Inequalities in prosthetic rehabilitation among elderly people: the importance of context

Risk factors and associated pathway for rural and urban unmet dental prosthetic needs among older adults in Central India

AIM

This study was undertaken to evaluate the risk factors and associated pathways for unmet dental prosthetic needs among older adult population in Central India.

METHODS

A total of 11,145 randomly selected older adults participated in the study; 4613 from urban region and 6532 form rural region. Oral examinations were conducted at individual households for recording dental caries, periodontal disease, prosthetic status and needs. Structural Equation Modelling (SEM) was used to examine relationship between a set of exogenous variables and unmet dental prosthetic needs with variables that remained significant in the adjusted multilevel logistic model. Path coefficients were calculated for all variables with 95% confidence interval. Goodness of fit of the model was assessed by several indices.

RESULTS

A total of 8433 (75.7%) participants had never visited a dentist and 9139 (82%) had unmet dental prosthetic needs. Dental caries was observed among 3207 (69.5%) and 4644 (71.1%) study participants from urban and rural regions respectively (p < .05). Low utilization of dental services was associated with high dental prosthetic needs in upper arch and lower arch (PC = -0.05, 0.001) and DMFT was associated with lower utilization of dental services (PC = -0.09, 0.001). DMFT was also associated with age, annual income, level of education, paternal education, type of family, tobacco consumption and CPI score in the hypothesized model. The fit indices used indicated that the model was adequate.

CONCLUSIONS

Dental prosthetic needs in the proposed pathway model was associated with low utilization of dental services, dental caries, periodontal disease and other socio-demographic factors.

Factors influencing the utilization of dental services in East Java, Indonesia

Background: Despite high levels dental issues and insurance coverage in the East Java province Indonesia, the utilization of dental services is still low. This research aims to test some indicators for dental service utilization among East Java residents. Methods: A secondary analysis was undertaken using data on the East Java province from the Indonesian Basic Health Research 2013, which included 90,551 randomly selected respondents aged 5-100 years old. Socio-demographic characteristics (age, sex, education and residential location), dental behavior (tooth brushing habit), and clinical (dental) condition were self-reported through a questionnaire. Multivariable models were generated to estimate prevalence ratios (PR), and 95% confidence intervals (95%CI). Results: Prevalence of dental service utilization during the last 12 months in East Java province is only 9 %. Respondents 25-50 years old showed the highest utilization of dental services. Being male, having lower education and living in a district (as opposed to municipalities) were indicators for having lower utilization of dental treatment (PR [95% CI] = 0.81 [0.79-0.84], PR [95% CI] = 0.89 [0.86-0.93] and PR [95% CI] = 0.91 [0.88-0.95], respectively). Respondents with poor tooth brushing habit showed lower utilization of dental services. Having teeth was associated with higher utilization of dental treatment (PR [95% CI] = 1.39 [1.16-1.66). Conclusions: Age, sex, education and residential location influence the utilization of dental services among Indonesia's East Java residents. Poor tooth brushing habits and being edentulous are also indicators of lesser utilization. These results call for urgent public health interventions to increase equitable dental care services utilization.

Factors influencing the utilization of dental services in East Java, Indonesia

Background: Despite high levels dental issues and insurance coverage in the East Java province Indonesia, the utilization of dental services is still low. This research aims to test whether certain individual-level sociodemographic, behavioural, and clinical characteristics influenced the current level of dental services utilization by East Java residents. Methods: A secondary analysis was undertaken using data on the East Java province from the Indonesian Basic Health Research 2013, which included 90,551 randomly selected respondents aged 5-100 years old. Socio-demographic characteristics (age, sex, education and residential location), dental behavior (tooth brushing habit), and clinical (dental) condition were self-reported through a questionnaire. Multivariable models were generated to estimate prevalence ratios (PR), and 95% confidence intervals (95% CI). Results: Prevalence of dental service utilization during the last 12 months in East Java province is only 9 %. Respondents 25-<50 years old showed the highest utilization of dental services. Being male, having lower education and living in a district (as opposed to municipalities) were indicators for having lower utilization of dental treatment (PR [95% CI] = 0.81 [0.79-0.84], PR [95% CI] = 0.89 [0.86-0.93] and PR [95% CI] = 0.91 [0.88-0.95], respectively). Respondents with poor tooth brushing habit showed lower utilization of dental services. Having teeth was associated with higher utilization of dental treatment (PR [95% CI] = 1.39 [1.16-1.66). Conclusions: Age, sex, education and residential location influence the utilization of dental services among Indonesia's East Java residents. Poor tooth brushing habits and being edentulous are also indicators of lesser utilization. These results call for urgent public health interventions to increase equitable dental care services utilization.

Prosthetic treatment in the adult French population: Prevalence and relation with demographic, socioeconomic and medical characteristics

BACKGROUND

The aim of this study was to estimate the prevalence of dental prosthetic treatment and to investigate the demographic, social, economic and medical factors associated with the use of fixed and removable dentures in a representative sample of adults living in France.

METHODS

The data were obtained from the 2002-2003 Decennial Health Survey, a cross-sectional study of a representative sample of the population living in France, which included 29,679 adults. Information was collected by interview. The variables collected were fixed denture, removable denture, age, gender, number of children, area of residence, nationality, educational attainment, family social status, employment status, annual household income per capita, supplementary insurance, chronic disease, eyesight problems/glasses, hearing problems/hearing aids. Multinomial logistic regression models were used to study the relationship between prosthetic treatment and demographic, socioeconomic and medical characteristics unadjusted, adjusted for age and adjusted for all the characteristics.

RESULTS

The prevalence of prosthetic treatment was 34.6% (95% confidence interval (CI): [34.1; 35.2]) for fixed prosthetic dentures and 13.8% (95% CI: [13.4; 14.2]) for removable prosthetic dentures. We showed a gradient between educational attainment and removable dentures; the odds ratio adjusted for all the variables (aOR) associated with no or primary education compared to post-secondary education was 2.56; 95% CI: [2.09; 3.13]. When annual household income per capita was low, subjects were less likely to report fixed dentures (aOR=0.68; 95% CI: [0.62; 0.75]) than those with high annual household income per capita. Individuals without insurance less often reported fixed dentures than those with private insurance. Those reporting chronic disease were less likely to report fixed dentures (aOR=0.87; 95% CI: [0.79; 0.95]) but more likely to report removable dentures (aOR=1.29; 95% CI: [1.17; 1.43]) than those without chronic disease.

CONCLUSION

This study reveals social, economic and medical inequalities in fixed and removable prosthetic treatment among adults in France.

Economic and sociodemographic inequalities in complete denture need among older Brazilian adults: a cross-sectional population-based study

Background

Brazil has severe socioeconomic inequalities, resulting in major oral health problems for the Brazilian elderly, such as tooth loss and, consequently, a need for oral rehabilitation. The aim of this study was to evaluate inequalities in complete denture need among older Brazilian adults in relation to social determinants at individual and contextual levels.

Methods

This retrospective study was based on data from the national oral health survey, SB Brasil 2010, in which 7,619 older adults aged 65–74 years participated. The dependent variable was complete denture need. The independent variables at the first level were age, sex, race, and socioeconomic status. The independent variables that were used to identify inequality at the contextual level were geographic region of Brazil, the population of the municipality where the subject lived, whether the subject lived in the state capital or not, and the Human Development Index. In order to describe the socioeconomic characteristics, a socioeconomic cluster variable was created using the multivariable cluster analysis technique. Prevalence ratios (PRs) with 95 % confidence intervals (CIs) were determined to evaluate the effect of each variable. Two-level multivariable modeling was performed to examine the individual and contextual effects.

Results

There was a high prevalence of complete denture need among older Brazilian adults. The main factors associated with the prevalence of complete denture need were individual socioeconomic status (PR: 1.81; 95 % CI: 1.65–1.99), and the city-level contextual effect (PR: 1.20; 95 % CI: 1.08–1.34).

Conclusions

Consistently poor rates of oral health rehabilitation were found among older Brazilian adults, and were associated with significant social inequality. Complete denture need was strongly associated with individual socioeconomic position. It was also verified that the Human Development Index, the city-level contextual effect, was associated with complete denture need.

Benefits of Rehabilitation With Implants in Masticatory Function: Is Patient Perception of Change in Accordance With the Real Improvement?

This study aimed to compare the index of satisfaction and masticatory function of edentulous patients before and after rehabilitation and to evaluate if patients' perception of the changes in their oral health status is in agreement with the results of masticatory performance test. Fourteen edentulous patients were rehabilitated with lower implant-supported fixed prosthesis and upper removable dentures. Index of satisfaction and masticatory capacity (subjective analysis) and performance test (objective analysis) were evaluated before and 20 days and 8 months after rehabilitation. The patients were asked to respond a yes/no masticatory capacity questionnaire and to rate their oral satisfaction on a 0 to 10 Visual Analogue Scale (VAS). Masticatory performance test comprised the ability of the individual to pulverize an artificial test food (Optocal), after 20 and 40 masticatory strokes. When baseline answers were compared to answers 8 months after treatment, all questions, excepting the ones that considered pain and social disability, were statistically different. Wilcoxon test was used to compare index of satisfaction before and after treatment. All answers showed statistically significant differences, excluding the one that referred to ease of cleaning the prostheses. Considering the masticatory performance test, Student t test (normally distributed) and Wilcoxon test (non-normally distributed) were used to test the null hypothesis that the weight of the particles of the test food left in sieves were equal in all times of evaluation. In the larger sieve with 20 cycles, statistically significant differences were observed between baseline and 8 months, 20 days and 8 months. With 40 strokes, baseline and 20 days, baseline and 8 months and 20 days and 8 months showed significant differences. It was concluded that oral rehabilitation leads to better masticatory function in edentulous patients and there is a coincidence between patient perception and real improvement on masticatory function.