Self-reported oral hygiene practices with emphasis on frequency of tooth brushing: A cross-sectional study of Mexican older adults aged 60 years or above

An exploration of the relationship between attitudes and experiences of prevention and oral health behaviours of the public within six European countries

OBJECTIVES

To survey the public's self-reported attitudes and knowledge towards prevention in oral healthcare and to explore their relationship with tooth brushing frequency and frequency of dental visits.

METHODS

Adults (18+) were approached by email to complete a questionnaire about their attitudes and knowledge towards prevention in oral healthcare in UK, Ireland, Denmark, Germany, the Netherlands and Hungary. Tooth brushing frequency and dental attendance were assessed to see if there was an association with: cost, motivation, responsibility, advice received, personalised advice and knowledge.

RESULTS

3372 participants were recruited. Participants who visited the dentist less often were more likely to see cost as a barrier, with the adjusted odds ratio (aOR) of the last visit being more than 2 years ago versus last visit less than one year ago being 2.58 (95% CI: 2.05 to 3.24). For both motivation and perceived responsibility to care for teeth/gums there was a relationship with frequency of brushing. Comparing those brushing ≥ twice-a-day to participants brushing less than once-a-day or never, the adjusted mean difference for the motivation score was - 1.18 (95% CI: -1.67 to - 0.68) and the aOR for perceived responsibility was 0.15 (95% CI: 0.09 to 0.25). Those who brushed their teeth less frequently were less likely to report receiving preventive advice, with the aOR for those brushing their teeth less than once-a-day or never compared to those who brush ≥ twice-a-day being 0.57 (95% CI: 0.36 to 0.90). Participants who brushed their teeth less frequently (aOR of less than once-a-day or never versus ≥ to twice-a-day 0.50 (95% CI: 0.31 to 0.79)) or visited the dentist less frequently (aOR of 2 or more years ago versus less than one year ago 0.30 (95% CI: 0.23 to 0.38)) were less likely to agree their dental professional knows them well enough to provide personalised oral health advice.

CONCLUSIONS

Self-reported frequent tooth brushing and regular dental visits correlated with higher motivation, responsibility, and personalized advice from dental professionals. Less regular dental visits were correlated with viewing cost as a barrier. Strengthening dentist-patient relationships and addressing barriers such as cost could further improve preventive dental behaviours and oral health outcomes. Demonstrating the successful use of a tool to allow for the first time multiple country exploration of the relationship between attitudes towards prevention and oral health behaviours.

Oral health inequalities among geriatric population: A systematic review

As per the World Health Organization, governments should aim to accomplish two significant global milestones by 2030: reducing health disparities and granting universal accessibility to healthcare. The aim of this article was to systematically review the inequalities and understand the multifactorial causation of oral health inequalities among the older adults.

Methods

Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) standards were used to carry out the review and is documented in PROSPERO CRD42026695761. Two authors did the search and screening in accordance with the protocol. Electronic databases such as PubMed, Google Scholar, and EBSCOhost articles of the last 10 years were searched for research presenting data on oral health status and oral health related quality of life in the elderly population. Quality assessment was performed using the Newcastle Ottawa Scale (NOS) for retrospective and prospective research.

Results

Only 24 studies fulfilled the eligibility criteria and were incorporated into the qualitative synthesis. Multiple aspects of oral health and the related variables influencing disparities in oral health in the elderly population living in institutions have a positive link.

Conclusion

The findings support the notion that this demographic consists of weak, dependent individuals who have poor oral health. The vulnerable elderly institutionalized population was recognized and validated, thus helps in providing measures that will eventually focus the risk factors to improve their OHRQoL.

Impaired oral health: a required companion of bacterial aspiration pneumonia

Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.

Factors predicting different times for brushing teeth during the day: multilevel analyses

BACKGROUND

The most effective and simple intervention for preventing oral disease is toothbrushing. However, there is substantial variation in the timing of brushing teeth during the day. We aimed to identify a comprehensive set of predictors of toothbrushing after lunch and after dinner and estimated contextual (i.e., geographic) variation in brushing behavior at different times of the day.

METHODS

We constructed a conceptual framework for toothbrushing by reviewing health behavior models. The main data source was the 2017 Community Health Survey. We performed a four-level random intercept logistic regression to predict toothbrushing behavior. (individual, household, Gi/Gun/Gu, and Si/Do).

RESULTS

Individuals under 30 years of age had higher likelihood of brushing after lunch, while brushing after dinner was higher among those aged 40-79 years. People engaged in service/sales, agriculture/fishing/labor/mechanics, as well as student/housewife/unemployed were 0.60, 0.41, and 0.49 times less likely to brush their teeth after lunch, respectively, compared to those working in the office, but the gap narrowed to 0.97, 0.96, 0.94 for brushing after dinner. We also found significant area-level variations in the timing of brushing.

CONCLUSIONS

Different patterns in association with various factors at individual-, household- and Si/Gun/Gu-levels with toothbrushing after lunch versus toothbrushing after dinner suggests a need for tailored interventions to improve toothbrushing behavior depending on the time of day.

Association between oral health behavior and chronic diseases among middle-aged and older adults in Beijing, China

OBJECTIVES

To evaluate the association between oral health behavior and multiple chronic diseases among middle-aged and older adults.

METHODS

We obtained data of the Beijing Health Service Survey and used multivariate logistic models to estimate the association between oral hygiene behavior and the risk of chronic diseases.

RESULTS

The risk of any chronic diseases (OR = 1.27, 95% CI: 1.18-1.37), cardiovascular diseases (CVD, OR = 1.30, 95% CI: 1.21-1.39), and endocrine or nutritional metabolic disorders (OR = 1.11, 95% CI: 1.01-1.22) was higher in those who with poor oral health behavior. There was no significant correlation between oral health behavior and the risk of diseases of the musculoskeletal, respiratory, digestive, and genitourinary systems.

CONCLUSIONS

Poor oral hygiene practices were associated with higher risk of chronic diseases, CVD and diabetes mellitus (DM) among middle-aged and older adults. These findings motivate further studies to evaluate whether improved oral health behavior may prevent the incidence of chronic diseases.

Tooth Loss and Associated Factors in Mexican Older Adults in Nursing Homes: A Multicenter Cross-Sectional Study

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.

Oral cleaning habits and the copy number of periodontal bacteria in pregnant women and its correlation with birth outcomes: an epidemiological study in Mibilizi, Rwanda

BACKGROUND

Since 1996, many studies have reported that periodontal disease during pregnancy may be a risk factor for preterm birth and low birth weight; however, in Africa, periodontal disease is considered a non-high-priority disease. In addition, there are few dental facilities in rural Rwanda; thus, the oral condition of pregnant women has not been investigated. The objective of this study was to assess the tooth brushing habits of pregnant women in rural Rwanda and evaluate whether periodontal bacteria in the oral cavity of pregnant women are related to birth outcomes or oral cleaning habits.

METHODS

A questionnaire survey and saliva collection were conducted for pregnant women in the catchment area population of Mibilizi Hospital located in the western part of Rwanda. Real-time PCR was performed to quantitatively detect total bacteria and 4 species of periodontal bacteria. The relationship of the copy number of each bacterium and birth outcomes or oral cleaning habits was statistically analyzed.

RESULTS

Among the participants, high copy numbers of total bacteria, Tannerella forsythia, and Treponema denticola were correlated with lower birth weight (p = 0.0032, 0.0212, 0.0288, respectively). The sex ratio at birth was higher in women who had high copy numbers of Porphyromonas gingivalis and T. denticola during pregnancy (p = 0.0268, 0.0043). Furthermore, regarding the correlation between oral cleaning habits and the amount of bacteria, the more frequently teeth were brushed, the lower the level of P. gingivalis (p = 0.0061); the more frequently the brush was replaced, the lower the levels of P. gingivalis and T. forsythia (p = 0.0153, 0.0029).

CONCLUSIONS

This study suggested that improving tooth brushing habits may reduce the risk of periodontal disease among pregnant women in rural Rwanda. It also indicated that the amount of bacteria is associated with various birth outcomes according to the bacterial species. Both access to dental clinics and the oral cleaning habits of pregnant women should be important considerations in efforts to alleviate reproductive-related outcomes in rural Africa.

Toothbrushing frequency and gastric and upper aerodigestive tract cancer risk: A meta-analysis

OBJECTIVE

Results of epidemiological studies evaluating the association between toothbrushing and gastric and upper aerodigestive tract (UADT) cancer risk showed inconsistent results. The purpose of this study was to evaluate the association between toothbrushing and gastric and UADT cancer risk and quantify the dose-response association between them.

METHODS

We searched the PubMed, EMBASE and Cochrane Library databases to identify relevant studies on toothbrushing and gastric and UADT cancer risk. Statistical analyses were performed using STATA 12.0 software.

RESULTS

A total of 30 studies of involving 1 194 017 participants met eligibility criteria and were included in the meta-analysis. Meta-analysis using a random-effect model showed that the high frequency of toothbrushing was associated with significantly reduced risk of gastric and UADT cancers (OR: 0.55, 95% CI 0.46-0.64, P < .05). Our dose-response analysis presented that every increased toothbrushing per day might reduce oral cavity cancer risk by 6%, pharyngeal cancer risk by 11%, laryngeal cancer risk by 3%, oesophageal cancer risk by 6% and gastric cancer risk by 4%.

CONCLUSIONS

This meta-analysis suggested the negative relationship between frequency of toothbrushing and risk of gastric and UADT cancers. Toothbrushing may be a protective factor for gastric and UADT cancers. However, this association must be further validated through large prospective studies.