Oral disadvantage among dentate adults

Comparative Effectiveness of Two Nonsurgical Treatments to Reduce Oral Health Disparities From Untreated Tooth Decay in Older Adults: Protocol for a Cluster Randomized Trial

BACKGROUND

The majority of dental caries lesions in older adults are at the gumline, at the edges of failed fillings and crowns, and in the surfaces of roots after gum recession. These lesions are difficult to restore with conventional surgical treatments using a dental drill and restorations often fail. Clinical guidelines are general and apply treatments that were designed for younger individuals in the dental care of older adults.

OBJECTIVE

This study will compare the effectiveness of 2 evidence-based nonsurgical strategies to manage dental caries lesions in adults aged 62 or older: (1) biannual topical application of silver diamine fluoride versus (2) atraumatic restorative treatment + biannual fluoride varnish.

METHODS

A cluster randomized clinical trial is being conducted in 22 publicly subsidized and other low-income housing facilities/sites (Arm 1: 11 sites, 275 participants; Arm 2: 11 sites, 275 participants). At baseline, participants will be screened for caries lesions. Those with nonurgent lesions will be treated according to the treatment arm to which the housing site was randomly assigned. The primary outcomes are caries lesion arrest, tooth sensitivity, and tooth pain at 52 weeks after treatment. Analytic methods for the primary aim include a generalized estimating equation approach to determine noninferiority of silver diamine fluoride relative to atraumatic restorative treatment + fluoride varnish treatment.

RESULTS

The trial was funded in April 2019. Enrollment began in September 2019 and results are expected in June 2023.

CONCLUSIONS

This study will inform the standard of care for treating caries lesions in older adults. If effective, either of these interventions has broad applicability in clinical and community-based settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03916926; https://clinicaltrials.gov/ct2/show/NCT03916926.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/17840.

Oral health and healthcare utilization in Belgian dentate adults

OBJECTIVES

In 2012-2014, the Belgian National Oral Health Data Registration and Evaluation Survey, integrated in the Health Interview Survey (HIS), was carried out. The present study investigated, in a sample of 1340 dentate adults (≥25 years), the association between oral healthcare utilization, oral health status and sociodemographic status.

METHODS

A multistage, stratified cluster sampling procedure was used. Oral examination for caries experience (World Health Organization, D₃ MFT-Index), periodontal status (Dutch Periodontal Screening Index, DPS-Index), number of teeth present and occlusal contacts without wearing removable dentures was performed by calibrated examiners. Oral healthcare utilization data were retrieved from the records of the Belgian Intermutualistic Agency. Participants' oral health and sociodemographic data were linked to registered oral care utilization in the previous 5-year period. Regular attenders (annual attenders and those with at least one registered contact in three different years) were compared with irregular attenders (those having had dental visits but not according to the definition of regular attenders) and nonattenders. Data were weighted to compensate for sampling and participation bias.

RESULTS

Six hundred and seventy-nine participants attended regularly, of whom 276 annually; 256 did not attend in the reference period. The overall D₃ MFT-Index was not noticeably different between attendance patterns (varying between 11 and 13), although regular attenders had more restored teeth than nonattenders (P < 0.01). No difference was seen for DPS-Index and number of teeth/occluding pairs (χ² test, P > 0.05). Females, participants with higher education, older participants and those in employment had higher rates of regular attendance.

CONCLUSIONS

Regular attenders had fewer untreated caries lesions, but neither lower caries experience nor lower DPS-Index than irregular attenders. Regular attendance was associated with sociodemographic variables.

Tooth Loss in Problem-oriented, Irregular, and Regular Attenders at Dental Offices

The aim of this retrospective study was to compare number of teeth lost among regular attenders (RAs), irregular attenders (IRAs), and problem-oriented attenders (POAs) at dental offices over a 10-yr observation period. Information on tooth loss was obtained from general practitioners. Patients were divided into 3 groups based on appointment adherence. A total of 1,886 teeth were lost in 1,400 patients. The mean number of teeth lost in men was 2.2±2.6 per patient over 10 yr in POAs, 1.2±1.7 in IRAs, and 1.5±1.5 in RAs. This number was significantly lower in IRAs (p = 0.011) or RAs (p=0.012) than in POAs. When the dependent variable was defined as "a patient with at least 2 or more extracted teeth", the independent variables showed the following correlations with tooth loss: IRAs (OR: 0.54; 95%CI: 0.35-0.84), RAs (OR: 0.65; 95%CI: 0.47-0.89), man (OR: 1.43; 95%CI: 1.11-1.83), hypertension (OR: 1.38; 95%CI: 1.04-1.85), 20-25 present teeth (OR: 2.41; 95%CI: 1.81-3.22), and 1-19 present teeth (OR: 3.75; 95%CI: 2.73-5.16). The risk of tooth loss showed a 0.65-fold increase in RAs undergoing maintenance compared with POAs. Motivating patients to visit the dentist more regularly and undergo maintenance is important. The present results may be of use to dental professionals in providing patients with detailed information on potential tooth loss and associated risk factors with the aim of achieving such a change in behavior.

Oral health under use of continuous positive airway pressure and interest in alternative therapy in patients with obstructive sleep apnoea: a questionnaire-based survey

BACKGROUND

Obstructive sleep apnoea (OSA) is associated with a variety of adverse health outcomes. Continuous positive airway pressure (CPAP) is considered first-line treatment for sleep apnoea patients, but there are few studies on oral health in patients with OSA who are using CPAP.

OBJECTIVE

This study aimed to estimate the prevalence of oral symptoms and interest in alternative treatments such as oral appliance (OA) therapy in CPAP users.

METHODS

A questionnaire was used to ascertain oral health including denture use, oral symptoms at present and since the start of CPAP, and interest in OA therapy. Relevant demographic and clinical data were collected from medical records.

RESULTS

The 744 participants who completed the questionnaire had following characteristics (mean ± standard deviation): age (55.1 ± 12.9 years); apnoea-hypopnoea index (40.9 ± 23.2/h); body mass index (27.9 ± 5.2 kg/m(2) ) and length of CPAP usage (49.1 ± 30.7 months); halitosis (30.4%); and gingival bleeding (27.5%). Nearly half (44.6%) complained of dry mouth since beginning CPAP therapy. Patients with diabetes were older (57.8 ± 11.9 vs. 54.2 ± 12.8 years), had a higher rate of denture use (28.3 vs. 19.0%), more dental clinic visits (71.4 vs. 58.7%) and more oral symptoms (50.0 vs. 38.2%) than non-diabetes patients (p < 0.05). Thirty-eight per cent of subjects were interested in OA therapy.

CONCLUSIONS

This study exhibited that almost 40% of CPAP users had oral symptoms. In particular, OSA patients with diabetes may be at high risk of oral disease.

Socio-demographic and behavioural inequalities in the impact of dental pain among adults: a population-based study

OBJECTIVES

To assess socio-demographic and behavioural inequalities in the impact of dental pain on daily activities, as well as to estimate the prevalence and intensity of dental pain.

METHODS

A population-based cross-sectional study was carried out in Florianopolis, Southern Brazil, with 1720 adults aged 20-59 years in 2009-2010. Interviews were performed at adults' households, which included socio-demographics and behavioural characteristics, such as smoking status and alcohol abuse, along with mental health, self-reported health, number of retained teeth, dental pain occurrence (including its intensity and its impact on daily life). The association between the impact of dental pain and the covariates was tested using multinomial logistic regression.

RESULTS

The global prevalence of dental pain was 14.8% (95% CI, 12.9-16.7). Adjusted analysis showed that women, those who self-classified as dark-skinned Blacks, those with low family income, current smokers and those with common mental disorders reported a higher impact of dental pain than their counterparts. Among subjects reporting dental pain, 12.7% indicated the maximum intensity, whereas 6.0% had some daily activity disrupted by it, such as difficulties in chewing certain foods (38.0%), sleep disturbance (21.0%), difficulty to work (21.0%) and difficulty in performing household tasks (8.0%). Prevalence ratios of impact of dental pain between the poorest income group and richest income group (2.4), between the highest and lowest schooling group (2.6), and between dark-skinned Blacks and Whites (2.1) were of higher magnitude than the dental pain prevalence ratios among the same groups (1.7, 1.3 and 1.4, respectively).

CONCLUSIONS

The impact of dental pain showed a social gradient. Inequalities between socio-economic groups found in this study should be taken into account, as the impact of dental pain leads to reduced daily activities and poor quality of life.

Autopercepção da mastigação e fatores associados em adultos brasileiros

Propôs-se estimar a prevalência da autopercepção da mastigação e investigar os fatores relacionados à autopercepção regular e ruim. Foram entrevistados e examinados 13.431 adultos, participantes do projeto SBBrasil. Foram realizadas análises descritiva, bivariada (χ2; p < 0,20) e multivariada por meio de regressão logística multinomial (p < 0,05), com IC95%. 55,6% classificaram a mastigação como boa; 24,9%, como regular; e 19,5%, como ruim. Na analise bivariada, todos os fatores foram associados à autopercepção da mastigação regular ou ruim (p < 0,20). No modelo final, os fatores associados tanto com a percepção regular como ruim foram: não receber informações sobre como evitar problemas bucais, apresentar menos de 23 dentes remanescentes, necessitar de prótese parcial ou total, perceber a saúde bucal como regular ou ruim/péssima, relatar dor em dentes e gengivas e necessidade de tratamento odontológico. Conclui-se que diversos fatores associam-se à autopercepção da mastigação, principalmente as condições subjetivas, reforçando sua importância como indicador em saúde bucal.

Avaliação do impacto na qualidade de vida causado por problemas bucais na população adulta e idosa em município da Região Sudeste

OBJETIVO: Avaliar a prevalência de impactos dos problemas bucais na qualidade de vida e associação com variáveis sociodemográficas, clínicas e utilização de serviços por adultos e idosos de Marechal Floriano, ES. MÉTODOS: Este estudo transversal utilizou uma amostra aleatória de 237 indivíduos. Foram utilizados roteiros para a coleta de dados incluindo o perfil do impacto de saúde bucal (OHIP-14). Os testes qui-quadrado e exato de Fischer (p<0,05) verificaram associações entre cada variável independente e as dimensões do OHIP. Para avaliar a força da associação entre evento e exposição foi calculado o Odds-radio. A análise de regressão logística foi realizada para valores significantes até 10%. O pacote estatístico utilizado foi SPSS versão 15. RESULTADOS: A maior percepção de impacto foi encontrada em indivíduos com mais de 40 anos (OR= 2,37), com necessidade declarada de prótese parcial removível (OR= 2,771), e de prótese total removível (OR= 2,292). CONCLUSÃO: A prevalência de impacto observada foi de 35% e associada à faixa etária e à necessidade declarada de prótese. Indicadores subjetivos devem ser utilizados de forma complementar aos indicadores objetivos para determinar a necessidade de tratamento, melhorando a saúde bucal e a qualidade de vida das pessoas.

The social and behavioural pathway of dental caries experience among Jewish adults in Jerusalem

AIMS

To report dental caries status, related health behaviours and social determinants among a representative sample of adults residing in Jerusalem.

METHODS

This cross-sectional study was conducted using a stratified sample of 254 Jewish and married adults aged 35-44 years in Jerusalem. Dental caries status was examined according to DMFT, percentage of caries-free persons and of people maintaining all their natural teeth (no teeth missing due to caries). The results were analysed by the independent variables and interpreted by weighted caries scores for the total Jerusalem population.

RESULTS

The mean age was 38.63 years. Weighted DMFT was found to be 10.59; 6.8% of the population were caries-free; 67.1% demonstrated maintenance of all natural teeth. Level of education was the distal factor, associated with number of natural teeth, DMFT and untreated decay. Mediating behavioural determinants included dental attendance, plaque level and sugar consumption.

DISCUSSION

The findings of this study demonstrated that caries experience among Jewish married adults in Jerusalem was moderate with low unmet dental caries needs. Additionally, data confirmed that a low level of education was a strong distal social determinant of caries experience, which affected dental health status via a pathway mediated by behavioural factors.

Desigualdades contextuais e individuais da prevalência de dor dentária em adultos e idosos no Brasil

O objetivo deste estudo foi conhecer a prevalência de dor dentária e fatores associados em adultos e idosos residentes nas capitais brasileiras usando os dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL), de 2009 (n = 54.367). Dor dentária foi a variável dependente. Macrorregião, idade, sexo, raça, escolaridade, posse de plano de saúde, tabagismo e consumo de refrigerantes foram as variáveis exploratórias. Foram realizadas regressões de Poisson multinível. A prevalência de dor dentária foi de 15,2%; Macapá e São Luís apresentaram prevalências maiores que 20% enquanto em todas as capitais do Sul e Sudeste, em Cuiabá, Campo Grande, Maceió, Recife e Natal foram encontradas prevalências menores que 15%. Residentes no Norte e Nordeste, mulheres, pretos e pardos, aqueles que não possuem plano de saúde, tabagistas e consumidores de refrigerantes apresentaram as maiores prevalências de dor dentária. A dor dentária é um problema de saúde pública que deve ser monitorado pelos sistemas de vigilância em saúde.

Quality of life related to oral health: contribution from social factors

Sociodental indicators have been widely used in epidemiological research related to oral health, as they add the dimension of the impact of oral health on the quality of life of individuals and populations. Various studies have been done in order to validate new instruments to assess these subjective perceptions, however, the association between social parameters and impact on oral health-related quality of life (OHRQoL) has not been systematically studied, thus there is still doubt as to the role of the main social variables as OHRQoL impact modulators. This study aims to systematically review the literature in order to evidence the association between six social parameters and OHRQoL. Based on six exclusion criteria, the literature search revealed 40 eligible publications for analyses. The frequency of expected (positive) association between the social parameters and OHRQoL was greater than the non-expected (negative) associations for the six parameters.

CONCLUSIONS

The social conditions most clearly associated with the perception of negative impact on OHRQoL were: women, with poor education and low income, immigrants or people belonging to minority ethnic groups.

Association between dietary quality of rural older adults and self-reported food avoidance and food modification due to oral health problems

OBJECTIVES

To quantify the association between food avoidance and modification due to oral health problems, to examine the association between food practices and dietary quality, and to determine foods associated with these self-management behaviors.

DESIGN

Cross-sectional.

SETTING

Rural North Carolina.

PARTICIPANTS

Six hundred thirty-five community-dwelling adults aged 60 and older.

MEASUREMENTS

Demographic and food frequency data and oral health assessments were obtained during home visits. Avoidance (0, 1-2 foods, 3-14 foods) and modification (0-3 foods, 4-5 foods) due to oral health problems were assessed for foods representing oral health challenges. Food frequency data were converted into Healthy Eating Index-2005 (HEI-2005) scores. Linear regression models tested the significance of associations between HEI-2005 measures and food avoidance and modification.

RESULTS

Thirty-five percent of participants avoided three to 14 foods, and 28% modified four to five foods. After adjusting for age, sex, ethnicity, poverty, education, and tooth loss, total HEI-2005 score was lower (P<.001) for persons avoiding more foods and higher for persons modifying more foods (P<.001). Those avoiding three to 14 foods consumed more saturated fat and energy from solid fat and added sugar and less nonhydrogenated fat than those avoiding fewer than three foods. Those who modified four to five foods consumed less saturated fat and solid fat and added sugar but more total grains than those modifying fewer than four foods.

CONCLUSION

Food avoidance and modification due to oral health problems are associated with significant differences in dietary quality. Approaches to minimize food avoidance and promote food modification by persons having eating difficulties due to oral health conditions are needed.

Long-term dental visiting patterns and adult oral health

To date, the evidence supporting the benefits of dental visiting comes from cross-sectional studies. We investigated whether long-term routine dental visiting was associated with lower experience of dental caries and missing teeth, and better self-rated oral health, by age 32. A prospective cohort study in New Zealand examined 932 participants' use of dentistry at ages 15, 18, 26, and 32. At each age, routine attenders (RAs) were identified as those who (a) usually visited for a check-up, and (b) had made a dental visit during the previous 12 months. Routine attending prevalence fell from 82% at age 15 to 28% by 32. At any given age, routine attenders had better-than-average oral health, fewer had teeth missing due to caries, and they had lower mean DS and DMFS scores. By age 32, routine attenders had better self-reported oral health and less tooth loss and caries. The longer routine attendance was maintained, the stronger the effect. Routine dental attendance is associated with better oral health.

Severe tooth loss in older adults as a key indicator of compromised dietary quality

OBJECTIVE

Poor oral health influences the dietary quality of older individuals. The objective of the present study was to relate the number of teeth to adherence to the 2005 Dietary Guidelines for Americans among an ethnically diverse sample of older adults.

DESIGN

A block cluster design was used to obtain a sample of older adults. Data were weighted to census data for ethnicity and gender. Dietary intakes were assessed using an FFQ and converted into Healthy Eating Index-2005 (HEI-2005) scores.

SETTING

Two counties in North Carolina, USA, with large African-American and American Indian populations.

SUBJECTS

Community-dwelling older adults (N 635).

RESULTS

Three hundred and twenty-six participants had severe tooth loss (0-10 teeth remaining), compared with 305 participants with 11+ teeth. After controlling for socio-economic factors, those with 0-10 teeth had lower total HEI-2005 scores and consumed less Total Fruit, Meat and Beans, and Oils, and more energy from Solid Fat, Alcohol and Added Sugar, compared with those with 11+ teeth. Less than 1 % of those with 0-10 teeth and 4 % of those with 11+ teeth met overall HEI-2005 recommendations. Those with 0-10 teeth were less likely to eat recommended amounts of Total Vegetables, Dark Green and Orange Vegetables, and energy from Solid Fat, Alcohol and Added Sugar.

CONCLUSIONS

Older adults with severe tooth loss are less likely than those with moderate to low tooth loss to meet current dietary recommendations. Nutrition interventions for older adults should take oral health status into consideration and include strategies that specifically address this as a barrier to healthful eating.

Disparities in oral health status between older adults in a multiethnic rural community: the rural nutrition and oral health study

OBJECTIVES

To compare oral health status according to ethnicity and socioeconomic status in African-American, American-Indian, and white dentate and edentulous community-dwelling older adults.

DESIGN

Cross-sectional study; data from self-reports and oral examinations.

PARTICIPANTS

A multistage cluster sampling design was used to recruit 635 participants aged 60 and older from rural North Carolina counties with substantial African-American and American-Indian populations.

MEASUREMENTS

Participants completed in-home interviews and oral examinations. Self-reported data included sociodemographic indicators; self-rated oral health status; presence or absence of periodontal disease, bleeding gums, oral pain, dry mouth; and fit of prostheses. Oral examination data included number of teeth and numbers of anterior and posterior functional occlusal units.

RESULTS

African Americans and American Indians had significantly lower incomes and educational attainment than whites. Self-rated oral health was significantly better in whites than in African Americans and American Indians. Prevalence of self-reported periodontal disease and bleeding gums was lower in whites. Of dentate participants, African Americans were significantly more likely than whites to have 11 to 20 teeth and one or two posterior occlusal contacts. Oral health deficits remained associated with ethnicity when adjusted for socioeconomic variables.

CONCLUSION

Oral health disparities in older adults in a multiethnic rural area were largely associated with ethnicity and not socioeconomic status. Clinicians should be aware of these health disparities in oral health status and their possible role in disparities in chronic disease. Further research is necessary to understand whether these oral health disparities reflect current or lifetime access to care, diet, or attitudes toward oral health care.

Oral health and oral treatment needs in patients fulfilling the DSM-IV criteria for dental phobia: Possible influence on the outcome of cognitive behavioral therapy

OBJECTIVE

To describe oral health and oral treatment needs in a group of dental phobic patients (DSM-IV) and to explore possible relationships between these factors and changes in self-reported dental anxiety before and after phobia treatment.

MATERIAL AND METHODS

Forty patients (25 women) fulfilling the DSM-IV criteria for specific phobia were included in the study. Mean age of the group was 34.9 years (range 19-60) and mean dental avoidance was 11.2 years (range 3-30 years). They were treated with cognitive behavioral therapy (CBT) during either one session (3 h) or five sessions (1 h each). Oral health was evaluated by orthopantomogram and clinical examination. The outcome of the CBT was measured by the change in dental anxiety scores (DAS, DFS) and in positive and negative thoughts during a standardized dental behavior test from pretreatment to 1-year follow-up.

RESULTS

Mean (SD) DMFT was 16.5 (5.8), range 3-26; DT was 6.6 (4.2). Mean number of teeth with dental treatment need (restorative, periodontal, extractions, etc.) was 9.6 (6.9), range 1-28. There were statistically significant correlations between number of decayed teeth and decrease in negative thoughts (r=-0.39, p=0.048) and maximum anxiety (r=-0.65, p=0.001). The total number of teeth with treatment need correlated with an increase in positive thoughts (r=0.60, p=0.001) and decrease in maximum anxiety (r=0.50, p=0.015).

CONCLUSIONS

There are large variations in oral health and treatment needs among patients fulfilling the DSM-IV criteria for dental phobia. Patients with the best dental health and lowest treatment needs experience the largest increase in positive cognitions during exposure to dental treatment at 1-year follow-up.

Validity of self-reported periodontal status in the Florida dental care study

BACKGROUND

Our objectives were to assess the validity of self-reported periodontal status by quantifying the 1) concordance between self-reported and clinical status at baseline; and 2) validity using a multivariable regression of self-reported periodontal status and sociodemographic status.

METHODS

The Florida Dental Care Study was a prospective study that used a population-based, stratified random sample of 873 persons in four counties of north Florida who were > or = 45 years of age at baseline. Analyses used baseline data derived from in-person interviews and clinical periodontal examinations. Multivariable logistic regressions were done to quantify the relationships between the outcome (clinically determined periodontal attachment level) and predictors (self-reported dental symptoms, self-reported dental behaviors, sociodemographic circumstances, and clinically determined number of remaining teeth).

RESULTS

Self-rated "gum" health and presence of a loose tooth were the only periodontal measures that were associated significantly with clinically determined periodontal status in multivariable regressions. The validity of self-reported periodontal status improved when the threshold of severity was increased. Significant racial differences in the validity of self-reports were evident.

CONCLUSION

Self-reported measures of periodontal status were related to clinically measured periodontal attachment loss and warranted classifying their validity as "moderate" and useful for some circumstances.

Orofacial pain: patient satisfaction and delay of urgent care

OBJECTIVE

Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will require a better understanding of the patterns of health care associated with orofacial pain. This study examined factors associated with pain-related acute oral health care.

METHODS

The authors used data on 698 participants in the Florida Dental Care Study, a study of oral health among dentate adults aged 45 years and older at baseline.

RESULTS

Fifteen percent of the respondents reported having had at least one dental visit as the result of orofacial pain. The majority of the respondents reportedly delayed contacting a dentist for at least one day; however, there was no difference between respondents reporting pain as the initiating symptom and those with other problems. Once respondents decided that dental services were needed, those with a painful symptom were nearly twice as likely as those without pain to want to be seen immediately. Rural adults were more likely than urban adults to report having received urgent dental care for a painful symptom. When orofacial pain occurred, those who identified as non-Hispanic African American were more likely than those who identified as non-Hispanic white to delay care rather than to seek treatment immediately, and women were more likely then men. Having a pain-related oral problem was associated with significantly less satisfaction with the services provided; non-Hispanic African American respondents were less likely than non-Hispanic white respondents to report being very satisfied, and rural residents were less likely than urban residents. Furthermore, men were more likely than women to suffer with orofacial pain without receiving either scheduled dental care or an urgent visit.

CONCLUSIONS

Barriers to care are complex and likely to be interactive, but must be understood before the goals of Healthy People 2010 can be accomplished.

Effectiveness of dental services in facilitating recovery from oral disadvantage

OBJECTIVE

To determine the effectiveness of dental health care services in facilitating recovery from quality of life decrements in symptom-specific subgroups with the most prevalent chronic infectious diseases (periodontal disease and dental caries), and a 'stained teeth' subgroup.

METHODS

Data were taken from the prospective longitudinal Florida Dental Care Study of 873 individuals 45+ years old. Logistic regression modeling quantified associations between recovery from oral health-related quality of life decrements ('recovery') and dental services.

RESULTS

Adjusting for age, race, gender, income, approach to dental care, and signs/symptoms, any dental visit (odds ratio, OR: 4.0; 95% confidence interval, CI: 2.3, 6.9), corrective treatment (OR: 3.8; 95% CI: 1.6, 8.7), denture visit (OR:4.8; 95% CI: 1.1, 21.9), or extraction (OR: 6.2; 95% CI: 2.2, 17.4) were positively associated with recovery. Upon conditioning the analyses on specific symptoms, point estimates increased substantially for most service types, and dental cleaning was associated with recovery for the stained teeth subgroup (OR: 10.9; 95% CI: 1.2, 99.4).

CONCLUSION

Dental care was highly effective in treating quality of life decrements. Treatment effectiveness increased substantially when analyses were restricted to symptom-specific subgroups similar to selection criteria of randomized clinical trials (RCTs). Restricted cohort analyses can be applied to many other health outcomes for which RCTs are not feasible or ethical.

Dental status and oral health quality of life in economically disadvantaged French adults

Expansion of French health insurance coverage has increased funding for dental care for economically disadvantaged adults. This study aimed to measure clinical and self-perceived oral health, behaviors, and use of dental services by adults who were eligible for such coverage. The regional agency that gives administrative services for the health insurance funds provided a sample of 900 adults aged 35-44 years, insured through this program. We reached 805 of these adults by mail; of these 18% were surveyed and clinically examined. Self-perceived oral health was measured by the Global Oral Health Assessment Index (GOHAI) and participants' attitudes to dental health, by questionnaire. Decayed and Missing teeth constituted 40% of the DMFT. Participants reported poor oral health (63%), and 79% perceived a need for care, although they used dental services infrequently and had poor knowledge of available services. Cost of care and number of carious teeth were important predictors of the GOHAI.

A cohort study found racial differences in dental insurance, utilization, and the effect of care on quality of life

OBJECTIVE

To describe racial differences in receipt of dental services and dental insurance; and to determine the effectiveness of specific dental services in facilitating recovery in symptom-specific and race-specific subgroups.

STUDY DESIGN AND SETTING

Using a restricted cohort analytic method, Florida Dental Care Study prospective cohort data were used to quantify associations between dental service use and the quality of life measure, "recovery" from oral disadvantage due to functional limitation.

RESULTS

Non-Hispanic Whites (NHW) were more likely to have a dental visit [odds ratio (OR); 95% confidence interval: 3.5; 2.2-5.3], corrective treatment (OR=2.1; 1.3-3.3), caps (OR=28.8; 6.6-126.4), and dental insurance coverage for caps (OR=2.9; 1.4-5.9). After adjusting for other covariates: (1) among NHW with severe gum disease, those receiving extractions were more likely to recover (OR=7.8; 1.0-59.1), but those receiving caps were less likely to recover (OR=0.1; 0.01-0.6); (2) among Non-Hispanic Blacks (NHB) with a sensitive tooth, those receiving corrective treatment (OR=3.2; 1.2-8.8) or extractions (OR=3.8; 1.3-11.2) were more likely to recover; (3) among NHB with tooth disease, those receiving corrective treatment (OR=2.3; 1.0-5.0) and extractions (OR=2.8; 1.2-6.5) were more likely to recover.

CONCLUSION

There were racial differences in dental insurance, in the receipt of dental services and in the effectiveness of dental services in improving oral health-related quality of life.

The dynamics of toothache pain and dental services utilization: 24-month incidence

OBJECTIVES

The aims of this study were twofold: (1) to describe patterns of change in reported toothache pain, and (2) to examine the impact of toothache pain on dental care utilization and vice versa.

METHODS

Data from the Florida Dental Care Study (FDCS), a longitudinal study of oral health and dental service utilization conducted in north Florida, were used to measure self-reported toothache pain among dentate adults at baseline and four subsequent times during a 24-month period. Only persons 45 years of age or older with at least one remaining natural tooth at baseline were eligible. A total of 873 subjects participated, 764 of whom participated through 24 months. The analysis is focused on modeling transitions in the reported experience of toothache pain during intervals of six months.

RESULTS

At the time of the baseline interview, 11.5 percent of subjects reported current toothache pain. During subsequent six-monthly interviews, from 13.4 percent to 21.6 percent of subjects reported having experienced toothache pain during the prior six-month interval. Among those with no toothache pain at baseline (n = 772), 31.2 percent experienced toothache pain at some time during the 24-month study period. The six-month incidence probability reflects the likelihood of developing toothache pain by estimating the conditional probability of reporting a toothache in a later interval given that this problem was not reported in the earlier one (for consecutive pairs of intervals). Overall, the six-month incidence probability for toothache pain in this study was. 11. Significantly higher 24-month incidence was observed for African-American subjects, those with less formal education, those in poorer financial circumstances, and problem-oriented dental attenders.

CONCLUSIONS

In this diverse sample of adults, toothache pain occurs frequently and is quite variable overtime. Toothache occurs in conjunction with various forms of self-reported oral disease (e.g., abscess, cavities) or tissue damage (e.g., loose tooth, broken tooth, bleeding gums). Subjects who experience toothache are slightly more likely than others to utilize dental services in the time period proximate to the toothache pain.

Two-year incidence of oral disadvantage, a measure of oral health-related quality of life

Dental research has progressed from describing the burden of oral disease using traditional epidemiologic measures of incidence and prevalence, to measuring how oral disease, oral signs, and oral symptoms affect the daily activities and the overall quality of life of the individual. However, longitudinal evaluation of these associations remains rare.

OBJECTIVES

To (i). describe the 2-year incidence and patterns of oral disadvantage; (ii). identify dimensions of oral health measures that are significant antecedents of oral disadvantage; and (iii). determine which oral health dimensions are the most strongly predictive of oral disadvantage.

METHODS

The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth and were 45 years or older. Incidence rates, odds ratios, and 95% confidence intervals were used to describe oral disadvantage and its relation to other measures of oral health.

RESULTS

Nearly one-half of the participants experienced oral disadvantage at least once during 24 months of follow-up. The strongest antecedents associated with oral disadvantage were toothache pain and chewing difficulty.

CONCLUSIONS

The incidence of oral disadvantage is substantial and consistent with the notion that oral health has a substantial impact on quality of life. Measures of oral pain and oral functional limitation were more strongly predictive of oral disadvantage than disease and tissue damage antecedents.

The paradox of dental need in a population-based study of dentate adults

BACKGROUND

Studies typically find that predisposing and enabling factors strongly predict dental utilization, but that need factors do not. However, few longitudinal studies have been conducted, and few have comprehensively measured dental need.

OBJECTIVES

To describe the paradox of dental need, and to test three hypotheses regarding need and dental care use.

MATERIALS AND METHODS

An observational study that included 873 persons who participated for interview and clinical examination at baseline and 24 months, with 6-month telephone interviews in between.

RESULTS

Persons who entered the dental care system during follow-up were actually in better dental health than those who did not. The ability of need factors to predict dental care use, and in which direction, varied with how dental need and the dental care use outcome were measured (eg, care of any type, problem-related care, to receive a dental cleaning, to get a dental checkup).

CONCLUSIONS

A substantial number of dental problems remained or developed among the population that did not enter the dental care system. The paradox of dental need has three components: (1) need predicts dental care use but is dependent upon how need is measured; (2) however, persons with a higher probability of new dental problems are actually less likely to seek dental care; and (3) self-reported disease and oral pain are associated with a higher likelihood of seeking care, whereas clinically-determined need, such as chewing difficulty, lower self-rating, and satisfaction with oral health, are actually associated with a lower likelihood, the former direction being the predominant and expected direction.

Socioeconomic and demographic disparities in symptoms of orofacial pain

OBJECTIVES

The purpose of this study was to document the association between socioeconomic status (SES) and the prevalence and impact of orofacial pain by anatomical location. In addition, differential effects of SES on orofacial pain across levels of sex, race, and age were documented.

METHODS

The subjects were 724 participants in the Florida Dental Care Study, a study of oral health among dentate adults, aged 45 years and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites using a standardized telephone interview.

RESULTS

Lower SES was associated with reporting pain and pain impact at many, but not all, of the orofacial sites. Some sex, race, and age cohort differences in orofacial pain were found when adjusting for differences in socioeconomic position. The most consistent result, as evidenced by similar findings across orofacial pain sites, was that the effects of SES on orofacial pain appear to have a sex-differentiated effect.

CONCLUSION

Consistent with findings for other subjective measures of oral health, persons of lower SES are at increased risk for orofacial pain and pain-related behavioral impact.

Predicting tooth loss during a population-based study: role of attachment level in the presence of other dental conditions

BACKGROUND

Our objectives were to quantify: 1) the association between incident tooth loss and prior periodontal attachment level; and 2) the contribution to tooth loss made by non-periodontal conditions in increasingly periodontally involved teeth.

METHODS

The Florida Dental Care Study was a prospective cohort study of persons who at baseline had at least 1 tooth and were 45 years or older. In-person interviews and clinical examinations were conducted at baseline, and at 24 and 48 months, with telephone interviews at 6-month intervals in between. A regression model was used to simultaneously quantify tooth-specific predictors of tooth loss, with person-level factors taken into account.

RESULTS

Of the 687 persons who participated for a 48-month clinical examination, 36% lost 1 or more teeth during follow-up, and 5.0% of all teeth were lost. Attachment level up to 2 years before tooth loss was strongly predictive of incident tooth loss, with increases in risk for each millimeter in attachment loss. Certain other tooth-specific conditions (tooth mobility, bulk restoration fracture, decayed surfaces, filled surfaces, tooth type and arch location, root fragment) were strongly and independently associated with increased risk for tooth loss, while others were not (prosthetic crown coverage, cusp fracture, root surface defect). Propensity to choose extraction over other treatment alternatives, as reported by participants at baseline, was also strongly predictive of tooth loss.

CONCLUSIONS

Increasingly severe attachment level was consistently associated with an increased risk for tooth loss in this sociodemographically diverse sample, with or without other tooth-specific conditions taken into account.

Tooth loss occurring at a place other than a health-care facility: 72-month incidence

Dental care can occur within or outside the formal health-care system. We hypothesized that certain subject characteristics would partly explain one type of dental self-care, non-professional extractions. A representative sample of diverse groups of dentate adults was studied. In-person interviews and clinical examinations were conducted at baseline, 24, 48, and 72 months, with semi-annual telephone interviews in between. Of 699 participants, 291 (42%) reported loss of at least one tooth, of whom 42 (14% of those with tooth loss) reported having lost the tooth at a place other than a health-care facility. Ninety-four percent of non-professionally lost teeth were self-extracted; relatives extracted the remainder. Fifty-eight percent of these teeth were deliberately removed; the remainder came out while subjects were eating or brushing their teeth, or due to injury. Attachment loss and mobility at previous examination were consistent with the occurrence of non-professional extraction. The incidence magnitude was substantive and persistent throughout follow-up.

Racial differences in predictors of dental care use

OBJECTIVE

To test five hypotheses that non-Hispanic African Americans (AAs) and non-Hispanic whites (NHWs) differ in responsiveness to new dental symptoms by seeking dental care, and differ in certain predictors of dental care utilization.

DATA SOURCES/STUDY SETTING

Florida Dental Care Study, comprising AAs and NHWs 45 years old or older, who had at least one tooth, and who lived in north Florida.

STUDY DESIGN

We used a prospective cohort design. The key outcome of interest was whether dental care was received in a given six-month period, after adjusting for the presence of certain time-varying and fixed characteristics.

DATA COLLECTION/EXTRACTION METHODS

In-person interviews were conducted at baseline and 24 months after baseline, with six-monthly telephone interviews in between.

PRINCIPAL FINDINGS

African Americans were less likely to seek dental care during follow-up, with or without adjusting for key predisposing, enabling, and oral health need characteristics. African Americans were more likely to be problem-oriented dental attenders, to be unable to pay an unexpected $500 dental bill, and to report postbaseline dental problems. However, the effect of certain postbaseline dental signs and symptoms on postbaseline dental care use differed between AAs and NHWs. Although financial circumstance was predictive for both groups, it was more salient for NHWs in separate NHW and AA regressions. Frustration with past dental care, propensity to use a homemade remedy, and dental insurance were significant predictors among AAs, but not among NHWs. The NHWs were much more likely to have sought care for preventive reasons.

CONCLUSIONS

Racial differences in responsiveness to new dental symptoms by seeking dental care were evident, as were differences in other predictors of dental care utilization. These differences may contribute to racial disparities in oral health.

A prospective study of the validity of data on self-reported dental visits

OBJECTIVE

To measure the validity of self-reported dental visits from a diverse sample of adults.

METHODS

The Florida Dental Care Study was a longitudinal cohort study of a diverse sample of residents of north Florida, USA. In-person interviews and dental examinations were conducted at baseline, 24 and 48 months after baseline, with half-yearly telephone interviews in between. Dental record information was abstracted afterward.

RESULTS

Agreement between self-report and dental record at each half-yearly interview ranged from 84 to 91%. Validity did not differ between persons of key sociodemographic groups (sex, race, age group, rural/urban residence, poverty status, level of formal education, or problem-oriented/regular approach to dental care). In a single bivariate multiple logistic regression (two outcomes: (i) self-reported use; and (ii) use measured from the dental chart), odds ratio estimates over-lapped for each of the 20 predictors.

CONCLUSIONS

Validity of self-reported dental care use was good. There would have been few differences in conclusions made about predictors of dental care use had chart data been available earlier.

Comparison of two methods of estimating 48-month tooth loss incidence

OBJECTIVES

This paper quantifies validity of self-reported tooth loss, compares incidence using two methods (semiannual self-report, biannual clinical examination), and compares conclusions about risk factors for tooth loss using these two methods.

METHODS

The Florida Dental Care Study included persons who at baseline had at least one tooth. In-person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with semiannual telephone interviews in between.

RESULTS

Agreement between self-reported and clinically derived tooth loss was high, although some statistically significant differences by certain baseline characteristics were evident. On a nominal scale (some tooth loss, none), kappa was 0.88 and percent concordance was 94 percent. On a ratio scale, Spearman's correlation was 0.90. Using self-report, the incidence estimate would have been 34 percent, as compared to 36 percent based on clinical examination. In a single bivariate (loss by self-report, loss by clinical examination) multiple logistic regression, conclusions about statistical significance and magnitude of seven risk factors for tooth loss did not differ.

CONCLUSIONS

Validity of self-reported incidence was excellent. The self-reported method allowed for semiannual estimates and was less resource intensive. Substantive conclusions about tooth loss using either method were similar, although validity did differ between persons with certain baseline characteristics.

Racial and socioeconomic disparities in oral disadvantage, a measure of oral health-related quality of life: 24-month incidence

OBJECTIVES

This paper estimates the incidence of oral disadvantage based on the subject's approach to dental care, sex, race, and financial status; identifies demographic and socioeconomic characteristics that were associated with oral disadvantage; and determines if these characteristics were differentially associated with the three domains of oral disadvantage.

METHODS

The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth, were 45 years or older, and were either African American or non-Hispanic white. Incidence rates, odds ratios, and 95 percent confidence intervals were used to describe oral disadvantage and its relation to race, income, and other key sociodemographic characteristics.

RESULTS

The strongest independent predictors of oral disadvantage were approach to dental care (problem-oriented attenders or regular), and situation if faced with an unexpected $500 dental bill. Demographic and socioeconomic characteristics were differentially associated with each disadvantage domain.

CONCLUSIONS

African Americans, females, rural residents, individuals who did not graduate from high school, individuals with limited financial resources, and problem-oriented dental attenders had significantly higher occurrences of oral disadvantage. Racial and sex disparities in oral disadvantage were largely explained by differences in approach to dental care and financial resources between these groups.

Use of specific dental treatment procedures by dentate adults during a 24-month period

OBJECTIVES

To (a) describe the incidence of use of specific dental services; (b) test the hypothesis that certain predisposing, enabling, and need (PEN) factors are differentially predictive of service use; and (c) test the hypothesis that even with other PEN factors taken into account, race and household income are differentially predictive of certain dental services. Previously, this study identified PEN factors that predicted use of any care; herein we identify whether these same factors were differentially predictive of specific service use among users of at least one service.

METHODS

The Florida Dental Care Study was a longitudinal study of persons aged 45 years or older who had at least one tooth. Subjects participated for interviews and clinical examinations at baseline and 24 months later, with 6-monthly telephone interviews between those times.

RESULTS

Seventy-seven percent of subjects reported one or more visits. Results from a single multivariate multiple logistic regression suggested that even once analysis was limited to persons who used at least one dental service, at least one measure from each of the PEN domains was predictive of specific dental service use.

CONCLUSIONS

Each PEN domain was predictive of service use, even once limited to persons with at least one visit. Even with differences in other PEN variables taken into account, African-Americans were much less likely to receive dental cleanings, restorative dentistry and fixed prosthodontic services, and were much more likely to have a tooth extracted. Household income was predictive of receipt of fixed prosthodontic services, but not other service categories.

Racial differences in orofacial pain

This study investigated racial differences in the subjective report of orofacial pain in a stratified sample of adults dwelling in the community. The subjects were 724 participants in the Florida Dental Care Study, a longitudinal study of oral health among dentate adults aged 45 years and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites by means of a standardized telephone interview. The results suggest that white respondents were more likely to report painful oral sores than were black respondents (19.0% vs 6.3%). As was consistent with findings from patients seeking health care and laboratory-based experimental pain studies, a higher percentage of black subjects rated pain as severe enough to have an impact on behavior for temperature sensitivity (59.6% vs 30.3%), pain when chewing (70.0% vs 40.0%), and painful oral sores (53.8% vs 27.9%). These racial differences were most apparent within male sex for temperature sensitivity, pain when chewing, and toothache pain, with black men rating pain as more severe than white men. For jaw joint pain and painful oral sores, both black and white women rated pain as more severe than did white men. This study has documented race by sex interactions in the impact from orofacial pain across multiple symptoms in a community-based sample.

On Adding a Dental Practice Component to an Ongoing Longitudinal Population-based Study of Oral Health

OBJECTIVE

To determine the feasibility and effectiveness of adding a dental practice component to the Florida Dental Care Study (FDCS).

METHODS

The FDCS was a study of dental health in which no treatment was provided. In-person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with six-month telephone interviews between those times. Participants reported any dentists visited and treatment received. All but four of the 764 participants at the 24-month session gave written permission to review their dental records. Dental hygienist research assistants abstracted information on treatment that was received during the 48-month interval.

RESULTS

Of the 286 practices named by FDCS subjects, all but 10 (of whom five refused) practices participated. Eight practices allowed access to records, but did not allow us to record fees. Fees were unavailable at another 13 practices. Of the 764 persons who participated for the 24-month interview, 677 ultimately reported at least one dental visit during the first 48 months of the study. Of those 677, we located dental records on 619. We also found records on four of the 111 persons who reported no dental visits, by querying practices while recording information on other participants. Charts varied in comprehensiveness; nevertheless, in conjunction with office staff consultation, all practices had adequate record of what procedures were performed.

CONCLUSIONS

Although time intensive, this method of collecting data substantially increased information about dental treatment received, compared to relying on participant self-report and clinical examination.

Effects of dental attendance frequency in heavy and low private care-using young adults

In Finland, adults born in 1961 or later were progressively entitled to subsidies for dental care from private practitioners during 1986-90, while at the same time having access to care in the Public Dental Service. The aim of this study was to compare the effects of attendance frequency of private dental care on treatment costs and treatment spectrum for the heaviest and lowest users over a period. Three separate cohorts of recipients of reimbursements were formed, using the Social Insurance Register. The highest and lowest cost groups in 1986, 1990, and 1994 were followed up to 1997. Initially, the mean numbers of visits were 1.2-1.3 and 5.2-5.6 and cost Euro 48 53 and Euro 358-379 among low users and heavy users, respectively, in all cohorts. Among the heavy users (the high-cost category) infrequent attendance was related to higher and frequent attendance to lower mean annual costs of care. Among the low users (the low-cost category the opposite was true. Those who initially belonged to the high-cost category received in 1997 significantly more (P < 0.01) restorative treatment and, to a lesser extent, more (P < 0.01) preventive and periodontal treatment than those belonging to the low-cost category. Frequent dental care seemed to benefit those who received a lot of care. Frequency of attendance was not associated with being a low or a heavy user, indicating rigid check-up routines. The inclusion of simple oral health data would greatly improve the usefulness of the register as an evaluation tool for health-political decisions.

Coping with tooth pain: a qualitative study of lay management strategies and professional consultation

This research analyzes transcripts of semi-structured interviews with patients presenting with tooth pain at a rural dental clinic in North Florida. The primary objectives are to identify the strategies patients use to manage their pain and to elucidate the decision-making process leading to the clinic visit. Although respondents understood that their condition was not self-limiting, only about one-half contacted the clinic within several days of the onset of their pain. Most tried one or more lay management strategies.

Orofacial pain symptoms: an interaction between age and sex

This study investigated sex and age cohort differences in the subjective report of orofacial pain symptoms in a stratified sample of community dwelling adults. The subjects were 724 participants in the Florida Dental Care Study, a longitudinal study of oral health among dentate adults, age 45 and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites using a standardized telephone interview. The results suggest that the 6-month prevalence of jaw joint pain (8.3%), face pain (3.1%), toothache pain (12.0%), painful oral sores (15.6%), and burning mouth (1.6%) found in the FDCS sample are similar to United States population estimates. In addition, prevalence for pain when chewing and temperature sensitivity were also reported as 23% and 24% respectively, suggesting that these two seldom documented painful experiences are common. Female respondents reported higher 6-month prevalence for multiple symptoms and painful oral sores, with trends also observed for female sex as a risk factor for jaw joint pain and face pain, whereas males were more likely to report temperature sensitivity. A higher percentage of females rated their pain as severe enough to impact behavior for jaw joint pain, toothache pain, and painful oral sores. Few overall age effects were found, with the exception of higher prevalence of temperature sensitivity and pain when chewing in the 45--64-year-old group, compared to respondents in the 65+ age cohort. However, the most interesting finding was that when sex by age cohort comparisons were made, with the exception of painful oral sores, all significant differences in pain ratings were found within the 45--64-year-old cohort and not the 65+ group. This finding clarified inconsistencies found in earlier studies in the orofacial pain literature where sex differences in pain ratings were found in several adult samples of a wide range of ages but not in a sample of older adults.

Dental self-care among dentate adults: contrasting problem-oriented dental attenders and regular dental attenders

Self-care behaviors are common and can act as substitutes for or supplements to formal health care services. We tested the hypothesis that problem-oriented dental attenders (POAs) report more dental self-care behaviors than do regular dental attenders (RAs), presumably as a substitute for professional care. The Florida Dental Care Study is a longitudinal cohort study of changes in oral health, in which we measured dental self-care behaviors related to three common dental problems: toothache pain, bleeding gums, and tooth loss. Despite using less dental care, POAs were less likely to report "conventional" methods as means to prevent the three dental problems; however, they were more likely to report that homemade remedies, topical medications, or mouthwashes were ways to prevent or treat these problems. POAs were also more likely to believe that "nothing can be done" to prevent these problems. Additionally, POAs had more negative dental attitudes, used less dental care during follow-up, had more dental disease, were the only persons who extracted at least one of their own teeth, and were more likely to use tobacco. With the exception of dental self-extractions, no single self-care belief or behavior distinguished POAs from RAs, nor were POAs likely to have different explanations for dental problems. Instead, the pattern was one of modest differences on a number of items. Although POAs use less dental care, they do not compensate by employing more "conventional" dental self-care behaviors, but report being more likely to employ "unconventional" behaviors. They also are more likely to believe that nothing can be done to prevent dental problems.

Patterns of change in self-reported oral health among dentate adults

BACKGROUND

Although self-assessments of oral health have become useful tools in dental research, the use of self-reports to study changes in oral health over time has been limited. The aim of this investigation was to describe how oral disease and tissue damage, pain, functional limitation, disadvantage, and self-rated oral health change over time.

METHODS

The Florida Dental Care Study (FDCS) (n = 873) is a longitudinal study of oral health among dentate adults (age, > or = 45 years). Incidence rates and transition probabilities were used to describe changes in oral health over a 24-month period.

RESULTS

The probability of reporting a specific problem during the 24-month study ranged from 0.52 for perceived need for dental care to 0.07 for avoided eating with others. Only dental sensitivity and perceived need for dental care had transition probabilities >0.20. Decomposition of transition probabilities revealed moderate probabilities of onset coupled with relatively high probabilities of recovery.

CONCLUSION

Although oral health status is clearly dynamic, no individual measure exhibited profound fluctuation. Most oral health problems were episodic rather than chronic. Patterns of change in oral health varied across dimensional lines.

Tooth-specific and person-level predictors of 24-month tooth loss among older adults

OBJECTIVES

To describe: (1) the 24-month incidence of tooth loss in a diverse sample of dentate adults; and (2) the clinical, attitudinal, behavioral, and sociodemographic correlates of tooth loss incidence.

METHODS

The Florida Dental Care Study is a prospective longitudinal cohort study of persons who at baseline had at least one tooth, were 45 years or older, and who resided in north Florida. An in-person interview and clinical examination were conducted at baseline and 24-months after baseline, with 6-monthly telephone interviews between those times. A two-level hierarchical generalized linear regression (logit model) was used to quantify tooth-specific and person-level factors simultaneously.

RESULTS

Of the 739 persons who attended for a 24-month examination, 24% lost one or more teeth during follow-up. Tooth loss was more common in persons with dental disease at baseline, incident dental signs or symptoms, those with negative attitudes toward dental care and dental health, those with limited financial resources, older adults, blacks, females, and problem-oriented users of dental care (as distinct from regular attenders). Although disease presence at baseline was a major factor associated with incident tooth loss, most diseased teeth were in fact still present 24 months after baseline.

CONCLUSIONS

Other than periodontal attachment loss, severe tooth mobility, and dental caries, no single factor was a dominant predictor of tooth loss; instead, numerous factors made statistically significant but small contributions to variation in tooth loss. Tooth loss apparently is the result of complex interactions among dental disease, incident dental signs and symptoms, tendency to use dental care in response to specific dental problems, dental attitudes, and ability to afford non-extraction treatment alternatives.

Determinants of dental care use in dentate adults: six-monthly use during a 24-month period in the Florida Dental Care Study

The objective of this study is to describe for a diverse sample of dentate adults the incidence of dental care use and predisposing, enabling, and need correlates of that use. The Florida Dental Care Study (FDCS) is a prospective longitudinal cohort study of persons who at baseline had at least one natural tooth, were 45 years or older, and who resided in north Florida, U.S.A. An in-person interview and clinical dental examination were conducted at baseline and 24 months after baseline, with 6-monthly telephone interviews between those times. Seventy-seven percent of subjects reported one or more dental visits during the 24 months of follow-up. Six-monthly use ranged from 46% to 55%. Incident perceived need for care and certain incident self-reported oral signs and symptoms were strongly predictive of incident dental care use. Decrements in oral functional limitation, oral disadvantage, and self-rated oral health were predictive of less care bivariately, but were not salient in a multivariate model, with two notable exceptions: two measures related to esthetics. The conclusions are that certain measures of need (perceived need and specific self-reported signs and symptoms) were important predictors of incident dental care. However, persons with need as determined by direct clinical examination and persons with need as determined by self-reported decrements in the more distal measures of oral health (oral functional limitation, oral disadvantage, and self-rated oral health) were actually less likely to seek dental care. The salience of esthetics in predicting use is consistent with cross-sectional findings that dental esthetic cues are important to oral "health". Typical approach to care, dental attitudes, ability to pay for care, race, and sex were also important for understanding incident dental care use.