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Ishimaru M, Zaitsu T, Kino S, Taira K, Inoue Y, Takahashi H, Tamiya N. Dental Utilization Stratified by the Purpose of Visit: A Population-Based Study in Japan. Int Dent J 2023; 73:896-903. [PMID: 37414691 PMCID: PMC10658419 DOI: 10.1016/j.identj.2023.06.007] [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: 01/16/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND This study aimed to provide a stratified description of dental visit utilisation by Japanese residents based on patient age, sex, prefecture, and the purpose of the visits. METHODS This cross-sectional study used the National Database of Health Insurance Claims of Japan to identify participants visiting dental clinics in Japan (April 2018-March 2019). Dental care utilisation by populations stratified by age, sex, and prefecture was assessed. We estimated the slope index of inequality (SII) and relative index of inequality (RII) to evaluate regional differences based on regional income and education. RESULTS Amongst the Japanese population, 18.6% utilised preventive dental care visits; 59,709,084 participants visited dental clinics, with children aged 5 to 9 years having the highest proportion. SII and RII were higher for preventive dental visits than those for treatments in all settings. The largest regional differences for preventive care were observed in SII of children aged 5 to 9 years and in RII of men in their 30s and women aged 80 years and older. CONCLUSIONS This nationwide population-based study revealed that the proportion of people utilising preventive dental care in Japan was low, with regional differences. Preventive care needs to be more easily accessible and available to improve the oral health of residents. The above findings may provide an important basis for improving policies related to dental care for residents.
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Affiliation(s)
- Miho Ishimaru
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Takashi Zaitsu
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Shiho Kino
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kento Taira
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuko Inoue
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | | | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Ferreira RC, Souza JGS, Soares ARDS, Vieira RV, Kawachi I. Income- and education-based inequalities of edentulism and dental services utilization in Brazil. Community Dent Oral Epidemiol 2023; 51:829-837. [PMID: 35801281 DOI: 10.1111/cdoe.12771] [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: 05/31/2021] [Revised: 06/05/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tooth loss is a worldwide public health problem affecting mainly socioeconomically disadvantaged groups. Dental services utilization may increase access to preventive actions and conservative treatment, reducing the prevalence of tooth loss. This study evaluated the income- and education-based inequalities in edentulism according to the utilization of dental services among adults and older adults in Brazil. METHODS Data from the National Oral Health Survey (SB Brazil, 2010) of adults (ages 35-44 years, n = 9779) and older adults (ages 65-74 years, n = 7619) were analysed. Socioeconomic indicators (SES) included education and income. The magnitude of inequality in edentulism by education and income levels was estimated by the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). The changes in the RII and SII according to the utilization of dental services were estimated. Regression models estimated the association between SES and edentulism and whether dental services utilization modified this association. RESULTS Higher edentulism prevalence was observed among those with lower education and income levels. The utilization of dental services changed the education-based inequality index in edentulism for adults, with percentage changes of 17.4% (RII) and 56.8% (SII). For adults with low education (0-4 years of study), the odds of edentulism were 80% (OR 0.2; 95% CI 0.1-0.6) and 90% (OR 0.1; 95% CI 0.01-0.2) lower for those who had used dental services within the preceding year and within 1-2 years compared with those who had used such services within the preceding 3 or more years, respectively. CONCLUSION There was a social gradient in the prevalence of edentulism in adults and older adults, and the education-based inequalities in edentulism were lower among adults reporting utilization of dental services in the preceding year.
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Affiliation(s)
- Raquel Conceição Ferreira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Gabriel Silva Souza
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Dental Research Division, Guarulhos University, São Paulo, Brazil
- Dental Science School (Faculdade de Ciências Odontológicas - FCO), Brazil
| | - Anna Rachel Dos Santos Soares
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renato Vitor Vieira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Martínez-García M, Rodríguez-Hernández AP, Gutiérrez-Esparza GO, Castrejón-Pérez RC, Hernández-Lemus E, Borges-Yáñez SA. Relationship between the Social Development Index and Self-Reported Periodontal Conditions. Healthcare (Basel) 2023; 11:healthcare11111548. [PMID: 37297688 DOI: 10.3390/healthcare11111548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Inequalities in oral health are influenced by the social strata of the population. Few studies have focused on the multitude of factors related to social development as indicators of living conditions and periodontal health status. The aim of this study is to evaluate the association between self-reported periodontal conditions and the Social Development Index (SDI). A cross-sectional validated questionnaire was carried out among 1294 Mexican adults. Descriptive statistics and multivariate logistic regression models were used to identify the best predictors of self-reported periodontal conditions. Bone loss reporting was used as a proxy for the presence of periodontal disease. We found that higher global scores on the SDI and quality and available space in the home (QASH) increase the probability of having bone loss. Global SDI (OR = 7.27) and higher QASH (OR = 3.66) were indeed the leading societal factors related to periodontal disease. These results have pointed out how SDI and its indicators, in particular QASH, can be used to further explore inequities related to privileged access to dental care in the context of periodontal diseases.
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Affiliation(s)
- Mireya Martínez-García
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Adriana-Patricia Rodríguez-Hernández
- Laboratory of Molecular Genetics, Graduate Studies and Research Division, School of Dentistry, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Guadalupe O Gutiérrez-Esparza
- Cátedras CONACYT Consejo Nacional de Ciencia y Tecnología, Mexico City 08400, Mexico
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Roberto Carlos Castrejón-Pérez
- Department of Clinical and Epidemiological Geriatric Research, Instituto Nacional de Geriatría, Mexico City 10200, Mexico
| | - Enrique Hernández-Lemus
- Computational Genomics Division, Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
- Center for Complexity Sciences, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Socorro Aída Borges-Yáñez
- Dental Public Health Department, Graduate Studies and Research Division, School of Dentistry, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
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Rocha-Ortiz JA, Tepox-Puga SM, Borges-Yañez SA, Mendoza-Rodríguez M, Escoffié-Ramirez M, Minaya-Sánchez M, Casanova-Rosado JF, Casanova-Rosado AJ, Pontigo-Loyola AP, Medina-Solis CE. Tooth Loss and Associated Factors in Mexican Older Adults in Nursing Homes: A Multicenter Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2023; 2023:4169097. [PMID: 37096226 PMCID: PMC10122601 DOI: 10.1155/2023/4169097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/07/2023] [Accepted: 02/18/2023] [Indexed: 04/26/2023]
Abstract
The objective of this study was to determine the experience of tooth loss and associated factors in older adults and elderly residing in nursing homes. A cross-sectional study was conducted in Mexican older adults and elderly aged ≥60 years living in four nursing homes (two in Mexico City, Mexico: one in Cuernavaca, Morelos, and one in Oaxaca, Oaxaca). The data were collected at the facility (home nursing) by two dentists in 2019. To determine the number of tooth loss and DMFT, a clinical oral examination was performed. In addition, a questionnaire was applied to determine diverse independent variables (demographic, socioeconomic, and behavioral). The analysis was performed using nonparametric tests and negative binomial regression (p < 0.05). 257 subjects were included. The mean age was 81.25 ± 9.02 years, and 60.7% were women. The mean number of lost teeth was 18.78 ± 9.05 (women = 19.43 ± 8.59 and men = 17.77 ± 9.68; p > 0.05). In the multivariate negative binomial regression model, it was found that, for each one-year increase in age, the mean tooth loss increased 0.92% (p < 0.05). In current smokers (p < 0.01) and in those who brush their teeth < 2 times a day (p < 0.01), the average of tooth loss increased 22.04% and 61.46%, respectively. The experience of tooth loss in Mexican older adults and elderly was high. Demographic (age) and habit of behavior (tobacco use and less frequent tooth brushing) were associated with increased tooth loss. It is important to promote oral health programs for institutionalized older adults.
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Affiliation(s)
- Jesús Alberto Rocha-Ortiz
- Master and Doctoral Program in Medical, Dental and Health Sciences at the School of Dentistry, National Autonomous University of México, 04510 Mexico City, Mexico
| | - Sandra Manuela Tepox-Puga
- Master and Doctoral Program in Medical, Dental and Health Sciences at the School of Dentistry, National Autonomous University of México, 04510 Mexico City, Mexico
| | - S. Aída Borges-Yañez
- Dental Public Health Department, Graduate and Research Division at the School of Dentistry, National Autonomous University of México, 04510 Mexico City, Mexico
| | - Martha Mendoza-Rodríguez
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, 42160 Pachuca, Mexico
| | | | | | | | | | | | - Carlo Eduardo Medina-Solis
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, 42160 Pachuca, Mexico
- Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata” of School of Dentistry at Autonomous University State of Mexico, Toluca, Mexico
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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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Ferreira RC, Senna MIB, Rodrigues LG, Campos FL, Martins AEBL, Kawachi I. Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference? BMC Oral Health 2020; 20:246. [PMID: 32887590 PMCID: PMC7650222 DOI: 10.1186/s12903-020-01238-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 08/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live. We examined whether there is contextual variation in socioeconomic inequalities in tooth loss across Brazilian municipalities. METHODS Data from the 2010 National Oral Health Survey of 9633 adults living in 157 Brazilian municipalities were used. The individual socioeconomic indicators were education and household income. At the municipal level, we used the Municipal Human Development Index (HDI) as our contextual indicator of socioeconomic status (low:< 0.699 versus high: > 0.70). The Relative (RII) and Slope (SII) Indexes of Inequality, Relative (RCI), and Absolute (ACI) Concentration Indexes were calculated to compare the magnitude of education and income-based inequalities among municipalities with low versus high HDI. Multilevel Poisson regression models with random intercepts and slopes were developed. RESULTS At the individual level, adults with lower education & income reported more tooth loss. The mean number of missing teeth was 9.52 (95% CI: 7.93-11.13) and 6.95 (95% CI: 6.43-7.49) in municipalities with low and high HDI, respectively. Municipalities with high HDI showed higher relative and absolute education-based inequality. For income-based inequalities, higher SII and RCI was observed in municipalities with lower HDI. A significant cross-level interaction indicated that high-education adults reported fewer missing teeth when they lived in municipalities with high HDI compared to adults with the same education level living in low HDI municipalities. For individuals with the lowest education level, there was no difference in the number of teeth between those from municipalities with high and low HDI. CONCLUSIONS There was a social gradient in tooth loss by education and income. Living in disadvantaged municipalities cannot overcome the risk associated with low schooling. The protective effect of higher education can be reduced when people live in disadvantaged areas.
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Affiliation(s)
- Raquel Conceição Ferreira
- Department of Community and Preventive Dentistry, School of Dentistry, Federal University of Minas Gerais, Av. Presidente Antonio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Maria Inês Barreiros Senna
- Department of Dental Clinic, Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Av. Presidente Antonio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Lorrany Gabriela Rodrigues
- School of Dentistry, Federal University of Minas Gerais, Av. Presidente Antonio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Fernanda Lamounier Campos
- School of Dentistry, Federal University of Minas Gerais, Av. Presidente Antonio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Andrea Eleuterio Barros Lima Martins
- University of Montes Claros, Campus Universitário Professor Darcy Ribeiro, Avenida Rui Braga, S/N, Vila Mauricéia, Montes Claros, Minas Gerais, 39401-089, Brazil
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA
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