Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia

Enhancing Oral Hygiene in Children With Hearing Impairment: The Impact of Skit Video Interventions -A Randomized Controlled Trial

Aim. This study aimed to assess the effectiveness of 3 interventions-skit video, pictorial, and sign language-in improving the oral hygiene of children with hearing impairment. Materials and Methods. Sixty children randomly divided into 3 groups: Skit video, Pictorial, and Sign language. The mean gingival and Oral Hygiene Index scores were recorded before and after interventions. A 1-way ANOVA was used for statistically significant difference between pre and post intervention scores. Results. A significant difference in mean oral hygiene and gingival index scores before and after interventions was found in Group A (P < .005). A statistically significant difference was also found between group A and B in inter group comparison of OHI and GI scores post intervention (P < .004). Conclusion. Skit video and pictorial intervention effectively improves oral health resulting in reduced mean oral hygiene and gingival scores.

Frequency of Going Outdoors and Risk of Poor Oral Health Among Older Japanese Adults: A Longitudinal Cohort From the Japan Gerontological Evaluation Study

BACKGROUND

The association between the frequency of going outdoors and the risk of poor oral health has been reported in several studies; however, the findings have been inconclusive.

METHODS

We conducted a 3-year longitudinal study of 19,972 Japanese adults aged ≥65 years who reported no poor oral condition at baseline in 2013. The respondents rated their frequency of going outdoors in three categories (≤1, 2-3, or ≥4 times/week), and the oral conditions reported in 2016 included tooth loss, chewing difficulty, swallowing difficulty, dry mouth, and composite outcomes. The associations between the frequency of going outdoors and the risk of poor oral health were examined as relative risk ratios (RRs) and 95% confidence intervals (CIs) using multivariable Poisson regression, while mediation analysis was performed to investigate indirect effects.

RESULTS

During the follow-up, 32.5% of participants developed poor oral health. In the mediation analysis, indirect effects were observed through low instrumental activities of daily living, depressive symptoms, little social network diversity, and underweight. Compared to going outdoors ≥4 times/week, the multivariable RRs of composite poor oral health conditions were 1.12 (95% CI, 1.05-1.20) for 2-3 times/week and 1.22 (95% CI, 1.07-1.39) for ≤1 time/week (P-trend < 0.001). Similar associations were observed for tooth loss, chewing difficulty, and swallowing difficulty; the corresponding RRs were 1.07 (95% CI, 0.97-1.19) and 1.36 (95% CI, 1.13-1.64) (P-trend = 0.002), 1.18 (95% CI, 1.06-1.32) and 1.30 (95% CI, 1.05-1.60) (P-trend < 0.001), and 1.15 (95% CI, 1.01-1.31) and 1.38 (95% CI, 1.08-1.77) (P-trend = 0.002), respectively.

CONCLUSION

The frequency of going outdoors was inversely associated with the risk of poor oral health through several modifiable risk factors in the older population.

Socioeconomic, behavioral, and psychological factors related to oral health in Myanmar: A cross-sectional study

OBJECTIVES

This study aims to evaluate the effects of socioeconomic, behavioral, and psychological factors on oral health status and oral health-related quality of life in Myanmar adults.

METHODS

Data were from a convenience sample of Myanmar adults who are from a township health center in Yangon city. Face-to-face interviews using a paper-based questionnaire in the Myanmar language and clinical oral examinations were performed at the health center. Mann-Whitney U test and linear regressions were used to assess the association of socio-demographic, behavioral, and psychological variables with oral health outcomes.

RESULTS

In socio-demographic variables, significant associations were observed in individual income with periodontal pocket and OHIP-14, and history of COVID-19 infection with OHIP-14. However, there were no associations between behavioral factors and oral health outcomes. After adjustment for sex, age, educational level, and individual income, the depression subscale was statistically significant with the number of present teeth, decayed teeth, decayed, missing, and filled teeth, and OHIP-14. The anxiety subscale remained significant with periodontal pocket, but no stress subscale was associated with oral health outcomes.

CONCLUSION

The experiences of oral health status were high, and the oral health-related quality of life was unfavorable in Myanmar adults. A large proportion of them suffers from psychological distress. Additionally, individuals with lower income and who experienced a history of COVID-19 infection were susceptible to poor oral health-related quality of life. Psychological distress indicates a higher risk for oral health problems in Myanmar adults.

Social support and oral health among working-age and older adults in the United States

OBJECTIVES

The purpose of this study was to examine the association of social support with untreated dental caries and severe tooth loss in adults in the United States.

METHODS

This cross-sectional study was conducted by analyzing data obtained from 5,447 individuals, 40 years of age and older, in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 who had both a complete dental examination and social support index measures. Sample characteristics, overall and by social support level, were examined through descriptive statistical analyses. Logistic regression analyses were performed to estimate the association of social support with untreated dental caries and severe tooth loss.

RESULTS

In this nationally representative sample (mean age 56.5 years) the prevalence of low social support was 27.5%. The prevalence of individuals with moderate-to-high social support increased with higher levels of educational attainment and income level. In fully adjusted models, relative to those who had moderate-high social support levels, individuals with low social support had 1.49 higher odds of untreated dental caries (95% CI, 1.17-1.90, p=0.002) and 1.23 higher odds of severe tooth loss (95% CI, 1.05-1.44, p=0.011).

CONCLUSIONS

Higher odds of untreated dental caries and severe tooth loss were found among U.S. adults with low levels of social support compared to those with moderate-to-high levels of social support. Additional studies are warranted to provide a more current perspective on the impact of social support on oral health so that programs may be developed and tailored to reach these populations.

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.

Mental Health and its Influencing Factors Among Immigrants with Chronic Diseases in China

Immigrants are a special group in society, and their health is of great concern. Few studies have targeted this population in China. A cross-sectional descriptive correlational study was conducted from July to August 2018 in Hubei Province, China. Chi-square tests, Z-tests and multivariable linear regression analysis were performed to analyze the data using SPSS 24.0. A total of 1068 questionnaires were distributed. The results showed that the variables that affected the mental health of the immigrants with chronic diseases included gender, annual income, life events (L), negative emotion (NE), negative coping styles (NC) and objective support (OS) (p ≤ 0.05). Future research should focus on the physical and mental health of different immigrant groups and design effective, individualized interventions to improve the health status of immigrants, especially those with chronic diseases.

Social support and dental caries experience: Findings from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

OBJECTIVE

To examine the association of social support with dental caries experience in Hispanics/Latinos living in the United States (US) and to assess whether the relationship is modified by nativity status.

METHODS

This cross-sectional study analysed data for 4459 dentate men and women aged 18-74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. At baseline (2008-2011), dentists quantified dental caries experience as the number of decayed, missing, and filled permanent tooth surfaces (DMFS) for all teeth excluding third molars. Social support was assessed according to measures of structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List). Covariate-adjusted multiple linear regression estimated the relationship between social support and dental caries experience and tested whether the association was modified by nativity status (born within the 50 US states, foreign-born <10 years in the United States, foreign-born >10 years or more in the United States).

RESULTS

In covariate-adjusted models, each additional role in the social network was associated with 1.39 fewer DMF tooth surfaces (95% CI: -2.21, -0.58) among foreign-born Hispanics/Latinos with fewer than 10 years lived in the US. For foreign-born Hispanics/Latinos with 10 years or more in the United States, each additional social network role was associated with 0.57 fewer DMF tooth surfaces (95% CI: -1.19, 0.04). No association was observed between functional social support and dental caries experience regardless of nativity status.

CONCLUSIONS

Our findings suggest that structural social support is protective against dental caries experience among recent immigrants of Hispanic/Latino background. This association may reflect the importance of social support to integration into the medical and dental infrastructure and thus receipt of dental care. Future research that examines the behavioural and cultural factors that moderate the relationship between social support and dental caries experience will inform development of culturally sensitive dental caries prevention programs for Hispanics/Latinos in the United States.

The Role of the Oral Microbiota Related to Periodontal Diseases in Anxiety, Mood and Trauma- and Stress-Related Disorders

The prevalence of anxiety, mood and trauma- and stress-related disorders are on the rise; however, efforts to develop new and effective treatment strategies have had limited success. To identify novel therapeutic targets, a comprehensive understanding of the disease etiology is needed, especially in the context of the holobiont, i.e., the superorganism consisting of a human and its microbiotas. Much emphasis has been placed on the role of the gut microbiota in the development, exacerbation, and persistence of psychiatric disorders; however, data for the oral microbiota are limited. The oral cavity houses the second most diverse microbial community in the body, with over 700 bacterial species that colonize the soft and hard tissues. Periodontal diseases encompass a group of infectious and inflammatory diseases that affect the periodontium. Among them, periodontitis is defined as a chronic, multi-bacterial infection that elicits low-grade systemic inflammation via the release of pro-inflammatory cytokines, as well as local invasion and long-distance translocation of periodontal pathogens. Periodontitis can also induce or exacerbate other chronic systemic inflammatory diseases such as atherosclerosis and diabetes and can lead to adverse pregnancy outcomes. Recently, periodontal pathogens have been implicated in the etiology and pathophysiology of neuropsychiatric disorders (such as depression and schizophrenia), especially as dysregulation of the immune system also plays an integral role in the etiology and pathophysiology of these disorders. This review will discuss the role of the oral microbiota associated with periodontal diseases in anxiety, mood and trauma- and stress-related disorders. Epidemiological data of periodontal diseases in individuals with these disorders will be presented, followed by a discussion of the microbiological and immunological links between the oral microbiota and the central nervous system. Pre-clinical and clinical findings on the oral microbiota related to periodontal diseases in anxiety, mood and trauma- and stress-related phenotypes will be reviewed, followed by a discussion on the bi-directionality of the oral-brain axis. Lastly, we will focus on the oral microbiota associated with periodontal diseases as a target for future therapeutic interventions to alleviate symptoms of these debilitating psychiatric disorders.

Is there a healthy migrant effect in relation to oral health among adults in England?

OBJECTIVE

The aim of the study was to assess the healthy migrant effect in relation to oral health among adults in England.

STUDY DESIGN

This is a secondary data analysis of a nationally representative survey.

METHODS

Data from 13,373 adults of Irish, black Caribbean, Indian, Pakistani, Bangladeshi and Chinese ethnicity, who participated in the Health Survey for England, were analysed. The proportions of edentate and dentate adults with toothache in the last 6 months in first- and second-generation migrants within each ethnic group were compared with those in the white British (reference group) ethnic group in logistic regression models after adjusting for demographic factors and socio-economic position. Among first-generation migrants, the associations of age at arrival and length of residence with each oral health outcome were assessed in logistic regression models after adjusting for sociodemographic factors.

RESULTS

Compared with white British migrants, first-generation black Caribbean (odds ratio [OR]: 1.42) and second-generation Pakistani (OR: 3.16) migrants had higher odds of being edentulous, whereas first-generation Indian (OR: 0.62), Pakistani (OR: 0.62), Bangladeshi (OR: 0.41) and Chinese (OR: 0.49) migrants had lower odds. Among dentate adults, second-generation Irish (OR: 1.51) migrants, first- and second-generation black Caribbean (OR: 1.61 and 1.54, respectively) migrants, first-generation Indian (OR: 1.24) migrants and second-generation Pakistani (OR: 1.34) migrants had higher odds of having toothache in the past 6 months, whereas second-generation Bangladeshi (OR: 0.51) migrants had lower odds than white British. Age at arrival and length of residence were positively associated with being edentulous among first-generation black Caribbean, Pakistani and Bangladeshi migrants.

CONCLUSION

Evidence on the healthy migrant effect was mixed, with more consistent findings seen for edentulousness among Asian groups. Black Caribbean migrants were generally the ethnic group with the worst oral health when compared with white British.

Impact of social support on oral health among immigrants and ethnic minorities: A systematic review

Objective

Adaptation to social life changes after migration may be beneficial or detrimental to migrants’ oral health outcomes and related behaviors. This systematic review aims to synthesize the scientific literature on the impact of social support on immigrants’ and ethnic minorities’ oral health status and/or behaviors.

Methods

A comprehensive electronic search, up to November 2018, was conducted using five electronic databases. We included cross-sectional and longitudinal quantitative studies that examine associations between social support and oral health outcomes among immigrants and ethnic minorities. Study selection, data extraction, and risk of bias assessment were completed in duplicate and the Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies.

Results

A total of 26 studies met the eligibility criteria. Included studies examined multiple oral health outcomes such as dental care utilization, oral health behaviors, oral health problems, self-rated oral health, oral health knowledge, and oral health-related quality of life among immigrants and ethnic minorities. The social support level is assessed either by social support indicators or by adapting certain scales. Overall, social support was found to be positively associated with dental care utilization, number of carious teeth, periodontal disease, oral health behaviors, oral health knowledge, oral health-related quality of life, and self-rated oral health.

Conclusion

Although immigrants and ethnic minorities encounter several challenges after migration to a new country that could affect their oral health, social support from their surrounding environment in the form of structural or functional support plays an important role in improving their oral health outcomes.

The association between caries related treatment needs and socio-demographic variables among young Israeli adults: a record based cross sectional study

Backgroud

The need for dental treatments, especially those related to dental caries, may be associated with and influenced by a wide range of demographic variables. The aim of this study was to describe caries related treatment needs among young Israeli adults and the association with several socio-demographic factors, including socio-economic cluster (SEC), intellectual capabilities, ethnicity and other variables.

Methods

Data were collected from dental records of army recruits between 2012 and 2013. We cross-examined data regarding dental treatment needs with socio-demographic variables: age, gender, SEC, intellectual capability score (ICS), birth place of participant and parents, education and immigration.

Results

Data received regarding 13,398 combat recruits during their first four months of military training. Most subjects were males (92.4%), with a mean age of 18.9 years. 10.8% were immigrants, with 12.2 years living in Israel before their recruitment. Only 17.7% had no dental treatment needs. Mean number of teeth needing treatment was: for restorations 1.96 ± 2.59, for root canal therapies 0.07 ± 0.44 and for extractions 0.05 ± 0.28. Low ICS scores and low SEC group were significantly associated with higher treatment needs (P < 0.001). Statistically significant higher treatment needs were observed among participants who originated from immigrant families. In a multivariate analysis (Generalized Linear Model), gender, age, ICS score, SEC group and country of birth were found as independent predictors for number of restorations needed.

Conclusion

Socio-demographic variables significantly influence dental treatment needs and should be taken into account when preparing intervention programs in this population.

The relationship between children's oral health-related behaviors and their caregiver's social support

Background

Social support might play a role in helping people adopt healthy behaviors and improve their health. Stronger social support from mothers has been found to be positively related to higher tooth brushing frequency in 1- to 3-year-old children. However, little is known regarding the relationship between the caregiver’s social support and the oral health-related behaviors of 5-year-old children in China. This study aimed to investigate this relationship.

Methods

A cross-sectional study was conducted among 1332 5-year-old children and their caregivers in Guangzhou, southern China. Data were collected using questionnaires that were completed by the caregivers and the children’s caries status were examined. The caregivers’ social support was measured using the Social Support Rating Scale. The measurements of the children’s oral health-related behaviors included the frequencies of sugary snack intake and tooth brushing, utilization of dental services, and patterns of dental visits. Univariate and multiple logistic regression analyses were used to analyze the relationships between the variables.

Results

No association was found between the caregiver’s social support and the child’s oral health-related behaviors in a multiple logistic regression analysis. However, other factors, particularly the oral health-related behaviors of the caregiver, were found to be significantly linked to the child’s oral health-related behaviors.

Conclusions

The oral health-related behaviors of 5-year-old children in Guangzhou are unrelated to the caregiver’s social support but are related to other specific factors, particularly the caregiver’s oral health-related behaviors.

Is Social Network Diversity Associated with Tooth Loss among Older Japanese Adults?

BACKGROUND

We sought to examine social network diversity as a potential determinant of oral health, considering size and contact frequency of the social network and oral health behaviors.

METHODS

Our cross-sectional study was based on data from the 2010 Japan Gerontological Evaluation Study. Data from 19,756 community-dwelling individuals aged 65 years or older were analyzed. We inquired about diversity of friendships based on seven types of friends. Ordered logistic regression models were developed to determine the association between the diversity of social networks and number of teeth (categorized as ≥20, 10-19, 1-9, and 0).

RESULTS

Of the participants, 54.1% were women (mean age, 73.9 years; standard deviation, 6.2). The proportion of respondents with ≥20 teeth was 34.1%. After adjusting for age, sex, socioeconomic status (income, education, and occupation), marital status, health status (diabetes and mental health), and size and contact frequency of the social network, an increase in the diversity of social networks was significantly associated with having more teeth (odds ratio = 1.08; 95% confidence interval, 1.04-1.11). Even adjusted for oral health behaviors (smoking, curative/preventive dental care access, use of dental floss/fluoride toothpaste), significant association was still observed (odds ratio = 1.05 (95% confidence interval, 1.02-1.08)).

CONCLUSION

Social connectedness among people from diverse backgrounds may increase information channels and promote the diffusion of oral health behaviors and prevent tooth loss.

Community social capital and tooth loss in Japanese older people: a longitudinal cohort study

OBJECTIVE

To date, no study has prospectively examined the association between social capital (SC) in the community and oral health. The aim of this longitudinal cohort study was to examine the association between both community-level and individual-level SC and tooth loss in older Japanese people.

DESIGN

Prospective cohort study

SETTING

We utilised data from the Japan Gerontological Evaluation Study (JAGES) performed in 2010 and 2013 and conducted in 525 districts.

PARTICIPANTS

The target population was restricted to non-institutionalised people aged 65 years or older. Participants included 51 280 people who responded to two surveys and who had teeth at baseline.

PRIMARY OUTCOME MEASURE

The primary outcome measure was loss of remaining teeth, measured by the downward change of any category of remaining teeth, between baseline and follow-up.

RESULTS

The mean age of the participants was 72.5 years (SD=5.4). During the study period, 8.2% (n=4180) lost one or more of their remaining teeth. Among three community-level SC variables obtained from factor analysis, an indicator of civic participation significantly reduced the risk of tooth loss (OR 0.93; 95% CI 0.88 to 0.99). The individual-level SC variables 'hobby activity participation' and 'sports group participation' were also associated with a reduced risk of tooth loss (OR 0.88; 95% CI 0.81 to 0.95 and OR 0.90; 95% CI 0.82 to 0.99, respectively).

CONCLUSIONS

Living in a community with rich SC and individuals with good SC is associated with lower incidence of tooth loss among older Japanese people.

Caries Experience among Adults Exposed to Low to Moderate Doses of Ionizing Radiation in Childhood - The Tinea Capitis Cohort

While the impact of therapeutic levels of ionizing radiation during childhood on dental defects has been documented, the possible effect of low doses on dental health is unknown. The study aim was to assess the association between childhood exposure to low-moderate doses of therapeutic radiation and caries experience among a cohort of adults 50 years following the exposure. The analysis was based on a sample of 253 irradiated (in the treatment of tinea capitis) and 162 non-irradiated subjects. The decayed, missing, and filled teeth (DMFT) index was assessed during a clinical dental examination and questions regarding dental care services utilization, oral hygiene behavior, current self-perceived mouth dryness, socio-demographic parameters, and health behavior variables were obtained through a face-to-face interview. An ordered multivariate logistic regression model was used to assess the association of the main independent variable (irradiation status) and other relevant independent variables on the increase in DMFT. Mean caries experience levels (DMFT) were 18.6 ± 7.5 for irradiated subjects compared to 16.4 ± 7.2 for the non-irradiated (p = 0.002). Controlling for gender, age, education, income, smoking, dental visit in the last year, and brushing teeth behavior, irradiation was associated with a 72% increased risk for higher DMFT level (95% CI: 1.19-2.50). A quantification of the risk by dose absorbed in the salivary gland and in the thyroid gland showed adjusted ORs of 2.21 per 1 Gy (95% CI: 1.40-3.50) and 1.05 per 1 cGy (95% CI: 1.01-1.09), respectively. Childhood exposure to ionizing radiation (0.2-0.4 Gy) might be associated with late outcomes of dental health. In line with the guidelines of the American Dental Association, these results call for caution when using dental radiographs.

Evaluation of association between psychological stress and serum cortisol levels in patients with chronic periodontitis - Estimation of relationship between psychological stress and periodontal status

Background:

Stress classically describes a destructive notion that can have a bearing on one's physical and mental health. It may also add to an increased propensity to periodontal disease.

Aim:

To investigate the association between psychological stress and serum cortisol levels in patients with chronic periodontitis.

Materials and Methods:

Forty subjects were recruited from the outpatient department at the Department of Periodontics, from a college in Mangalore, divided into two groups, i.e., twenty as healthy controls and twenty were stressed subjects with chronic periodontitis. The clinical examination included the assessment of probing pocket depth, clinical attachment level and oral hygiene index-simplified. Serum cortisol levels were estimated biochemically using the enzyme-linked immunosorbent assay method and the estimation of psychological stress was done by a questionnaire.

Results:

Descriptive statistics such as mean and standard deviation was used to review the collected data. Independent sample t-test was used for comparison and correlation was evaluation using Pearson's correlation test. As per our observation, high serum cortisol levels and psychological stress are positively linked with chronic periodontitis establishing a risk profile showing a significant correlation (P < 0.05).

Conclusion:

Routine serum cortisol assessment may be a reasonable and a valuable investigative indicator to rule out stress in periodontitis patients as it should be considered as an imperative risk factor for periodontal disease.

Long-Term Effects of Exposure to Ionizing Irradiation on Periodontal Health Status - The Tinea capitis Cohort Study

Studies among long-term survivors of childhood cancer who had received high-dose irradiation therapy of 4–60 Gy, demonstrated acute and chronic dental effects, including periodontal diseases. However, the possible effects of low to moderate doses of radiation on dental health are sparse. The aim of this study is to investigate the association between childhood exposure to low–moderate doses of ionizing radiation and periodontal health following 50 years since exposure. The study population included 253 irradiated subjects (treated for Tinea capitis in the 1950s) and, 162 non-irradiated subjects. The estimated dose to the teeth was 0.2–0.4 Gy. Dental examination was performed according to the community periodontal index (CPI). Socioeconomic and health behavior variables were obtained through a personal questionnaire. Periodontal disease was operationally defined as “deep periodontal pockets.” A multivariate logistic regression model was used for the association of irradiation status and other independent variables with periodontal status. The results showed that among the irradiated subjects, 23%, (95% CI 18–28%) demonstrated complete edentulousness or insufficient teeth for CPI scoring as compared to 13% (95% CI 8–19%) among the non-irradiated subjects (p = 0.01). Periodontal disease was detected among 54% of the irradiated subjects as compared to 40% of the non-irradiated (p = 0.008). Controlling for education and smoking, the ORs for the association between radiation and periodontal disease were 1.61 (95% CI 1.01–2.57) and 1.95 (95% CI 1.1–3.5) for ever never and per 1 Gy absorbed in the salivary gland, respectively. In line with other studies, a protective effect for periodontal diseases among those with high education and an increased risk for ever smokers were observed. In conclusion, childhood exposure to low-moderate doses of ionizing radiation might be associated with later outcomes of dental health. The results add valuable data on the long-term health effects of exposure to ionizing radiation and support the implementation of the ALARA principle in childhood exposure to diagnostic procedure involving radiation.

Anxiety, depression, and oral health among US pregnant women: 2010 Behavioral Risk Factor Surveillance System

OBJECTIVES

Maternal periodontal disease is associated with adverse perinatal outcomes. Anxiety and depression adversely impact oral health in nonpregnant women; however, this association has not been evaluated during pregnancy, a time characterized by higher rates of anxiety and depression. Therefore, we examined the association between these factors and oral disease and oral healthcare utilization among 402 pregnant respondents to the 2010 Behavioral Risk Factor Surveillance System.

METHODS

Self-reported lifetime diagnoses of anxiety, depression, and current depression were assessed. Oral health outcomes included self-reported tooth loss and dental visits in the past year.

RESULTS

One-fifth (21.2 percent) of respondents reported a tooth loss and 32.5 percent reported nonuse of oral health services. The prevalence of lifetime diagnosed anxiety and depression was 13.6 percent and 11.3 percent, respectively, whereas 10.6 percent reported current depression. After adjusting for risk factors, pregnant women with diagnosed anxiety had increased odds of one or more tooth loss [odds ratio (OR) = 3.30; 95 percent confidence interval (CI): 1.01-10.77] compared with those without the disorder. Similarly, after adjusting for socioeconomic factors, women with anxiety had increased odds of nonuse of oral health services (OR = 2.67; 95 percent CI: 1.03-6.90); however, this was no longer significant after adjusting for health behaviors and body mass index. We observed no significant association with depression.

CONCLUSIONS

In this population-based sample, we found a two- to threefold increased odds of tooth loss and nonuse of oral health services among pregnant women with a lifetime diagnosis of anxiety. To our knowledge, this is the first study to examine these associations among pregnant women.

Psychological distress and self-rated oral health among a convenience sample of Indigenous Australians

OBJECTIVES

This study sought to: a) estimate the frequency of poor self-rated oral health as assessed by a summary measure; b) compare frequency according to sociodemographic, behavioral, and psychological distress factors; and (3) determine if psychological distress was associated with poor self-rated oral health after adjusting for confounding.

METHODS

Data were from a convenience sample of Indigenous Australian adults (n = 289) residing in Australia's Northern Territory. Poor self-rated oral health was defined as reported experience of toothache, poor dental appearance or food avoidance in the last 12 months. A logistic regression model was used to evaluate socio-demographic, behavioral, and psychological distress associations with poor self-rated oral health (SROH). Effects were quantified as odds ratios (OR).

RESULTS

The frequency of poor SROH was 73.7 percent. High psychological distress, measured by a Kessler-6 score ≥8, was experienced by 33.9 percent of participants. Poor SROH was associated with high levels of psychological distress, being older, being female, and usually visiting a dentist because of a problem. In the multivariable model, factors that were significantly associated with poor SROH after adjustment for other covariates included having a high level of psychological distress (OR 2.74, 95% CI 1.25-6.00), being female (OR 2.22, 95% CI 1.03-4.78), and usually visiting a dentist because of a problem (OR 3.57, 95% CI 1.89-6.76).

CONCLUSIONS

Poor self-rated oral health and high levels of psychological distress were both highly frequent among this vulnerable population. Psychological distress was significantly associated with poor self-rated oral health after adjustment for confounding.

[Association between social capital and oral health conditions and behavior]

The theory of social capital seeks to explain social inequality in health through the interaction of social, economic and environmental factors and has been associated with many health problems, though there is still little research in the area of oral health. The scope of this study was to evaluate the association between social capital and socio-demographic and behavioral factors related to oral health among schoolchildren aged from 15 to 19. A random sample of 1,417 adolescents filled out a self-administered survey and the data were descriptively analyzed (simple frequencies, central tendency and variability measurement) and inferential statistics (Pearson's chi-square test). The results showed that the social capital which is more prevalent among adolescents was intermediate level, as well as between each of its dimensions, except for social action where the majority were classified as lower-leveled. Among the variables analyzed, social capital was statistically associated only with sex, with women being more likely to be classified under the 'low social capital' label. This area still needs considerable research to increase theoretical-conceptual and methodological maturity in order to better understand the social contexts that are essential for formulating effective public health policies.

Protocol for a systematic review of the association between chronic stress during the life course and telomere length

BACKGROUND

The effects of stress on ill health have become evident in recent years. Under acute stress situations, a cascade of physiological events helps the body mount an appropriate adaptive response. However, under chronic stress situations, this physiological response may lead to wear and tear on the body that accelerates the decline in physiological functioning and increases the risk of chronic conditions. Recent evidence for social stress experienced during childhood suggests serious consequences many years later, even later life. Telomere length, a marker of cell aging, may provide a link between chronic social stress and age-associated physical and mental decline and risk of chronic conditions. This study examines whether chronic social stress is associated with telomere length throughout the life course.

METHODS/DESIGN

We will perform a systematic review of the literature on the relationship between chronic social stress, for example, due to violence, extreme poverty, or caregiving of people with disabling conditions (exposure), and telomere length (outcome) by searching electronic databases in MEDLINE (PubMed interface), EMBASE (OVID interface), Cochrane Central (OVID interface) and gray literature from their start date onwards. We will limit the search to studies performed on human populations. Two reviewers will conduct standardized screening, eligibility assessment, data abstraction, and scientific quality assessment. All study designs investigating the association between chronic social stress and telomere length in healthy or diseased adults and children will be eligible for inclusion in the review. We will extract individual demographic and socioeconomic characteristics, research setting, method of measuring telomere length, reported outcome, and determinants of interest. Studies will also be stratified by 1) age into 3 groups: childhood (0 to 18 years), adulthood (19 to 64 years) and late life (65+); 2) cell type; 3) study design; and 4) telomere length assessment method. Where feasible, study results will be combined through meta-analyses to obtain a pooled measure of associations. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement.

DISCUSSION

This systematic review will provide knowledge on the existing evidence for chronic social stress and its association with telomere lengths throughout the life course.

Latino Immigrant Children's Health: Effects of Sociodemographic Variables and of a Preventive Intervention Program

The number of Latino immigrant children is expanding rapidly, and the factors that affect their health are multiple and interlinked. We therefore propose to describe the sociodemographic characteristics of a mostly Dominican immigrant population, to examine to what extent immigrant status and other factors play a role in determining measures of their children's health and well-being, and finally to investigate whether a home visiting intervention modified any of these factors. The data were collected as part of an evaluation of a primary prevention home visitation program for high-risk mothers and their children. Bivariate and multivariate models were constructed to investigate the factors that affected the outcome variables. We found that numerous factors, especially a composite for overall stress, affected the health and well-being of participant children. We also demonstrated that the visitation program had a positive effect on many of these outcomes. Future program planners will need to understand the strengths and weaknesses of the specific population they serve.