Social relations as determinants of oral health among persons over the age of 80 years

The Association of Oral Processing Factors and Nutrient Intake in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

CONTEXT

Oral health and food oral-processing issues emerge with functional decline in the older adult population, potentially increasing the risk of malnutrition. Impairment of oral health is associated with poorer nutrition status; however, the relationship between oral factors and the intake of each nutrient remains poorly understood.

OBJECTIVE

The associations between different oral factors and nutrient intakes among community-dwelling older adults were investigated.

DATA SOURCES

A literature search from 5 databases (Web of Science, Scopus, Cochrane Library, Ovid [MEDLINE and Embase], and CINAHL) was completed on February 1, 2022. The search was limited to peer-reviewed articles published between the years 2012 and 2022.

DATA EXTRACTION

Six cross-sectional studies were included in the meta-analysis. Two authors independently completed the data extraction and summarized the study characteristics, factors adjusted for in the statistical analysis, the outcome, and summary statistics of the results.

DATA ANALYSIS

Meta-analyses showed evidence of a significant association between compromised oral factors (namely, denture status, chewing ability, and the number of teeth) with lower energy (weighted mean difference [WMD], -107 kcal d-1 (95% CI, -132 to -81), protein (WMD, -5.2 g d-1; 95% CI, -6.6 to -3.8), fat (WMD, -4.6 g d-1; 95% CI, -6.7 to -2.6), carbohydrate (WMD, -8.8 g d-1; 95% CI, -13.9 to -3.7), and vitamin C intakes (WMD, -12.9 mg d-1; 95% CI, -16.6 to -9.2) in older adults.

CONCLUSION

Oral health can be an indicator of compromised daily energy, protein, fat, carbohydrate, and vitamin C intakes in older adults. However, the small sample size of the studies included in this review and the heterogeneity among macronutrient studies should be considered. Because of the lack of studies covering all aspects of food oral processing (eg, salivary flow rate, tongue pressure), the associations between oral processing and nutrient intake were not thoroughly explored.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022308823.

Impact of social wellbeing on tooth loss and cognition: A scoping review

OBJECTIVE

The proposed explanations for the association between tooth loss and cognitive function have largely focused on systemic inflammation, mechanoreceptor feedback, and nutritive deficiencies. However, the role of social wellbeing in this relationship remains unknown. The aim of this scoping review is to explore the pathways linking different aspects of social function, collectively grouped under the umbrella of social wellbeing, to tooth loss and cognitive impairment.

DATA AND SOURCES

An electronic database search was performed in PubMed, Scopus, and Embase. Reference lists of relevant articles were also searched. Data on the associations between social wellbeing, cognitive function and tooth loss was charted in an extraction form and summarised qualitatively.

STUDY SELECTION

From the initial search of 3293 records, 71 studies were included in the present review. Forty-seven studies investigated the relationship between social wellbeing and cognition, 21 studies investigated the relationship between social wellbeing and tooth loss, and only 3 studies investigated all three variables.

CONCLUSION

This review demonstrates the need for further research on tooth loss, cognition and social wellbeing in tandem and describes potential psychological, biological, cognitive, and behavioural mechanisms interlinking these factors. While substantial evidence was found for the association between social relationships and cognition, fewer studies explored the potentially bidirectional relationship of social wellbeing and tooth loss.

CLINICAL SIGNIFICANCE

The implications of this review may guide clinicians to focus on the social consequences of tooth loss, which may have broader repercussions on cognitive health. The role of social support in helping older people cope with oral disease and the benefits of fostering positive lifestyle habits should not be underestimated.

Social Relationships and Tooth Loss in Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis

OBJECTIVE

To systematically assess current evidence on the extent to which social relationships are associated with tooth loss in adults aged 60 years and older.

METHODS

A systematic literature search was conducted on PubMed, Embase, Web of Science, CINAHL and The Cochrane Library databases to identify relevant studies published from 1966 up to March 2024. Cross-sectional or cohort studies investigating the association between structural, functional and/or combined (structural and functional) components of social relationships and the number of remaining teeth or edentulism among community-dwelling or institutionalised older adults were included. Data were extracted on participants' and study characteristics, including study design, the type of measures used to assess social relationships (structural, functional, and combined), outcome measures and association estimates. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the adapted NOS for cross-sectional studies. The reported association between social relationships and the number of remaining teeth or edentulism was summarised using meta-analysis with robust variance estimation.

RESULTS

Twenty studies were included in the review and 12 studies (125 553 participants) in the meta-analysis. Across the 12 studies, the average odds ratio (95% confidence interval) was 1.15 (1.01-1.32), indicating a 15% higher likelihood of having a lower number of teeth or edentulism for those with weaker social relationships. The GRADE certainty of the body of evidence was low.

CONCLUSIONS

Weak social relationships were associated with a lower number of teeth or edentulism in older adults. Our findings may inform potential public health approaches that target and modify social relationships to prevent and address older adults' oral diseases. Still, the directionality and the underlying mechanisms connecting social relationships and tooth loss need to be further explored by longitudinal studies with follow-up long enough for oral health outcomes or changes in social relationships to occur.

TRIAL REGISTRATION

Protocol Registration: PROSPERO (CRD42023417845).

Oral Health Factors Related to Rapid Oral Health Deterioration among Older Adults: A Narrative Review

Older adults who face systemic health issues and lack adequate social support are at risk for oral health deterioration. How rapidly such changes take place depends on the severity of their medical condition and their ability to access oral health services in a timely manner. The management of dental caries and periodontal disease in this cohort is made complex by the interaction of local and host factors such as the presence of dry mouth, involvement of root surfaces, and altered wound healing. in addition to enhanced maintenance needs to avoid recurrence or progression. Tooth replacement can be beneficial in restoring oral function, allowing patients to enjoy a healthy and nutritious diet but requires careful consideration to avoid further damage to remaining dental units. Establishing a dental home for the older adult can facilitate routine surveillance, disease prevention, and patient/caregiver education to achieve oral health goals commensurate with overall health. This narrative review details oral health factors that are related to rapid oral health deterioration among older adults.

Oral status and homebound status: A 6-year bidirectional exploratory prospective cohort study

OBJECTIVES

Little is known about the association between oral status and homebound status, and there is a possibility of a bidirectional relationship between them. In this exploratory prospective cohort study, we examined the association between four oral status measurements and being homebound bidirectionally.

METHODS

We used 2010-2016 panel data gathered from the Japan Gerontological Evaluation Study. All functionally independent participants aged 65 years or older (n = 26,579) were included in this study. Multiple imputation and Poisson regression were used for analyses. We adjusted for age, sex, education, comorbidity, and depressive symptoms.

RESULTS

In the fully adjusted model, the prevalence ratio (PR) of being homebound at follow-up was 1.42 for having <20 remaining teeth, 1.28 for having chewing difficulty, 0.99 for having choking experience, and 0.94 for having dry mouth at baseline. Reversely, being homebound at baseline predicted having chewing difficulty at follow-up (PR = 1.17), while no significant association was demonstrated with having <20 teeth (PR = 1.00), choking experience (PR = 1.06), and dry mouth (PR = 1.02).

CONCLUSION

Chewing difficulty and having <20 remaining teeth predicted homebound status after 6 years. Reversely, homebound status at baseline only predicted having chewing difficulty at follow-up. These findings may help to determine the oral frailty assessment measures for older people.

The association between social isolation and oral health of community-dwelling older adults-A systematic review

AIM

Social isolation and oral health problems commonly exist in older populations and can influence each other. However, evidence on this bidirectional correlation is scarce. This systematic review aimed to provide a comprehensive overview of literature in which social isolation and oral health were associated with each other separately.

METHODS

Electronic searches were performed through six databases. Original cross-sectional and longitudinal prospective studies that evaluated the associations between social isolation and oral health as either exposure or outcome were included.

RESULTS

In total, 282 articles were retrieved. Of these, 10 cross-sectional studies and one longitudinal study were included in the analysis. The level of evidence reported was generally moderate to strong. Most studies found that both stronger objective and perceived social isolation were associated with worse oral health in both directions. The frequency of meeting friends had an inconsistent association with oral health.

CONCLUSIONS

The results of our systematic review showed a bidirectional association between social isolation and oral health in independent community-dwelling older adults. Both objective and perceived social isolation are associated with oral health. As objective social isolation indicators, quality of social connectedness appears to play a more important role in the association with oral health.

Tooth retention, health, and quality of life in older adults: a scoping review

OBJECTIVE

This scoping review describes the relationship between tooth retention, health, and quality of life in older adults.

METHODS

Seven databases were searched for English language articles for subjects ≥ 65 y from 1981 to 2021. Exposure was tooth retention (≥ 20), and outcomes were general/systemic health and quality of life. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool.

RESULTS

140 articles were included, only four were randomized trials. Inter-rater agreement (κ) regarding study inclusion was 0.924. Most were assessed with low risk of bias (n = 103) and of good quality (n = 96). Most studies were conducted in Japan (n = 60) and Europe (n = 51) and only nine in the US. Tooth retention was referred to as "functional dentition" in 132 studies and "shortened dental arch" in 19 studies. Study outcomes were broadly synthesized as (1) cognitive decline/functional dependence, (2) health status/chronic diseases, (3) nutrition, and (4) quality of life.

DISCUSSION

There is a positive relationship between tooth retention, overall health, and quality of life. Older adults retaining ≥ 20 teeth are less likely to experience poorer health. Having < 20 teeth increases the likelihood for functional dependence and onset of disability, and may affect successful ageing. This review supports the general finding that the more teeth older adults retain as they age, the less likely they are to have adverse health outcomes. However, significant knowledge gaps remain which can limit decision-making affecting successful ageing for many older adults. This review highlights the need to consider, as an important marker of oral health and function, the retention of a functional minimum of a natural dentition, rather than a simple numeric score of missing teeth.

Predictors of tooth loss in Brazilian older adults: An 8-year follow-up

OBJECTIVE

To investigate the risk factors for tooth loss after 8 years among community-dwelling older adults in a southern Brazilian city.

METHODS

In 2004, 388 dentate community-dwelling older adults from Carlos Barbosa, southern Brazil, were selected using simple random sampling. In 2012, the follow-up consisted of 199 (51.3%) participants. Data collection comprised an interview with data about socio-demographic, behavioural and access to services and an oral examination. The outcome variable of this study is the ratio between the sum of the teeth lost during the 8-year period of follow-up, and the sum of the teeth present in 2004, per person, modelled through binomial regression analysis.

RESULTS

Being older (IOR = 1.03, 95% CI: 1.00-1.06), living in a rural area (IOR = 1.56, 95% CI: 1.17-2.07), earning two or more monthly minimum wages (IOR = 1.46, 95% CI: 1.09-1.96), living alone (single, widowed or divorced; IOR = 1.36, 95% CI: 1.00-1.85), having more gingival bleeding sites (IOR = 1.01, 95% CI: 1.00-1.02) and wearing partial removable prosthesis (IOR = 2.82, 95% CI: 2.15-3.71) were risk factors for tooth loss. Approximately 48% of the participants lost one or more teeth over the 8-year follow-up period.

CONCLUSION

Socio-demographic, economic and clinical variables were associated with the risk for tooth loss. This might be a result of social determinants of health influencing people's access to oral health care, oral health behaviours and oral health status. Public policy aimed at older adults living in rural areas, living alone and using removable dentures may contribute to reducing the risk of tooth loss.

Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde

OBJECTIVE

The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde.

MATERIAL AND METHODS

This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated.

RESULTS

The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m²' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors.

CONCLUSIONS

The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Prevalence and determinants of dental visits among older adults: findings of a nationally representative longitudinal study

BACKGROUND

The first aim was to present descriptive data on the frequency of dental visits among older adults in Germany. The second aim was to identify the determinants of the number of dental visits using a longitudinal approach.

METHODS

Longitudinal data were derived from the German Ageing Survey, which is a nationally representative sample of community-dwelling individuals ≥40 years in Germany. The frequency of dental visits in the past 12 months was recorded in the years 2002, 2008 and 2011. In order to control for time-constant unobserved heterogeneity, Poisson fixed effects regressions were used.

RESULTS

While the mean number of dental visits was 2.3 (SD: 2.0) in 2002, it was 2.0 (SD: 1.7) in 2008 and 2.1 (SD: 1.7) in 2011. The frequency of dental visits declined with age (total sample and women), transitions from normal weight to overweight (total sample), changes from divorced/widowed/single/married, living separated from spouse to 'married, living together with spouse' in women and with a decrease in the number of physical illnesses (total sample and men).

CONCLUSIONS

The frequency of dental visits declines with age in older adults. While some of the determinants of frequency are non-modifiable (e.g., ageing and worsening of general health), others are modifiable (e.g., change in weight category).

Oral health of quilombola and non-quilombola rural adolescents: a study of hygiene habits and associated factors

This study evaluated oral hygiene habits and their association with sociocultural, environmental factors and factors related to the use of dental services among Quilombola and non-Quilombola rural adolescents from inland Bahia. Thiswas a cross-sectional study conducted in 2015. Prevalence and prevalence ratios were estimated for the outcomes and multiple Poisson regression analysis with robust variance was performed. We interviewed 390 adolescents, of which 42.8% were Quilombola. Poor tooth brushing and non-flossing were found in 33.3% and 46.7% of adolescents, respectively. Poor tooth brushing was increased by male gender (PR = 1.45), not living with both parents (PR = 1.45), lower hand hygiene habit (PR = 1.72) and worse oral health self-assessment (PR = 1.38). Non-flossing was associated with economic level E (PR = 1.54), older age (PR = 0.91), lower hand hygiene habit (PR = 1.53) and worse oral health self-assessment (PR = 1.33). Different associated factors were observed between Quilombola and non-Quilombola. It is necessary to consider the specificities of the populations for the promotion of adolescent oral health and the importance of the intersectoriality between education and health and care to families.

Factors Affecting Older Persons' Ability to Manage Oral Hygiene: A Qualitative Study

A great challenge for the dental service is to support the growing group of elderly people with preserving good oral health throughout their lives. Limitations in the ability to manage oral hygiene and an increased number of risk factors are often reflected by poor oral health. Thus, the need for individualized support and oral health procedures based on the older person's condition is significant. Deficiencies in the motor skills needed to manage oral hygiene are well known, but other factors that affect the ability are not well studied. The aim of the present study was to identify factors that may affect an elderly person's ability to perform oral hygiene self-care, which is the first step to develop a more comprehensive "oral hygiene ability index." The design of the study was qualitative. Data were collected from 4 focus group interviews with a total of 23 participants. Three of the groups consisted of dental hygienists, occupational therapists, and assistant nurses, all working with elderly persons. The fourth group was made up of elderly people (72-89 years). Content analysis was used to analyze the data. The latent content was formulated into the core category, "oral hygiene-a complex activity." Three categories emerged: "psychological," "environmental," and "functional" dimensions. The psychological dimension described attitude/motivation, emotions, and cognitive factors. The environmental dimension included practical conditions and social context. The functional dimension dealt with bodily and oral function as well as the senses. In conclusion, self-care with respect to oral hygiene is a complex activity for elderly persons and includes a large number of factors. These factors should be taken into consideration when developing a future oral hygiene ability index. Knowledge Transfer Statement: Various factors may affect the ability to manage oral hygiene self-care. Impaired ability to manage oral hygiene, in combination with an increased number of risk factors, often results in deteriorating oral health and impaired quality of life in older persons. Factors necessary to manage oral hygiene were identified in a qualitative study of dental hygienists, occupational therapists, and assistant nurses, all working with elderly patients, and a group of elderly persons. The results of this study may be important for clinical oral health work with older patients and for the planning of oral health and social care interventions for the growing group of older people.

[Prospective study on tooth loss in a cohort of dentate elderly]

The aim of this study was to assess factors associated with tooth loss in elderly 60 years or older during a four-year observation period. A representative cohort of dentate elderly from the city of São Paulo, Brazil, participated in the study. The outcome was teeth loss incidence from 2006 to 2010. Demographic and socioeconomic characteristics, health services access and use, behavior, reported diseases, cognitive status, functional status, state of dentition, and use of dental prosthesis were recorded as independent variables in 2006 and the outcome was measured in 2010. Negative binomial regression models were used. Participation included 440 dentate elderly. Increased likelihood of tooth loss was associated with use of two removable prostheses (RR = 1.57; 95%CI: 1.02-2.41), fair self-rated oral health (RR = 1.62; 95%CI: 1.11-2.36), bad/very bad self-rated oral health (RR = 1.87; 95%CI: 1.11-3.17), male gender (RR = 1.74; 95%CI: 1.28-2.37), and living alone (RR = 2.03; 95%CI: 1.11-3.72).

Discontinued dental attendance among elderly people in Sweden

Aim:

Our objective was to study the loss of dental attendance and a possible age trend among patients aged ≥65 years in Sweden. Regular dental check-ups are considered to be an important factor in maintaining oral health. Approximately 80% of the adult population in Sweden are enrolled in a regular check-up system; however, dental practitioners often find that older patients attend fewer check-ups. Old people may naturally lose contact with dental services as they move to special housing or die. In this systematic study, these factors were investigated and used as exclusion criteria.

Materials and Methods:

Data were collected for all patients (n = 4759) aged 65 or older from the electronic journal system in 3 large public dental clinics in 3 communities. Their dental records for the years 2004–2009 were studied longitudinally by 1 person at each clinic; 1111 patients were excluded (patients died during study period, wanted emergency care only, obtained special dental care allowance, moved from the community or moved to special housing, or left the clinic for another caregiver). The statistical analyses were performed using the Statistical Package for the Social Sciences version 21 (IBM).

Results:

Of the 3648 patients (1690 men and 1958 women) included in the study, 13% lost contact with their dental service over the course of the study (10% of those were aged 65–79 and 21% ≥80). The decrease in regular dental contact had a statistically significant association with increasing age (P < 0.001).

Conclusion:

A considerable number of older people living independently or with moderate supportive care in their own homes lost contact with dental service despite enrolment in a recall system.

Edentulism and quality of life among older Ghanaian adults

Background

Edentulism affects the quality of life and general health of an individual. But in ageing individuals, it has been observed to have greater impact, manifesting in functional, psychological and social limitations. With an increasing older adult population in Ghana, its burden is likely to increase. This study was thus carried out to explore the association between edentulism and quality of life among older Ghanaian adults.

Methods

Secondary analysis of WHO’s Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Participants included a nationally representative sample of adult’s aged 50 years and older living in Ghana. Quality of life was measured using the 8 item WHOQOL measure and a single item measure which was a question “How would you rate your overall quality of life?”. To assess the association between edentulism and the independent variables, a bivariate analysis was carried out. A Poisson regression model was then performed, adjusting for age, sex, income, education and the diagnosis of a chronic disease condition. A Spearman’s correlation analysis was also carried out between the single and multi item measure of quality of life to assess how well they correlate.

Results

Edentulism was observed to be associated with significantly lower levels of SWB among older adults using both the single-item and multiple-item measure (WHOQOL). It, however, showed no association with happiness. Among edentulous respondents, females and those with no formal education reported significantly lower quality of life. The WHOQOL correlated positively and strongly with the single-item measure.

Conclusion

Edentulism may not be life threatening and yet it has been shown to have a negative effect on the quality of life of older adult Ghanaians. More emphasis may thus need to be placed on the oral health of the aging population in Ghana to avoid it.

Lifestyle and dental attendance as predictors of oral health-related quality of life

OBJECTIVES

To evaluate the impact of health-related behaviors and dental attendance on oral health-related quality of life (OHRQoL).

METHODS

One hundred and ninety-two individuals presenting for dental treatment were included in a cross-sectional survey using a self-administered questionnaire that assessed demographics, smoking and alcohol consumption, physical activity habits, dental attendance, and dental pain utilizing a numeric rating scale (NRS). Results of the Oral Health Impact Profile (OHIP)-14 questionnaire were considered as the dependent variable. A conceptual hierarchical data analysis model from distal to proximal determinants of the median OHIP-14 total score was adopted.

RESULTS

Analysis of the OHIP-14 domains and total score revealed several significant protector characteristics: younger age, academic education, no alcohol consumption, regular physical activity, fewer smoking pack years, routine dental attendance, and lower NRS scores. Routine dental attendance was related to lower NRS scores (P < 0.001) which in turn were associated with lower OHIP-14 scores (P = 0.018). Better health-related behaviors (P = 0.039) and routine dental attendance (P = 0.029) also correlated directly with lower OHIP-14 scores.

CONCLUSIONS

Better health-related behaviors and routine dental attendance have a protective effect on OHRQoL. Clinicians should assess these behaviors during routine diagnostic workups. Global health authorities need to integrate oral and general health care and improve both OHrQoL and HrQoL.

Root caries: a periodontal perspective

BACKGROUND AND OBJECTIVE

A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs.

MATERIAL AND METHODS

The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders.

RESULTS

Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking.

CONCLUSION

Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

Risk indicators for the presence and extent of root caries among caries-active adults enrolled in the Xylitol for Adult Caries Trial (X-ACT)

OBJECTIVE

This paper uses baseline data from a randomized clinical trial to evaluate cross-sectional indicators of root caries in caries-active adults.

MATERIALS AND METHODS

Adults (21-80 years) having at least 12 erupted teeth and between one and ten caries lesions were enrolled. Participants (n = 437) received caries exams by trained, calibrated examiners and responded to baseline demographic and medical-dental questionnaires. We examined associations between baseline characteristics and (1) the presence of any root caries using Mantel-Haenszel hypothesis tests and odds ratio (OR) estimators and (2) the number of root surfaces with caries among study participants with exposed root surfaces (n = 349) using Mantel-Haenszel mean score tests and Mann-Whitney estimators.

RESULTS/CONCLUSIONS

Adjusting for study site and age, male gender [OR, 1.72; 95% confidence interval (CI), 1.08, 2.78], white race (OR, 2.39; 95% CI, 1.43, 3.98), recent dental visit (OR, 1.98; 95% CI, 1.07, 3.66), poor self-described oral health (OR, 2.65; 95% CI, 1.10, 6.39), and recent professional fluoride treatment (OR, 1.85; 95% CI, 1.06, 3.25) were significantly associated with increased odds to have any root caries, and study participants with exposed root surfaces characterized by male gender [Mann-Whitney probability estimate (MW) = 0.57; 95% CI, 0.51, 0.63), white race (MW, 0.61; 0.55, 0.68), recent dental visit (MW, 0.58; 0.50, 0.67), poor self-described oral health (MW, 0.61; 0.53, 0.69), and flossing at least once per day (MW, 0.57; 95% CI, 0.51, 0.62) were significantly more likely to have a greater number of root surfaces with caries than a randomly selected study participant from their respective complementary subgroups (female gender, non-white, etc.).

CLINICAL RELEVANCE

Our findings may help identify individuals at higher root caries risk.

Social Relationships and Dental Care Service Utilization Among Older Adults

Objectives: This study described the association between dental care service utilization and two domains of social relationships (social integration and social support) among older adults. Methods: The study employed data from the 2008 Health and Retirement Study, examining regression models for whether a person visited a dentist in the past 2 years, including adjustments for demographic, socioeconomic, and health characteristics. Results: Social interaction, social participation, neighborhood cohesion, and marital status were related to an increased likelihood of having visited a dentist. Older persons exhibiting loneliness and having received financial aid from network members demonstrated a decreased likelihood of visiting a dentist. The increased likelihood of visiting a dentist when a child lives nearby only occurred after introducing health covariates. Discussion: The article discusses the implications of the study findings as they relate to social relationships and oral health and recommends some additional research directions to explore the etiology of dental care use.

Implications of edentulism on quality of life among elderly

This study aimed was to test the association between quality of life and edentulism among elderly individuals in a city in southeastern Brazil. This cross-sectional study was carried out with 163 individuals aged 60 years or older, functionally independent and non-institutionalized. Data were collected with a questionnaire and oral examination. The edentulism was the dependent variable. The independent variables were sex, age, household income and quality of life (WHOQOL-Old) and their scores. To assess the association between the dependent variable and independent variables was used bivariate analysis (p < 0.10). Poisson regression model was performed, adjusting for age and sex. The average age of participants was 69 years (± 6.1), 68.7% were female and 52.8% were diagnosed as completely edentulous (90% CI: 0.33–1.24). When the independent variables were associated to the prevalence of edentulism, statistically significant associations were found for age (p = 0.03) and social participation dimension of the WHOQOL-Old (p = 0.08). In the Poisson regression, social participation remained statistically associated to edentulism {RP = 2.12 [90% CI (1.10–4.00)]}. The social participation proved to have a significant association to edentulism, thereby attesting to the negative effect of this condition on social aspects.

Sense of coherence and oral health status in an adult Swedish population

OBJECTIVE

To investigate sense of coherence in relation to oral health status in an adult Swedish population in order to better understand the determinants of positive oral health-promoting behavior and differences in oral health.

MATERIAL AND METHODS

A stratified random sample of 910 individuals from Jönköping, Sweden aged 20, 30, 40, 50, 60, 70 and 80 years was obtained. The investigation used the Swedish short version of the Sense of Coherence (SOC) questionnaire comprising 13 items and a self-report questionnaire to elicit demographic information. In addition, a clinical and radiographic oral examination was performed.

RESULTS

A total of 525 individuals, 261 men and 264 women, consented to participate in the study. Bivariate analysis revealed that higher mean SOC scores were statistically significantly associated with more decayed and filled surfaces (DFS) and filled surfaces (FS), fewer decayed surfaces (DS), fewer teeth with calculus and periodontal health. Multivariate analysis showed that higher SOC scores represented a predictor of fewer occurrences of a periodontal probing pocket depth of ≥4 mm and a lower risk of plaque in different regression models.

CONCLUSIONS

Higher SOC scores may be a protective determinant of plaque and periodontal disease, indicating an association between SOC and oral health.

Differences in self-reported oral health among community-dwelling black, Hispanic, and white elders

OBJECTIVE

To compare differences in self-rated oral health among community-dwelling Black, Hispanic, and White adults aged 60 and older.

METHOD

A total of 4,859 participants in the National Health and Nutrition Examination Survey (1999-2004) provided self-report information on oral health.

RESULTS

Blacks and Hispanics reported poorer self-rated oral health than Whites. In separate dentate and edentulous groups, socioeconomic status, social support, physical health, clinical oral health outcomes, and dental checkups accounted for much of the difference in self-rated oral health in Blacks, but significant differences remained for Hispanics.

DISCUSSION

The study findings may have important implications for health policy and program development. Programs and services designed for minority populations should target treatments for dental diseases and include components that take into account subjective evaluations of oral health conditions and perceived dental needs of the individuals.

The association between demographic and oral health-related quality of life factors and dental care attendance among underprivileged older people

AIM

In order to identify whether demographic and oral health-related quality of life factors are associated with dental care attendance among an underprivileged older population, a comparison was performed between people who have and have not attended dental care.

METHODS

A cross-sectional purposive sample of 344 older underprivileged people comprised the study population. The dependent variable was dental care attendance. The 14-item version of the Oral Health Impact Profile index (OHIP-14) was used as the independent variable, together with other social and general variables, using a structured interview.

RESULTS

The variables that were significantly associated with dental care attendance were family status (not married, the highest attendance), dwelling location (living at home, the highest attendance), caregiver (family member, the highest attendance), place of birth (Western countries, the highest attendance) and income (pension, the highest attendance). Sex, welfare support, functional ability, education, age and OHIP-14 were not associated with dental care attendance.

CONCLUSIONS

Attending dental care was not associated with oral health-related quality of life measured by OHIP-14. Several socioeconomic variables were strongly associated.

Fatores associados a hábitos de saúde bucal e utilização de serviços odontológicos entre adolescentes

Estudo transversal com 1.170 adolescentes da sétima série da rede pública municipal de Gravataí, Rio Grande do Sul, Brasil, investigando a associação de fatores sócio-demográficos, psicossociais e relacionados ao estilo de vida com hábitos de saúde bucal e utilização de serviços odontológicos. Os dados foram analisados por regressão de Cox modificada para estudos transversais. As meninas tiveram maior freqüência de escovação dentária assim como aqueles que relataram não se sentirem discriminados ou sozinhos. O uso diário de fio dental associou-se à melhor inserção sócio-econômica, à busca por serviços privados, à compreensão dos pais e à ausência de sentimento de solidão. A freqüência anual de utilização de serviços odontológicos foi maior entre os de inserção sócio-econômica mais alta. Houve maior busca de serviços por motivo preventivo entre aqueles com melhor inserção sócio-econômica, os que se sentiram compreendidos pelos pais e os que não costumavam consumir doces. Os hábitos de saúde bucal apresentaram associação com inserção sócio-econômica familiar e com fatores psicossociais, exceção à utilização anual de serviços. Quanto ao estilo de vida, o baixo consumo de doces repercutiu positivamente sobre o motivo da visita ao serviço.

Elders assessment of an evolving model of oral health

OBJECTIVES

To evaluate qualitatively a model of oral health through focus groups among elders.

METHODS

The participants (30 women and 12 men; mean age: 75 years) attended one of six focus groups to discuss the relevance of the model to their oral health-related beliefs and experiences, and transcripts of the narratives were analysed systematically for the components, associations and recommendations emerging from the discussions.

RESULTS

The groups confirmed the relevance of the original components of the model with minor modifications, but felt that for completeness it required four additional components: diet; economic priorities; personal expectations; and health values and beliefs. They recommended that the negative connotations of limited activity, impairment and restricted participation were modified with the positive terms activity and participation, and they suggested that ellipses rather than concentric circles more aptly illustrate the dynamic and overlapping importance of the various components in the model.

CONCLUSION

The original model required additional components and graphic representation to accommodate all of the experiences and beliefs relating to the oral health of the elders who participated in this qualitative study.

Secular trends of dental status in five 70-year-old cohorts between 1971 and 2001

OBJECTIVE

The aims of this study, which are part of the gerontological and geriatric population studies in Göteborg, Sweden (H70), were to describe cohort differences and trends in dental status and utilization of dental care in 70-year-olds. The study is based on five cohorts examined in 1971/72, 1976/77, 1981/82, 1992/93 and 2000/01 (called cohort I, II, III, V and VI, respectively). The total number of participants was 2290 and varied between 386 and 583 in the different cohorts. The proportion of dentate 70-year-olds changed gradually from 49% in the first to 93% in the last cohort. The mean number of teeth in the dentate 70-year-olds was 14 in cohort I and 21 in cohort VI. The proportion of subjects with 20 or more teeth changed from 13% in cohort I, to 20% in cohort III, and to 65% in cohort VI. In cohort I, 76% of the 70-year-olds had some kind of removable denture; 37% in cohort III, but only 17% in cohort VI. About 20% of all 70-year-olds in cohort I reported regular yearly visits to a dentist. The corresponding figures in cohort III and cohort VI were 50% and 80%, respectively. Even though positive cohort trends were observed in all studied subgroups, factors such as low education, smoking, being un-married, having high waist circumference and being physically inactive were negatively associated with dental status at the end of the study period as well as at the beginning.

Suporte social, promoção de saúde e saúde bucal na população idosa no Brasil

O crescente envelhecimento da população mundial, inclusive no Brasil, ressalta a importância de medidas para se lidar com esta situação. No Brasil, a maioria dos idosos é do sexo feminino; vive em domicílios multigeracionais; é referência econômica nos mesmos; possui baixo nível socioeconômico; portadora de, pelo menos, uma doença crônica; independente para realização das atividades da vida diária; não possui dentes, e busca atenção em saúde no SUS. Os idosos brasileiros expostos a situações de vulnerabilidade social estão sujeitos à interferência direta dos determinantes sociais no processo saúde-doença. O Suporte Social inclui políticas e redes de apoio social, que atuam como agente de integração do idoso na sociedade, minimizando os riscos de exclusão social e, conseqüentemente, de danos à sua saúde por meio de medidas de Promoção de Saúde. Este artigo aborda o Suporte Social e alguns de seus aspectos, tais como: tipo e local de residência, transporte e suporte financeiro; em idosos brasileiros e sua relação com a Promoção de Saúde.

Healthy Practices, Social Relationships and Dental Perceptions Among US Dentate Adults

OBJECTIVE

This study explored and described the effects of healthy practices and social relationships on dental perceptions among U.S. dentate adults.

METHODS

Guided by the Alameda County Study: Health and Ways of Living, weighted data from the Third National Health and Nutrition Examination Survey of 8,449 U.S. dentate adults aged 18-64 years were analyzed with SUDAAN 7.5.3.

RESULTS

Healthy practices and social relationships showed protective effects against unfavorable dental perceptions after controlling for socio-demographic characteristics, dental access, and related clinical dental status. Besides healthy practices and social relationships, education, family income, having dental visit in the past 12 months, having dental decay, having defective tooth condition, and number of natural teeth helped explain unfavorable dental perceptions in the adjusted model. Compared with persons who had high social relationships and high healthy practices, those who had low social relationships with very low, low and medium healthy practices were about five, times (OR=5.07; 99% CI=3.24, 7.91), almost four times (OR=3.61; 99% CI=2.22, 5.87), and two times (OR=2.24; 99% CI=1.37, 3.67) more likely, respectively, to have unfavorable dental perceptions. In the adjusted model, these odds ratios decreased to three (OR=3.30; 99% CI=2.01, 5.41), two (OR=2.06; 99% CI=1.15, 3.69) and non-significant difference, consecutively.

CONCLUSIONS

Influence of healthy practices and social relationships on dental health may encourage dental health professions to participate in general health behavior modifications and social actions to foster social relationships, in addition to preventive dental care.

Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability

OBJECTIVE

To analyse whether cognitive function and functional ability are related to oral health among community-dwelling older people over the age of 80 years.

BACKGROUND

This cross-sectional study is based on the Kungsholmen Elders Oral Health Survey (KEOHS). The study included oral examinations carried out in two local clinics by standardised examiners and interviews using structured questionnaires.

MATERIALS AND METHODS

Altogether 159 individuals were included in this study. Coronal caries and root caries were assessed using the National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) index and functional ability was assessed by a global measure of self-reported changes.

RESULTS

Older adults with a low MMSE score (< or = 23) tended to have a higher risk of coronal caries than those with higher scores. Participants with mild cognitive decline (MMSE = 24-26) and with a decrease in functional ability had a significantly higher risk of root caries. These associations changed little when adjusted by the covariates. In addition, people with a low MMSE (0-23) had a four times higher risk of not using dental services regularly. This result was unchanged after adjusting for the variables studied.

CONCLUSIONS

This study revealed associations between the cognitive and functional status of the individual and aspects of oral health, that may contribute to a deeper understanding of the background of oral health status in older adults.