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Vemulapalli A, Mandapati SR, Kotha A, Rudraraju H, Aryal S. Prevalence of complete edentulism among US adults 65 years and older: A Behavioral Risk Factor Surveillance System study from 2012 through 2020. J Am Dent Assoc 2024:S0002-8177(24)00059-X. [PMID: 38520422 DOI: 10.1016/j.adaj.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The rapid growth of the older adult population in the United States and their increased risk of edentulism make it essential to analyze trends and factors associated with edentulism. METHODS Data were obtained from the Behavioral Risk Factor Surveillance System from 2012 through 2020. US- and state-level trend lines were reported. Multiple logistic regression analyses were used to evaluate the association between self-reported complete edentulism and demographic characteristics, chronic diseases, smoking status, and health insurance status. Multiple imputations were used to address the missing data. RESULTS A total of 771,513 (weighted n = 50,410,576) participants were included in the study. There was a significant (P = .021) downward trend in the prevalence of edentulism from 2012 (16.36%) through 2020 (13.54%). Having less than a high school education, being a smoker, being non-Hispanic Black, having an annual household income less than $75,000, and having chronic conditions, including diabetes, myocardial infarction, arthritis, depression, and stroke, were significantly associated with complete edentulism. CONCLUSIONS Despite a decrease in prevalence of edentulism, disparities based on race, income, and education still exist. Edentulism is associated with chronic diseases in older adults. PRACTICAL IMPLICATIONS Public health initiatives should be aimed at reducing the impact of edentulism and improving overall quality of life among older adults. Community health programs allocating resources to improve access to affordable care, reducing precursors to edentulism, expanding dental coverage, and promoting oral and general health awareness are vital components of these efforts.
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Ou X, Zeng L, Zeng Y, Pei Y, Zhang X, Wu W, Siamdoust S, Wu B. Health behaviors and tooth retention among older adults in China: findings from the 4th Chinese national oral health survey. BMC Oral Health 2022; 22:285. [PMID: 35836158 PMCID: PMC9281058 DOI: 10.1186/s12903-022-02283-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to examine the association between oral health behaviors and tooth retention among Chinese older adults.
Methods Data were used from the 4th Chinese National Oral Health Survey, a nationally representative sample. The sample included 9054 older adults aged 55 to 74. Control variables and oral health behaviors were measured through a questionnaire interview, and the number of remaining teeth and periodontal health were obtained from an oral health examination. A chi-square test was used for univariate analysis. Multivariate Logistic regression was used to explore the association between health behaviors and the number of remaining teeth. Results The average number of remaining teeth in the sample was 24.4 ± 7.7. There was a higher proportion of older adults living in urban areas with 20 or more teeth than those living in rural areas (83.2% vs. 79.4%, P < 0.001); and a higher proportion of individuals with high education levels with 20 or more teeth compared to those with low education levels (P < 0.001). Logistic regression models showed that older adults who used toothpicks `(OR = 3.37, 95% CI 2.94–3.85), dental floss (OR = 1.93, 95% CI 1.05–3.53), toothpaste (OR = 3.89, 95% CI 3.14–4.83); and never smoked (OR = 1.43 95% CI 1.20–1.70) were more likely to retain 20 or more natural teeth; whereas older adults who had a dental visit were less likely to retain 20 or more natural teeth (OR = 0.45, 95% CI 0.39–052). Conclusion Good oral hygiene practices, never smoking, and regular dental visits focusing on prevention are significantly associated with teeth retention. It is critical to promote a healthy lifestyle and improve prevention-oriented oral health care systems.
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Affiliation(s)
- Xiaoyan Ou
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China
| | - Liwei Zeng
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China.
| | - Yixuan Zeng
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Xiujuan Zhang
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China
| | - Wei Wu
- Key Laboratory of Oral Biomedicine, Jiangxi Province, Jiangxi Province Clinical Research Center for Oral Diseases, Affiliated Stomatological Hospital of Nanchang University, 49 Fuzhou Road, Nanchang, 330006, Jiangxi Province, China
| | - Shahrzad Siamdoust
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, 433 First Avenue, New York, NY, 10010, USA.
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Xu X, Zhao Y, Gu D, Pei Y, Wu B. Health Behaviors and Self-Reported Oral Health among Centenarians in Nanjing, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7285. [PMID: 34299735 PMCID: PMC8304003 DOI: 10.3390/ijerph18147285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/01/2022]
Abstract
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.
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Affiliation(s)
- Xin Xu
- Population Research Institute, Nanjing University of Posts and Telecommunications, Nanjing 210042, China;
| | - Yuan Zhao
- Population Research Institute, Nanjing University of Posts and Telecommunications, Nanjing 210042, China;
- Ginling College, Nanjing Normal University, Nanjing 210023, China
| | - Danan Gu
- Independent Researcher, New York, NY 10010, USA;
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA;
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA;
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López-Gómez SA, González-López BS, Scougall-Vilchis RJ, Pontigo-Loyola AP, Márquez-Corona MDL, Villalobos-Rodelo JJ, Rueda-Ibarra V, Medina-Solís CE. Tooth loss in patients with and without diabetes: A large-scale, cross-sectional study of Mexican adults. J Am Dent Assoc 2020; 151:276-286. [PMID: 32222176 DOI: 10.1016/j.adaj.2019.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to compare the experience and distribution of tooth loss in people with and without diabetes. METHODS The authors conducted a comparative cross-sectional study of patients at a public university. Analysis included medical records of those treated from 2013 through 2017. The dependent and main independent variables were the number of missing teeth and a diagnosis of diabetes, respectively. As covariables, the authors analyzed the sociodemographic and socioeconomic characteristics, as well as the general and oral health status of patients. A multivariate model based on negative binomial regression was constructed. RESULTS Of the 3,406 medical records analyzed, 64.2% (n = 2,185) pertained to women, the mean age was 42.45 years, 87.9% did not have diabetes, and 12.1% had received a diagnosis of diabetes. The mean (standard deviation) number of missing teeth was 7.46 (7.89), 7.09 (7.60) in patients without diabetes, and 10.12 (9.32) in patients with diabetes. According to our final multivariate model, the expected mean number of missing teeth was 11.4% higher in patients with diabetes than in those without (P = .006). For every 1-year increase in age, the expected mean number of missing teeth increased by 3.9% (P < .001). Other variables related to tooth loss included occupation, marital status, and type of insurance. CONCLUSIONS The results of the study indicate that the mean number of missing teeth is higher in people with diabetes and suggest that certain socioeconomic inequalities exist in the area of oral health. PRACTICAL IMPLICATIONS The population needs to be apprised of the impact of diabetes on oral health.
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Wu B, Pei Y, Zhang W, Northridge M. Immigrant Status, Resilience, and Perceived Oral Health Among Chinese Americans in Hawaii. Res Aging 2020; 42:186-195. [PMID: 32195629 DOI: 10.1177/0164027520912493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study aims to examine the associations among immigrant status, resilience, and perceived oral health for Chinese American older adults in Hawaii. METHOD Data derived from 430 Chinese American adults aged 55 years and older residing in Honolulu, HI. We compared the self-rated oral health and oral health problems between U.S.-born Chinese Americans and foreign-born Chinese Americans by using ordered logistic regression and ordinary least squares regression models. RESULTS Findings suggest that immigrant status and lower levels of resilience are associated with poorer self-rated oral health and more oral health problems for Chinese American older adults in Hawaii. Resilience is more strongly associated with self-rated oral health for U.S.-born Chinese American than for foreign-born Chinese Americans, but this pattern was not evident for oral health problems. DISCUSSION Older Chinese American immigrants in Hawaii are disadvantaged in terms of their oral health. Understanding their susceptibilities may lead to targeted interventions.
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Affiliation(s)
- Bei Wu
- Rory Meyers College of Nursing, New York University, NY, USA
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, NY, USA
| | - Wei Zhang
- Department of Sociology, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Mary Northridge
- NYU Grossman School of Medicine, New York University, NY, USA
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McDaniel JT, Davis T, Yahaya M, Nuhu K. Descriptive Epidemiology of Childhood Disability Prevalence by Sex in the Mississippi Delta and Appalachian Regions. THE JOURNAL OF SCHOOL HEALTH 2019; 89:969-976. [PMID: 31612505 DOI: 10.1111/josh.12837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/02/2018] [Accepted: 12/13/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Evidence suggests a rise in childhood disability rates across the United States with males and those with lower socioeconomic status bearing greater burden. We investigated childhood disability rates in the Mississippi Delta (MDR) and Appalachian regions (AR) in comparison to other parts of the country. METHODS Using data from the US Census Bureau, we calculated childhood disability rates by type and sex at national, regional, and subregional levels. We used risk ratios (RR) to compare childhood disability rates by sex, type, and region. We generated choropleth maps to represent the geographic distribution of disability. RESULTS Childhood disability was more prevalent, at the national level, among boys (6.64%) than girls (4.08%). Children in the MDR (boys = 8.60%; girls = 5.08%) and AR (boys = 7.81%; girls = 4.83%) had greater risk of disability than those elsewhere in the country (boys = 6.47%; girls = 3.98%), with rates generally higher in rural compared to urban areas in said regions. CONCLUSIONS Childhood disability affects rural areas of the country more extensively, with the MDR and AR affected to an even greater extent. School-based health centers, in particular, which are disproportionately located in urban areas, could benefit disabled children living in the MDR and AR.
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Affiliation(s)
- Justin T McDaniel
- Department of Public Health and Recreation Professions, Southern Illinois University, 475 Clocktower Drive, Mailcode 4632, Carbondale, IL, 62901
| | - Tammy Davis
- Department of Human Environmental Studies, Southeast Missouri State University, One University Plaza, Cape Girardeau, MO, 63701
| | - Musa Yahaya
- Department of Public Health and Recreation Professions, Southern Illinois University, 475 Clocktower Drive, Mailcode 4632, Carbondale, IL, 62901
| | - Kaamel Nuhu
- Department of Public Health, State University of New York, Potsdam, 44 Pierrepont Avenue, Potsdam, NY, 13676
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Luo H, Bell RA, Wright W, Wu Q, Wu B. Trends in annual dental visits among US dentate adults with and without self-reported diabetes and prediabetes, 2004-2014. J Am Dent Assoc 2018; 149:460-469. [PMID: 29615188 DOI: 10.1016/j.adaj.2018.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The authors assessed the trends of annual dental visits in dentate adults with diabetes or prediabetes or no diabetes, and assessed whether the racial and ethnic disparities in dental visits changed from 2004 through 2014. METHODS Data for this analysis came from the Behavioral Risk Factor Surveillance System, a US health survey that looks at behavioral risk factors that was developed by the Centers for Disease Control and Prevention in cooperation with state health departments. Respondents indicated whether they had a dental visit in the past 12 months. Weighted proportions were calculated for annual dental visits in adults by diabetes status, and trends were assessed by racial and ethnic groups. RESULTS From 2004 through 2014, the proportion of annual dental visits declined from 66.1% to 61.4% (trend P = .02) in the diabetes group, 71.9% to 66.5% (trend P = .01) in the no diabetes group, and 66.0% to 64.9% (trend P = .33) in the prediabetes group. Age, income, and health insurance were moderators of the association between diabetes status and dental visits. Overall, the racial and ethnic disparity in dental visits did not change significantly during the period. CONCLUSIONS Dental visits and services were less frequent in people with diabetes and prediabetes. Racial and ethnic disparities in use of dental services persisted during the observed period. PRACTICAL IMPLICATIONS All patients, especially those with diabetes, are encouraged to visit a dentist at least annually. It is important for health care providers, such as primary care physicians and dental care and public health professionals, to make concerted efforts to promote oral health care in diabetes management. Improving access to dental services is vital to achieving this goal.
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Caldwell JT, Lee H, Cagney KA. The Role of Primary Care for the Oral Health of Rural and Urban Older Adults. J Rural Health 2017; 33:409-418. [DOI: 10.1111/jrh.12269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 07/27/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Julia T. Caldwell
- Department of Hospital Medicine; University of Chicago; Chicago Illinois
| | - Haena Lee
- Department of Sociology; University of Chicago; Chicago Illinois
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Wiener RC, Shen C, Sambamoorthi U, Findley PA. Rural Veterans' dental utilization, Behavioral Risk Factor Surveillance Survey, 2014. J Public Health Dent 2017; 77:383-392. [PMID: 28686303 PMCID: PMC5739937 DOI: 10.1111/jphd.12230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 05/17/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Rural residents are overrepresented in the military; however, access to Veteran services is limited in rural areas. There is a need to identify rural Veteran healthcare utilization. This study addresses that need and has two purposes: a) to determine if there is an association between rural dwelling and Veteran utilization of dental services; and b) to determine if there is an association between rural dwelling and the oral health outcome of missing teeth. METHODS Data from the 2014 Behavioral Risk Factor Surveillance Survey were used in this study. Chi square and logistic regression analyses were conducted. FINDINGS Rural Veterans were less likely to have a dental visit during the previous year as compared with metropolitan Veterans in unadjusted analysis (Odds ratio = 0.71, 95% Confidence Interval, 0.64, 0.77) and in adjusted analysis [0.87 (95% Confidence Interval, 0.78, 0.96)]. In cases in which all teeth were missing, rural Veterans had an unadjusted odds ratio of 1.79 [95% Confidence Interval, 1.55, 2.08] and an adjusted odds ratio of 1.37 [95% Confidence Interval, 1.17, 1.62] as compared with metropolitan Veterans. DISCUSSION AND POLICY IMPLICATIONS The Veterans Health Administration develops policies for establishing centers for care for Veterans. The policy development should take into consideration that rural Veterans have not been as likely as urban Veterans to utilize dental services and have poorer oral health outcomes.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Departments of Health Services Research and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
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Martin CA, Dieringer BM, McNeil DW. Orthodontic Treatment Completion and Discontinuation in a Rural Sample from North Central Appalachia in the USA. Front Public Health 2017; 5:171. [PMID: 28791281 PMCID: PMC5524769 DOI: 10.3389/fpubh.2017.00171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 06/27/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Orthodontics has inherent demands, requiring regular appointments and active patient engagement, but relatively little is established in regard to rates of completion of treatment and possible factors affecting successful completion. These factors may be particularly important for cultural minority groups, such as those in rural Appalachia, given the environmental, social, and economic complexities affecting access to and utilization of treatment. DESIGN AND METHODS A naturalistic study design was employed, using retrospective data from a rural outpatient general dental office in July 2012. Chart abstraction yielded 219 (55.3% female) orthodontic patients (M age = 11.0 [3.7]). Chi-square tests for independence were conducted for categorical dependent variables. For continuous variables, t-tests were conducted. A logistic multivariate regression analysis was conducted to predict completion/non-completion of treatment, with age, gender, distance traveled, type of malocclusion, and payment type as predictors. RESULTS Overall, 49.8% of this sample successfully completed orthodontic treatment. Greater successful conclusion of treatment was found in self-pay patients (i.e., 74%) versus those whose care was funded through Medicaid/Children's Health Insurance Program (i.e., 34%) or through private insurance (i.e., 36%). Age, gender, and distance to the office from home had no association relative to successful completion of treatment, although average one-way distance to travel for care was considerable (i.e., 38.8 miles). CONCLUSION Rate of successful orthodontic treatment completion was low in this rural sample. Treatment outcome was related to the form of payment for services, with self-pay associated with the highest rate of successful completion.
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Affiliation(s)
- Chris A Martin
- Department of Orthodontics, West Virginia University School of Dentistry, Morgantown, WV, United States
| | - Breana M Dieringer
- Dental Hygiene Program, West Virginia University School of Dentistry, Morgantown, WV, United States
| | - Daniel W McNeil
- Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV, United States.,Department of Dental Practice and Rural Health, West Virginia University School of Dentistry, Morgantown, WV, United States
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Wiener RC, Shen C, Findley PA, Sambamoorthi U, Tan X. The association between diabetes mellitus, sugar-sweetened beverages, and tooth loss in adults: Evidence from 18 states. J Am Dent Assoc 2017; 148:500-509.e4. [PMID: 28483048 DOI: 10.1016/j.adaj.2017.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sugar-sweetened beverages (SSBs) are dietary sources of sugar that are factors in caries development and tooth loss. Dietary sugar also is linked to diabetes mellitus (DM). There is limited research related to SSBs and tooth loss in people with DM. The authors investigated the association between SSBs and tooth loss as it related to the presence or absence of DM. METHODS The authors used a cross-sectional design with data reported by adults (18 years and older) who responded to the 2012 Behavior Risk Factor Surveillance System questionnaire, which was used in 18 states (N = 95,897; 14,043 who had DM and 81,854 who did not have DM). The authors conducted χ2 and logistic regression analyses to determine associations related to DM status. RESULTS Overall, 12.3% of the survey respondents had DM, 15.5% had 6 or more teeth extracted, and 22.6% reported that they consumed 1 or more SSB daily. In the adjusted analyses, among adults who had DM, those who consumed at least 2 SSBs daily were more likely to have had 6 or more teeth extracted than those who reported that they did not consume SSBs (adjusted odds ratio, 2.35; 95% confidence interval, 1.37 to 4.01; P = .0018). Among adults who did not have DM, those who consumed more than 1 but fewer than 2 SSBs per day were more likely to have had at least 6 teeth extracted (adjusted odds ratio, 1.46; 95% confidence interval, 1.21 to 1.77; P < .0001). CONCLUSIONS The authors found that, among adults with DM, consuming 2 or more SSBs per day was associated with having had 6 or more teeth extracted. PRACTICAL IMPLICATIONS Dietary sugar is a concern for oral and systemic health; however, a strong, independent relationship between the number of teeth extracted and a single source of dietary sugar is not adequate to explain the complexity of tooth loss. Clinicians should use broadly worded dietary messages when discussing caries assessment with patients.
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Ju X, Spencer AJ, Brennan DS. Dentist age, period and cohort effects on provision of dental services in Australia: 1983-84 to 2009-10. Community Dent Oral Epidemiol 2017; 45:242-250. [PMID: 28145563 DOI: 10.1111/cdoe.12282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine age, period and cohort factors of dentists in relation to diagnostic, preventive and total dental services over time in Australia. METHOD The Longitudinal Study of Dentists' Practice Activity (LSDPA) was designed to monitor dental practice activity and service provision in Australia. Participating dentists were sampled randomly from the dental registers in Australia from 1983 to 1984, and dental services provision was collected by mailed questionnaire with a log of dental services provided over one or two typical days. The data collection has been repeated every 5 years until 2009-2010. Sample supplementation of newly registered dentists occurred at successive waves. This study focused on diagnostic, preventive and total services. The time trends in the mean rates of the services were described using a standard cohort table, and negative binomial regression was applied to estimate age, period and cohort effects. RESULTS The response rates were 73%, 75%, 74%, 71%, 76% and 67% in 1983, 1988, 1993, 1998, 2003 and 2009, respectively. The mean rates of diagnostic, preventive and total services increased between 1983 and 2009 across all age groups. The period effect showed a higher rate of diagnostic (rate ratios [RR]: 1.21 in 1993 to 1.80 in 2009), preventive (RR: 1.19 in 1988 to 1.85 in 2009) and the total service (RR: 1.08 in 1988 to 1.39 in 2009) over time, compared with the reference group of 1983. Older cohorts had a lower rate, and the younger cohorts had a higher rate of diagnostic, preventive and the total number of services over the study period. The highest rate of diagnostic (RR=2.53), preventive (RR=2.44) and the total service (RR=1.52) was in those aged 25-29 years in 1983 compared with the reference group of 30-34 years in 1983. CONCLUSIONS Trends in dental services provision can be associated with age, period and cohort effects. The study found the rate of diagnostic, preventive and total services increased over time. Meanwhile, an increasing rate of diagnostic, preventive and the total services was observed when moving from older cohorts to younger cohorts among Australian dentists suggesting a sustained shift towards these services into the future.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - A John Spencer
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - David S Brennan
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
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Feng X, Sambamoorthi U, Wiener RC. Dental workforce availability and dental services utilization in Appalachia: a geospatial analysis. Community Dent Oral Epidemiol 2016; 45:145-152. [PMID: 27957773 DOI: 10.1111/cdoe.12270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There is considerable variation in dental services utilization across Appalachian counties, and a plausible explanation is that individuals in some geographical areas do not utilize dental care due to dental workforce shortage. We conducted an ecological study on dental workforce availability and dental services utilization in Appalachia. METHODS We derived county-level (n = 364) data on demographic and socioeconomic characteristics and dental services utilization in Appalachia from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) using person-level data. We obtained county-level dental workforce availability and physician-to-population ratio estimates from Area Health Resources File and linked them to the county-level BRFSS data. The dependent variable was the proportion using dental services within the last year in each county (ranging from 16.6% to 91.0%). We described the association between dental workforce availability and dental services utilization using ordinary least squares regression and spatial regression techniques. Spatial analyses consisted of bivariate local indicators of spatial association (LISA) and geographically weighted regression (GWR). RESULTS Bivariate LISA showed that counties in the central and southern Appalachian regions had significant (P < 0.05) low-low spatial clusters (low dental workforce availability, low percent dental services utilization). GWR revealed considerable local variations in the association between dental utilization and dental workforce availability. In the multivariate GWR models, 8.5% (t-statistics > 1.96) and 13.45% (t-statistics > 1.96) of counties showed positive and statistically significant relationships between the dental services utilization and workforce availability of dentists and dental hygienists, respectively. CONCLUSIONS Dental workforce availability was associated with dental services utilization in the Appalachian region; however, this association was not statistically significant in all counties. The findings suggest that program and policy efforts to improve dental services utilization need to focus on factors other than increasing the dental workforce availability for many counties in Appalachia.
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Affiliation(s)
- Xue Feng
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - R Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry, West Virginia University, Morgantown, WV, USA
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McNeil DW, Hayes SE, Randall CL, Polk DE, Neiswanger K, Shaffer JR, Weyant RJ, Foxman B, Kao E, Crout RJ, Chapman S, Brown LJ, Maurer JL, Marazita ML. Depression and Rural Environment are Associated With Poor Oral Health Among Pregnant Women in Northern Appalachia. Behav Modif 2015; 40:325-40. [PMID: 26643277 DOI: 10.1177/0145445515615353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Both oral health problems and depression among pregnant women contribute to maternal-infant health outcomes. Little is known, however, about the potential effects of clinically significant depression on the oral health status of pregnant women. The purpose of the present study was to determine the influence of clinically significant depression and rural- or urban-dwelling status on oral health outcomes among pregnant women. Pregnant women (N = 685) in rural (i.e., West Virginia) and urban (i.e., Pittsburgh, PA) areas of northern Appalachia were assessed by calibrated examiners regarding gingivitis, oral hygiene, and DMFT (decayed, missing, and filled teeth), completed the Center for Epidemiologic Studies-Depression Scale (CES-D) and provided demographics. Participants were categorized based on clinically significant depressive symptoms (CES-D ≥ 16) and rural/urban domicile. Women with depression and those living in rural areas had worse oral health on all three indices than their non-depressed and urban counterparts. Depression, particularly among women in rural areas, affects certain oral health indices and represents a modifiable target for intervention. Moreover, treatments designed specifically for rural populations may be of particular utility. Women who are pregnant or planning to become pregnant may benefit from regular depression screenings from their dental and medical health care providers.
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Affiliation(s)
- Daniel W McNeil
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Sarah E Hayes
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Cameron L Randall
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Deborah E Polk
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - Kathy Neiswanger
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - John R Shaffer
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - Robert J Weyant
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - Betsy Foxman
- Center for Oral Health Research in Appalachia University of Michigan, Ann Arbor, USA
| | - Elizabeth Kao
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Richard J Crout
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Stella Chapman
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Linda J Brown
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Jennifer L Maurer
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - Mary L Marazita
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
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15
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Caries Experience Differs between Females and Males across Age Groups in Northern Appalachia. Int J Dent 2015; 2015:938213. [PMID: 26106416 PMCID: PMC4461765 DOI: 10.1155/2015/938213] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 12/29/2022] Open
Abstract
Sex disparities in dental caries have been observed across many populations, with females typically exhibiting higher prevalence and more affected teeth. In this study we assessed the sex disparities in two Northern Appalachian populations from West Virginia (WV, N = 1997) and Pennsylvania (PA, N = 1080) by comparing caries indices between males and females across four phases of dental development: primary dentition in children aged 1–5 years, mixed dentition in children aged 6–11 years, permanent dentition in adolescents aged 12–17 years, and permanent dentition in adults aged 18–59 years. No significant sex differences were observed for children aged 1–5 years. Contrary to national and international trends, WV girls aged 6–11 years had 1.5 fewer affected teeth than boys (p < 0.001). However, by ages 12–17, caries indices in the WV girls matched those in boys. In both WV and PA adults, women and men had similar total counts of affected teeth (i.e., DMFT), although women had more dental restorations (p < 0.001) and men had more current decay (p < 0.001). These results suggest that in some Appalachian populations, young girls benefit from protection against caries that is lost during adolescence and that adult women utilize dental health care to a greater degree than men.
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16
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Slade GD, Akinkugbe AA, Sanders AE. Projections of U.S. Edentulism prevalence following 5 decades of decline. J Dent Res 2014; 93:959-65. [PMID: 25146182 DOI: 10.1177/0022034514546165] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
After decades of decline in prevalence of complete tooth loss (edentulism), the trend continues to be misinterpreted, producing flawed projections and misdirected health goals. We investigated population trends in edentulism among U.S. adults aged ≥ 15 yr by creating time-series data from 5 national cross-sectional health surveys: 1957-1958 (n ≈ 100,000 adults), 1971-1975 (n = 14,655 adults), 1988-1998 (n = 18,011 adults), 1999-2002 (n = 12,336 adults), and 2009-2012 (n = 10,522 adults). Birth cohort analysis was used to isolate age and cohort effects. Geographic and sociodemographic variation in prevalence was investigated with a sixth U.S. survey of 432,519 adults conducted in 2010. Prevalence through 2050 was projected with age-cohort regression models using Monte-Carlo simulation of prediction intervals. Across the 5-decade observation period, edentulism prevalence declined from 18.9% in 1957-1958 (95% confidence limits: 18.4%, 19.4%) to 4.9% in 2009-2012 (95% confidence limits: 4.0%, 5.8%). The most influential determinant of the decline was the passing of generations born before the 1940s, whose rate of edentulism incidence (5%-6% per decade of age) far exceeded later cohorts (1%-3% per decade of age). High-income households experienced a greater relative decline, although a smaller absolute decline, than low-income households. By 2010, edentulism was a rare condition in high-income households, and it had contracted geographically to states with disproportionately high poverty. With the passing of generations born in the mid-20th century, the rate of decline in edentulism is projected to slow, reaching 2.6% (95% prediction limits: 2.1%, 3.1%) by 2050. The continuing decline will be offset only partially by population growth and population aging such that the predicted number of edentulous people in 2050 (8.6 million; 95% prediction limits: 6.8 million, 10.3 million) will be 30% lower than the 12.2 million edentulous people in 2010.
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Affiliation(s)
- G D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, USA
| | - A A Akinkugbe
- Department of Dental Ecology, University of North Carolina at Chapel Hill, USA
| | - A E Sanders
- Department of Dental Ecology, University of North Carolina at Chapel Hill, USA
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