15,821 adults, including Asians, Blacks, Hispanics, Whites, and others to assess the relationships between tooth loss and their predictors. RESULTS The prevalence of complete tooth loss increased with age from 0.7% for ages 20-44 to 20.2% for ages 65 and over. There are disparities in complete tooth loss regarding race/ethnicity, with the highest percentages (9%) among Whites and Blacks and the lowest percentages among Asians (3%) and Hispanics (4%). After adjusting for predictors, their impact on tooth loss was not consistent within racial/ethnic groups, as Asians had more tooth loss from Model 1 (β = -1.974, p < 0.0001) to Model 5 (β = -1.1705, p < 0.0001). CONCLUSION Tooth loss was significantly higher among older adults and racial/ethnic groups even after controlling for other predictors among a nationally representative sample. The findings point to the fact that subgroup-tailored preventions are necessary.
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Affiliation(s)
- Haeok Lee
- Nursing Department, University of Massachusetts Boston, Robert and Donna Manning College of Nursing and Health Sciences, Boston, MA 02125, USA;
| | - Deogwoon Kim
- Nursing Department, University of Massachusetts Boston, Robert and Donna Manning College of Nursing and Health Sciences, Boston, MA 02125, USA;
| | - Andrew Jung
- College of Dentistry, New York University, New York, NY 10012, USA;
| | - Wonjeong Chae
- Office of Strategic Planning, Healthcare Policy and Strategy Task Force, Yonsei University Health System, Seoul 03722, Korea;
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Muralikrishnan M, Sabbah W. Is Racial Discrimination Associated with Number of Missing Teeth Among American Adults? J Racial Ethn Health Disparities 2021; 8:1293-1299. [PMID: 33051748 PMCID: PMC8452587 DOI: 10.1007/s40615-020-00891-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objectives of this study are to assess the association of racial discrimination with tooth loss among American adults and whether this relationship, if existed, explains ethnic differences in tooth loss. METHODS Data is from the Behavioural Risk Factor Surveillance System (BRFSS) 2014, a cross-sectional survey of a nationally representative sample of American adults. The survey included data on sociodemographic characteristics, behaviour, health insurance and number of missing teeth. The survey also included questions on whether a person was treated differently because of his/her race. Logistic regression analysis was conducted to assess the relationship between tooth loss and indicators of discrimination. We also examined the relation between ethnicity and indicators of discrimination. RESULTS The analysis included 4858 participants aged 18 to 44 years. Tooth loss (> one tooth) was reported by 26% of participants. Among those reporting discrimination at healthcare facility, there was 141% increase in tooth loss compared to those not reporting discrimination. Discrimination at work and emotional impact of discrimination were both significantly associated with tooth loss in the partially adjusted models. Accounting for discrimination slightly attenuated ethnic differences in too loss. Black Americans had significantly higher odds for reporting all types of discrimination used here. CONCLUSION This study demonstrated a potential role for discrimination in tooth loss among American adults. Discrimination could also explain part of ethnic inequalities in oral health.
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Affiliation(s)
- Malini Muralikrishnan
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, 2nd Floor Dental Extension, Bessemer Road, Denmark Hill, London, SE5 9RS, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, 2nd Floor Dental Extension, Bessemer Road, Denmark Hill, London, SE5 9RS, UK.
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