Trends in oral health from childhood to early adulthood: a life course approach

Long-Term Impact of Childhood Dental Attendance on Perceived Adult Oral Health: The British Cohort Study

OBJECTIVE

To evaluate the effect of childhood dental attendance pattern on self-rated oral health in middle adulthood among the British population.

METHODS

Data from the 1970 British Cohort Study involving participants born in England, Scotland, and Wales were used. Self-rated oral health was assessed at age 46. Childhood dental attendance patterns, derived from follow-up surveys at ages 5, 10, and 16, were classified as 'always', 'sometimes', or 'never' regular. Logistic regression was performed to estimate the effect of childhood dental attendance on adult oral health. Subgroup analyses by education level and oral hygiene practices examined potential variations across these factors.

RESULTS

This study analyzed data from 4699 participants. An association was found between childhood dental attendance pattern and self-rated oral health in middle adulthood. The odds of reporting poor oral health were higher among those with 'sometimes' and 'never' regular dental attendance patterns than 'always' regular attenders. However, this association became insignificant after adjusting for covariates. Subgroup analyses revealed that 'sometimes' and 'never' regular attendance patterns were associated with higher odds of reporting poor oral health among participants who brushed less than twice daily and those with lower parental academic qualifications.

CONCLUSION

This study suggests that childhood dental attendance is associated with perceived adult oral health, though this relationship diminished after adjusting for covariates. However, the association persisted among those who brushed less than twice daily and had lower parental academic qualifications. It underscores the importance of both demographic factors and health-related behaviors in determining long-term oral health outcomes.

Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies

AIM

To systematically review longitudinal studies investigating the impact of dental visiting patterns on oral health across the life course.

METHODS

Five databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) were searched up to March 2023. Results were screened based on eligibility criteria in a two-stage process: title and abstract, and full-text review. A backward search of reference lists and a forward search of citations of the included papers was also conducted. The quality of the included papers was assessed using the Newcastle-Ottawa Scale. Key study information was extracted and a narrative synthesis of the findings was performed.

RESULTS

Eleven papers from five longitudinal studies in five countries (Australia, Brazil, China, New Zealand, Sweden) met the inclusion criteria. Studies of moderate to high quality consistently reported that regular dental attendance was associated with having less dental caries experience, fewer missing teeth and better oral health-related quality of life. Inconsistent findings were observed for decayed teeth, and no association was found for periodontal condition.

CONCLUSIONS

This review highlights an association between regular dental visiting pattern and improved oral health, notably less dental caries experience and better oral health-related quality of life. Dental attendance emerges as an important predictor of oral health across the life course, underscoring the importance of routine dental care.

REGISTRATION INFORMATION

The PROSPERO registration number is CRD42023396380.

Family behavior theory-based intervention via mobile messaging to improve oral health of adolescents: study protocol for a cluster randomized controlled trial

Background

Due to some unique physical, social and psychological features in the adolescent population, adolescents can be a time of heightened caries activity and periodontal disease. Oral health-related behaviors can be modified to improve oral health status. The family networks and the built environment can promote or inhibit health behaviors. The aim of this study is to implement and evaluate a behavior theory-based, integrated family intervention via mobile messaging to improve oral health of adolescents.

Methods

This is a three-arm parallel-design cluster-randomized controlled trial. This trial will allocate 12 local secondary schools (clusters) in Hong Kong to three test or comparison groups with a ratio 1:1:1. The enrolled Form II to IV students (ages 12 to 15) will be eligible for participation. The intervention to three study groups will be (i) Health Belief Model (HBM)-based mobile messaging to the adolescents and their parents, which will consist of several blocks of HBM-based messages and reinforcement during 24 weeks; (ii) same HBM-based messaging to adolescents only; and (iii) delivering e-version of oral health education pamphlets to adolescents. The primary outcome will be caries increment 2 years post-intervention. Changes in oral health self-efficacy and behaviors, oral hygiene, and gingival status will be the secondary outcomes.

Discussion

No school dental care service is available to secondary school students in Hong Kong. This study will be the first to test a theory-driven and family-engaged preventive intervention among adolescents in Hong Kong. Findings will contribute to developing a low-cost, feasible, and efficient oral health preventive program for adolescents.

Trial registration

ClinicalTrials.govNCT05448664. Registered on 7 July 2022.

Trend on dental caries status and its risk indicators in children aged 12 years in China: a multilevel analysis based on the repeated national cross-sectional surveys in 2005 and 2015

Background

This study aimed to explore the trend and risk indicators for dental caries of children aged 12 years in China based on national oral health survey data in 2005 and 2015.

Methods

Research data were from the two latest national oral health surveys conducted in mainland China, including 30 and 31 provinces, autonomous regions, and municipalities in 2005 and 2015, respectively. Children aged 12 years were clinically examined for dental caries and dental fluorosis according to the World Health Organization criteria. Sociodemographic characteristics and oral health-related behaviours were collected using questionnaires. Multilevel zero-inflated negative binomial regression model was used to investigate the association between dental caries severity and dental fluorosis, sociodemographic characteristics, and oral health-related behaviours.

Results

The final analyses included 12,350 and 27,818 children surveyed in 2005 and 2015, respectively. The standardized prevalence of dental caries increased from 27.05% (95% confidence interval [CI], 24.25-28.85) in 2005 to 37.92% (95% CI, 34.94-40.90) in 2015, and the respective standardized mean decayed, missing, filled teeth (DMFT) index scores increased from 0.50 (standard deviation [SD], 1.04) to 0.83 (SD, 1.45) (P < 0.001). Fujian province had the highest increase in dental caries, followed by Liaoning, Heilongjiang, Hainan, and Yunnan. Results revealed that children who were girls, more frequently experienced dental pain, and had more recent dental visits, had significantly higher DMFT scores after adjusting for the survey year and other variables (all P < 0.05).

Conclusions

Dental caries of 12-year-old children in China deteriorated from 2005 to 2015, particularly in the northeast and southwest regions. Dental caries was associated with sex, dental pain, and dental service utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12262-x.

Self-reported and clinically evident gingival bleeding and impact on oral health-related quality of life in young adolescents: a comparative study

Background

Very little is known about how self-reported gingival bleeding affects the oral health-related quality of life in adolescents compared with clinically evident bleeding. This study aimed to compare the impact of self-reported gingival bleeding and clinically evident gingival bleeding on the oral health-related quality of life in young adolescents.

Methods

This was a cross-sectional study involving 976 students (aged 10–14 years) in randomly selected primary schools in Ibadan. Data were obtained by oral examination and completion of the Child Oral Impact on Daily Performance Questionnaire. Data were analysed with SPSS version 24. The Mann Whitney U test was used to determine the association between gingival bleeding and the quality of life.

Results

The mean age of the participants was 11.4±1.3 years. Almost half (48.3%) of the participants reported gingival bleeding during tooth cleaning while the gingiva of 534 (54.7%) participants bled on examination. Pupils with self-reported bleeding suffered a significantly greater impact on their overall quality of life than those without self-reported bleeding (mean ranks: 528.1 vs. 451.6, P<0.001). For pupils with self-reported bleeding, there were higher impacts on all domains relating to quality of life than those who did not report bleeding (eating: mean ranks=521.0 vs. 458.2; speaking: 502.2 vs. 475.8; teeth cleaning: 522.7 vs. 456.7; sleeping: 497.7 vs. 456.7; showing teeth/smiling: 503.4 vs. 474.6; emotional stability: 501.1 vs. 476.8; school work: 492.4 vs. 484.9, and enjoying contact with other children: 494.0 vs. 483.4). There was no statistically significant association between clinically evident bleeding and impacts on the quality of life (P=0.272).

Conclusion

Almost half of the students reported gingival bleeding while cleaning their teeth and over 50% experienced gingival bleeding on probing. Those with self-reporting of gingival bleeding had greater impacts on oral health-related quality of life compared with those with clinically evident bleeding.

A cross-sectional analysis of oral health care spending over the life span in commercial- and Medicaid-insured populations

BACKGROUND

Life course theory creates a better framework to understand how oral health care needs and challenges align with specific phases of the life span, care models, social programs, and changes in policy.

METHODS

The authors obtained data from the 2018 IBM Watson Multi-State Medicaid MarketScan Database (31 million claims) and the 2018 IBM Watson Dental Commercial and Medicare Supplemental Claims Database (45 million claims). The authors conducted analysis comparing per enrollee spending on fee-for-service dental claims and medical spending on oral health care for patients from ages 0 through 89 years.

RESULTS

Oral health care use rate and spending are lower during the first 4 years of life and in young adulthood than in other periods of life. Stark differences in the timing, impact, and severity of caries, periodontal disease, and oral cancer are seen between those enrolled in Medicaid and commercial dental plans. Early childhood caries and oral cancer occur more frequently and at younger ages in Medicaid populations.

CONCLUSIONS

This life span analysis of the US multipayer oral health care system shows the complexities of the current dental service environment and a lack of equitable access to oral health care.

PRACTICAL IMPLICATIONS

Health policies should be focused on optimizing care delivery to provide effective preventive care at specific stages of the life span.

Association between socioeconomic status and dental caries among Chinese preschool children: a cross-sectional national study

OBJECTIVES

Socioeconomic inequalities in oral health are often neglected in oral health promotion. This cross-sectional study assessed the association between dental caries and socioeconomic status (SES) among preschool children in China.

DESIGN

Cross-sectional study.

SETTING

Data from the Fourth National Oral Health Survey of China (2015), comprising of 40 360 children aged 3-5 years was used.

METHODS

Dental caries indicators including prevalence of dental caries, dental pain experience and number of decayed, missing and filling teeth (dmft). SES indicators included parental education and household income. The associations between SES and dental caries were analysed by using negative binomial regression or Poisson regression models according to data distribution. Relative and absolute inequalities in dental caries were quantified by using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII), respectively.

RESULTS

There were significant associations between SES and prevalence of dental caries and dmft (p<0.001). Children from lower educated (RII 1.36, 95% CI 1.3 to 1.43; SII 0.97, 95% CI 0.81 to 1.13) and lower household income (RII 1.17, 95% CI 1.11 to 1.24; SII 0.55, 95% CI 0.35 to 0.75) families had higher dmft than those from well-educated and most affluent families. Relative and absolute inequalities in dental caries were larger in urban areas by household income, and in rural areas by parental education.

CONCLUSIONS

Association between dental caries and SES was demonstrated and socioeconomic inequalities in dental caries existed among Chinese preschool children.

Association of sense of coherence with oral health behaviors and gingival bleeding among adolescents

Context:

Adolescents experience many types of gingival and periodontal diseases, including gingivitis, localized or generalized aggressive periodontitis, and periodontal complications of various systemic diseases. The occurrence of periodontal diseases is not only related to biotic factors but may also be affected by nonbiotic factors such as oral health behaviors and practices. Various factors that influence an individual's health-related behaviors include a psychosocial construct named sense of coherence (SOC).

Aim:

The aim of this study is to investigate the association of SOC with oral health behaviors and gingival bleeding.

Settings and Design:

This was a cross-sectional, analytical study that was done in the school setting.

Materials and Methods:

A random sample of 850 adolescents was selected from nine schools of the Faridabad block of Faridabad district (Haryana) through the multistage cluster sampling technique. Methods of data collection included a combination of questionnaire administration and clinical examination. The questionnaire comprised sociodemographic variables, questions related to oral health behaviors, and Antonovsky's SOC scale. The questionnaire was interviewer administered.

Statistical Analysis:

Unadjusted and adjusted rate ratios of gingival units having bleeding on probing were estimated by Poisson regression multilevel analysis in Statistical Package for the Social Sciences (SPSS) software for Microsoft Office.

Results:

Adolescents whose mothers had studied <8 years (relative risk [RR] 1.26; 95% confidence interval [CI] 1.04–1.38), who were males (RR 1.198; 95% CI 1.01–1.29), low SOC (RR 15.93; 95% CI 13.06–19.35), and toothbrushing frequency of less than once a day (RR 1.43; 95% CI 1.21–1.67) and children with plaque index >1 (RR 2.765; 95% CI 2.12–3.25) presented with the higher number of gingival units having bleeding.

Conclusion:

SOC is associated with gingival bleeding through oral health behaviors.

Household food insecurity and children's oral health: Findings from the 2016-2018 National Survey of Children's Health

OBJECTIVES

The purpose of the present study is to examine the association between household food insecurity and oral health problems among US children, and the role that socioeconomic, insurance, and oral health care utilization variables play in this association.

METHODS

A large, nationally representative sample of children from the 2016-2018 National Survey of Children's Health (NSCH) was employed in the present study (N = 99,962). Logistic regression and negative binomial regression were used to assess the influence of household food insecurity on diverse oral health problems and unmet oral health care needs. The Karlson-Holm-Breen (KHB) method was used to examine the attenuating roles of socioeconomic, insurance, and oral health care utilization variables.

RESULTS

Children in food-insecure households exhibited significantly greater odds of all examined oral health problems as well as unmet oral health care needs. These associations were a) most pronounced in the case of moderate-to-severe food insecurity and b) partly explained by a subset of socioeconomic and insurance-related variables.

CONCLUSIONS

Household food insecurity is a potent risk factor for oral health problems and unmet oral health care needs among US children. Programmatic efforts to address household food insecurity may yield collateral benefits for the oral health of children. Furthermore, because socioeconomic status and insurance-related variables explain part of the association, targeted interventions to improve these factors may improve oral health among at-risk children.

Parental incarceration and children's oral health in the United States: Findings from the 2016-2018 National Survey of Children's Health

OBJECTIVE

This study aimed to examine the association between parental incarceration and children's oral health in the United States and assess the degree to which household socioeconomic factors, children's healthcare insurance and oral healthcare utilization/preventive care explain this association.

METHODS

Using data from the 2016-2018 National Survey of Children's Health (NSCH; N = 99 962), a series of logistic regression models were used to investigate the association between parental incarceration and a variety of children's oral health conditions. The Karlson-Holm-Breen method was used to assess the degree to which household socioeconomic factors, children's healthcare insurance and oral healthcare utilization/preventive care visits reduced the association between parental incarceration and children's oral health.

RESULTS

Results from logistic regression analyses demonstrated that net of control variables, children of incarcerated parents have significantly worse oral health including poor or fair teeth condition (OR = 2.71, 95% CI = 2.23-3.29), toothaches (OR = 1.72, 95% CI = 1.36-2.18), gum bleeding (2.12, 95% CI = 1.52-2.94), cavities/tooth decay (OR = 1.50, 95% CI = 1.26-1.77) and are more likely to have unmet dental care needs (OR = 1.78, 95% CI = 1.28-2.46). Attenuation analyses demonstrated this relationship is partially explained by household material hardship and children's health insurance.

CONCLUSIONS

Parental incarceration is associated with worse oral health and unmet dental care needs. Household material hardship and children's health insurance partially attenuate this association. Efforts to expand oral health literacy to incarceration-exposed parents, and policies that buffer against material hardship and inadequacies in children's health insurance may be useful for improving oral health of children whose parents have been incarcerated.

Socioeconomic Life Course Models and Oral Health: A Longitudinal Analysis

We compared socioeconomic life course models to decompose the direct and mediated effects of socioeconomic status (SES) in different periods of life on late-life oral health. We used data from 2 longitudinal Swedish studies: the Level of Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Two birth cohorts (older, 1925 to 1934; younger, 1944 to 1953) were followed between 1968 and 2011 with 6 waves. SES was measured with 4 indicators of SES and modeled as a latent variable. Self-reported oral health was based on a tooth conditions question. Variables in the younger and older cohorts were grouped into 4 periods: childhood, young/mid-adulthood, mid /late adulthood, late adulthood/life. We used structural equation modeling to fit the following into lagged-effects life course models: 1) chain of risk, 2) sensitive period with late-life effect, 3) sensitive period with early- and late-life effects, 4) accumulation of risks with cross-sectional effects, and 5) accumulation of risks. Chain of risk was incorporated into all models and combined with accumulation, with cross-sectional effects yielding the best fit (older cohort: comparative fit index = 0.98, Tucker-Lewis index = 0.98, root mean square error of approximation = 0.04, weighted root mean square residual = 1.51). For the older cohort, the chain of SES from childhood → mid-adulthood → late adulthood → late life showed the following respective standardized coefficients: 053, 0.92, and 0.97. The total effect of childhood SES on late-life tooth loss (standardized coefficient: -0.23 for older cohort, -0.17 for younger cohort) was mediated by previous tooth loss and SES. Cross-sectional effects of SES on tooth loss were observed throughout the life course, but the strongest coefficients were at young/mid-adulthood (standardized coefficient: -0.41 for older cohort, -0.45 for younger cohort). SES affects oral health cumulatively over the life course and through a chain of risks. Actions to improve socioeconomic conditions in early life might have long-lasting effects on health if they help prevent people from becoming trapped in a chain of risks.

A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study

OBJECTIVES

Childhood socio-economic status (SES) has long been associated with later-life oral health, suggesting that childhood is a sensitive period for oral health. Far less attention has been given to the long-term impact of childhood trauma, abuse, and smoking on later-life oral health. This study fills the gap in the literature by examining how adverse childhood experiences-social, psychological, and behavioral-shape total tooth loss over the life course, with an assessment of the sensitive period, accumulation, and social mobility models from life course research.

METHODS

Data are drawn from the 2012 Health and Retirement Study (HRS) merged with multiple HRS data sources to obtain childhood information (N = 6,427; age > 50). Adverse childhood experiences include childhood financial hardship, trauma, abuse, and smoking. Total tooth loss is measured to assess poor oral health in later life. Educational attainment and poverty status (since age 51) are measured as adult adversity. Current health conditions and health behaviors are assessed to reflect the correlates of oral health in later life.

RESULTS

The sensitive period model indicates that childhood trauma such as parental death or divorce (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.04, 1.80), physical abuse (OR = 1.17, 95% CI = 1.03, 1.34), and low educational attainment (≤ high school; OR = 1.52, 95% CI = 1.04, 2.22) are associated with higher odds of total tooth loss in later life. Poverty status was not associated with the outcome. There was a clear graded relationship between accumulation of adverse experiences and oral health, which supports the accumulation model. In the social mobility model, older adults who occupied a stable disadvantageous position were more likely to be toothless (OR = 1.77, 95% CI = 1.08, 2.90) compared to those who did not face adversity in any case. Neither upward nor downward mobility mattered.

CONCLUSIONS

Failing oral health in older adults, especially total tooth loss, may have its roots in adverse experiences such as childhood trauma, abuse, and low educational attainment. Findings also suggest that oral health in later life may be more influenced by accumulation of adversity rather than changes in social and economic position over the life course.

A public health perspective on personalized periodontics

In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.

Can a School-Based Intervention Improve the Oral Health-Related Quality of Life of Brazilian Children?

INTRODUCTION

Evidence of the effectiveness of oral health promotion strategies among children from different socioeconomic backgrounds is necessary to support the implementation of public health interventions.

OBJECTIVES

This study aimed to test the effectiveness of a school-based intervention to enhance the sense of coherence (SOC) and oral health-related quality of life (OHRQoL) of socially vulnerable Brazilian children. Furthermore, we explored the pathways by which the intervention may improve OHRQoL and SOC, assessing the direct and indirect pathways among demographic, clinical, socioeconomic, behavioral, and psychosocial variables.

METHODS

In this cluster-randomized trial, 5 primary schools in Brazil were randomly allocated into intervention and control groups. The intervention comprised 7 sessions of SOC-based activities over 2 mo, which focused on making the school environment a place to develop children's SOC through involving teachers, school staff, and children. Trained teachers delivered the intervention. OHRQoL and SOC data were collected at baseline, 2 wk after the intervention, and at 3-mo follow-up.

RESULTS

Information about oral clinical conditions, socioeconomic status, OHRQoL, and SOC was obtained from 356 children aged 8 to 14 y (165 in the intervention group and 191 in the control group). Children from the SOC-based intervention group reported fewer impacts of their oral health on their daily lives (Child Perceptions Questionnaire mean, 7.22) than those from the control group (9.14). The intervention group also reported greater improvement of SOC at 2 wk (SOC mean, 52.98) and 3 mo (52.75) than the control group (52.21 and 51.65, respectively).

CONCLUSION

The intervention was effective in improving SOC and OHRQoL among socially vulnerable Brazilian children. Moreover, SOC was a relevant predictor for oral symptom and functional status in this population (Brazilian Clinical Trials Registry RBR-2N9NHJ).

KNOWLEDGE TRANSFER STATEMENT

Clinicians and policy makers can use the results of this study to decide which approach to use when planning public health policy to improve the SOC and OHRQoL of socially vulnerable children. Our findings can assist policy makers in making more appropriate community health decisions in school environments that will improve community empowerment.

Life course socioeconomic inequalities and oral health status in later life: ELSI-Brazil

OBJECTIVE

To investigate the association between life course socioeconomic conditions and two oral health outcomes (edentulism and use of dental prostheses among individuals with severe tooth loss) among older Brazilian adults.

METHODS

This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) which includes information on persons aged 50 years or older residing in 70 municipalities across the five great Brazilian regions. Regression models using life history information were used to investigate the relation between childhood (parental education) and adulthood (own education and wealth) socioeconomic circumstances and edentulism and use of dental prostheses. Slope index of inequality and relative index of inequality for edentulism and use of dental prostheses assessed socioeconomic inequalities in both outcomes.

RESULTS

Approximately 28.8% of the individuals were edentulous and among those with severe tooth loss 80% used dental prostheses. Significant absolute and relative inequalities were found for edentulism and use of dental prostheses. The magnitude of edentulism was higher among individuals with lower levels of socioeconomic position during childhood, irrespective of their current socioeconomic position. Absolute and relative inequalities related to the use of dental prostheses were not related to childhood socioeconomic position.

CONCLUSIONS

These findings substantiate the association between life course socioeconomic circumstances and oral health in older adulthood, although use of dental prostheses was not related to childhood socioeconomic position. The study also highlights the long-lasting relation between childhood socioeconomic inequalities and oral health through the life course.

A Developmental Approach to Pediatric Oral Health

Orofacial growth and development is a complex process spanning the life course. This article provides an oral health overview in the context of overall growth, physical and social development from infancy through adolescence. It reviews oral health-specific developmental milestones during childhood (0-12 years) and adolescence (≥13 years). It examines issues particular to each age category or spanning multiple ages (eg, pediatric overweight and obesity, tobacco use, and dental trauma) in relation to oral health and development. In addition, the oral microbiome and its potential role in informing personalized oral health care across the life course is discussed.

Longitudinal measurement invariance and explanatory IRT models for adolescents' oral health-related quality of life

BACKGROUND

Longitudinal invariance is a perquisite for a valid comparison of oral health-related quality of life (OHRQoL) scores over time. Item response theory (IRT) models can assess measurement invariance and allow better estimation of the associations between predictors and latent construct. By extending IRT models, this study aimed to investigate the longitudinal invariance of the two 8-item short forms of the Child Perception Questionnaire (CPQ_11-14) regression short form (RSF:8) and item-impact short form (ISF:8) and identify factors associated with adolescents' OHRQoL and its change.

METHODS

All students from S1 and S2 (equivalent to US grades 6 and 7) who were born in April 1997 and May 1997 (at age 12) from 45 randomly selected secondary schools were invited to participate in this study and followed up after 3 years. Data on the CPQ_11-14 RSF:8 and CPQ_11-14 ISF:8, demographics, oral health behavior and status were collected. Explanatory graded response models were fitted to both short forms of the CPQ_11-14 data for assessing longitudinal invariance and factors associated with OHRQoL. The Bayesian estimation method - Monte Carlo Markov Chain (MCMC) with Gibbs sampling was adopted for parameter estimation and the credible intervals were used for inference.

RESULTS

Data from 649 children at age 12 at baseline and 415 children at age 15 at follow up were analyzed. For the 12 years old children, healthier oral health behavior, better gum status, families with both parents employed and parents' education level were found to be associated with better OHRQoL. Four items among the 2 short forms lacked longitudinal invariance. With statistical adjustment of longitudinal invariance, OHRQoL were found improved in general over the 3 years but no predictor was associated with OHRQoL in follow-up. For those with decreased family income, their OHRQoL had worsened over 3 years.

CONCLUSIONS

IRT explanatory analysis enables a more valid identification of the factors associated with OHRQoL and its changes over time. It provides important information to oral healthcare researchers and policymakers.

Integrated oral, mental and sexual health management for adolescents: a call for professional collaboration

BACKGROUND

Globally, young people account for 15.5% of the total global disability-adjusted life-years burden for all age groups. They face mental health, nutritional problems, accidental and intentional injuries, sexual and reproductive health problems, and substance abuse. These health challenges have effects on their oral health. This paper discusses the oral health problems adolescents face and suggests approaches for providing integrated oral and general health care for adolescents.

DISCUSSION

Oral health issues linked with adolescent health concerns include: malocclusion and esthetic concerns linked with mental health status; oral and maxillofacial injuries linked with accidental and intentional injuries; oral manifestations of sexually transmitted infections; oral leukoplakia and oral cancers linked with alcohol, tobacco and psychoactive substance abuse; and oral manifestations of anemia resulting from nutritional problems. Training oral health care providers on adolescent health and care could promote prompt diagnosis, management and prevention of complications associated with major health challenges affecting adolescents.

CONCLUSION

Adolescent oral health care needs focused attention: as a possible route for early diagnosis and management of general health problems and for promoting adolescent oral health care. Oral health care should be integrated into adolescent friendly services and oral health care providers should learn how to handle adolescents' health needs.

The Relationship Between Life Course Factors, Parental Demographics, Dental Coping Beliefs and Its Influence on Adolescents Dental Visit: a Cross Sectional Study

Background

Oral Disease is a multifactorial one that includes behavioral and cultural components, and the severity of the disease depends on regularity of dental visits. The purpose of the study was to evaluate the relationship between parental demographics, life course factors, dental coping beliefs with therecent dental attendance among adolescents in Udupi Taluk.

Methods

Three hundred and fifty adolescents aged 16–19 years from four randomly selected schools in Udupi Taluk participated in this cross sectional study. Information was obtained regarding their parental demographics, their early life course, dental coping beliefs and recent dental attendance. Bivariate followed by multiple logistic regression analysis was performed to elicit variables which predict recent dental attendance.

Results

Out of the 324 adolescents who completed the questionnaire, 25.3% reported visiting a dentist within a period of one year. Childhood dental visit, childhood dental experience, housing, internal and external locus of control and self-efficacy were significantly associated with recent dental visit (p<0.05). Participants who lived in cement/brick houses were 4.3 times more likely to visit a dentist within one year compared to those living in hut/mud/combined houses (p<0.05). Adolescents with lower external (OR= 0.11, P<0.003) and low internal (OR=0.05, P<0.001) locus of control had lower odds of visiting a dentist within a year when compared with those having higher locus of control.

Conclusion

Childhood financial hardships, childhood dental visits and experiences and dental coping beliefs affect dental attendance pattern during adolescence. These factors should be considered while tailoring interventions to promote the oral health and dental attendance behaviors of adolescents.

Life course models for upper aero-digestive tract cancer

Upper aero-digestive tract (UADT) cancers are collectively cancers of various human body sites, such as the oral cavity, pharynx, oesophagus and larynx. Worldwide, they are the fourth most frequent cancer type and the fourth most common cause of mortality from cancer. Many studies have shown that several chronic diseases, such as cancer, which occur more commonly in later adulthood, are influenced by social and psychological circumstances during birth, childhood, adolescence and early adult life. It is suggested that the build up of problematic circumstances throughout life is the cause of disease, rather than circumstances that happen at one point in time. UADT cancer is a chronic disease of complex multifactorial origin and most of the underlying exposures/risks cannot be considered as individual factors or in isolation, as they act at different levels, which differ from time to time. Thus, life-course epidemiology, rather than drawing false dichotomies between different risk factors of the underlying disease, attempts to integrate biological and social risk processes that cause the chronic disease. It studies how socially patterned exposures during all stages of life--childhood, adolescence and early adult--influence disease risk in adulthood and socio-economic position and hence may account for social inequalities in adult health and mortality. Furthermore, varying health effects, according to the timing or duration of exposure to socio-economic circumstances, may indicate important traces to the causes of cancer. In this paper, we have attempted to draw a conceptual framework on the relationships between socio-economic inequalities, oral health risk factors along the life-course of an individual and incidence of UADT cancer.

Which life course model better explains the association between socioeconomic position and periodontal health?

AIM

To assess whether the relationship between socioeconomic position (SEP) and periodontal health fitted the Critical Period or the Social Mobility life course models.

METHODS

A nationally representative sample of 5570 Korean adults from KNHANES IV study. Log-binomial regression models adjusting for adulthood or childhood socioeconomic (SES) variables was used to assess independent effects of socioeconomic differences for childhood, adulthood and period of transition from child to adult in periodontal health.

RESULTS

In the Critical Period model, poorer periodontal status was associated with SES disadvantage in adulthood and not predicted by SES disadvantage in childhood. For the intergenerational Social Mobility model, prevalence of current periodontal disease was only different for females aged 30-39 and 40-49 years, after adjustment. Prevalence of periodontal disease in females was highest in the downwardly mobile group.

CONCLUSIONS

The Critical Period model was better at explaining association between socioeconomic position and periodontal health, such as the adulthood socioeconomic variables (SEP), had a stronger effect than childhood factors on periodontal disease. The Social Mobility model explained more of the variation in the association between SEP and periodontal health among women than among men.

Determinants of tooth loss and chewing ability in mid- and late life in three Swedish birth cohorts

The aim of the research presented is to determine the influence of socio-economic factors in childhood and mid-life on multiple tooth loss and chewing problems in mid- and late life in three Swedish birth cohorts (1903–1910, 1911–1920 and 1921–1925). Longitudinal national Swedish surveys were used for the analysis. Participants were interviewed in mid-life in 1968 and later in life (77–99 years of age) in 2002. Childhood socio-economic positions (SEP) did not result in different odds of multiple tooth loss and chewing problems in mid- and late life, but persons with higher mid-life SEP had lower odds. Persons born into the 1921–1925 birth cohort had significantly lower odds of multiple tooth loss in late life than the 1903–1910 birth cohort. Women had higher odds of losing multiple teeth than men in late life but not mid-life. Neither gender nor childhood and mid-life SEP predicted chewing problems late in life, but older people with multiple tooth loss had higher odds of chewing difficulty than those with mainly natural teeth. Childhood conditions may contribute to multiple tooth loss in mid-life, which subsequently contributes to multiple tooth loss in late life. Tooth loss in late life is strongly associated with difficulty chewing hard food. Prevalence of multiple tooth loss is higher in women than in men in late life but not in mid-life.

Early life conditions, adverse life events, and chewing ability at middle and later adulthood

OBJECTIVES

We sought to determine the extent to which early life conditions and adverse life events impact chewing ability in middle and later adulthood.

METHODS

Secondary analyses were conducted based on data from waves 2 and 3 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in the years 2006 to 2009 and encompassing information on current chewing ability and the life history of persons aged 50 years or older from 13 European countries. Logistic regression models were estimated with sequential inclusion of explanatory variables representing living conditions in childhood and adverse life events.

RESULTS

After controlling for current determinants of chewing ability at age 50 years or older, certain childhood and later life course socioeconomic, behavioral, and cognitive factors became evident as correlates of chewing ability at age 50 years or older. Specifically, childhood financial hardship was identified as an early life predictor of chewing ability at age 50 years or older (odds ratio = 1.58; 95% confidence interval = 1.22, 2.06).

CONCLUSIONS

Findings suggest a potential enduring impact of early life conditions and adverse life events on oral health in middle and later adulthood and are relevant for public health decision-makers who design strategies for optimal oral health.

Risk indicators of oral health status among young adults aged 18 years analyzed by negative binomial regression

Background

Limited information on oral health status for young adults aged 18 year-olds is known, and no available data exists in Hong Kong. The aims of this study were to investigate the oral health status and its risk indicators among young adults in Hong Kong using negative binomial regression.

Methods

A survey was conducted in a representative sample of Hong Kong young adults aged 18 years. Clinical examinations were taken to assess oral health status using DMFT index and Community Periodontal Index (CPI) according to WHO criteria. Negative binomial regressions for DMFT score and the number of sextants with healthy gums were performed to identify the risk indicators of oral health status.

Results

A total of 324 young adults were examined. Prevalence of dental caries experience among the subjects was 59% and the overall mean DMFT score was 1.4. Most subjects (95%) had a score of 2 as their highest CPI score. Negative binomial regression analyses revealed that subjects who had a dental visit within 3 years had significantly higher DMFT scores (IRR = 1.68, p < 0.001). Subjects who brushed their teeth more frequently (IRR = 1.93, p < 0.001) and those with better dental knowledge (IRR = 1.09, p = 0.002) had significantly more sextants with healthy gums.

Conclusions

Dental caries experience of the young adults aged 18 years in Hong Kong was not high but their periodontal condition was unsatisfactory. Their oral health status was related to their dental visit behavior, oral hygiene habit, and oral health knowledge.

Location of community pharmacies and prevalence of oral conditions in the Western Cape Province

Community pharmacists are approached regularly for oral health advice; most commonly for ulcers which could be indicative of oral cancer, HIV, and various systemic diseases. Community pharmacists should know how to manage these conditions yet they have very limited training to manage these conditions appropriately. The area location and socioeconomic status (SES) of the pharmacy should be considered as it may influence patient management. A study of this nature has not yet been conducted in the Western Cape Province of South Africa. To determine the prevalence and frequency of oral complaints at community pharmacies and if these parameters differ by metropolitan location and SES. A cross-sectional survey of 162 randomly-selected private sector pharmacies was conducted. The sample (n = 121) was stratified by SES and metropolitan location. An open-ended structured questionnaire was faxed to pharmacists. A telephonic interview was conducted a day later. Community pharmacists were asked about the frequency and type of oral health problems they encountered. Most pharmacists (91%) dealt with oral health problems frequently, most commonly for ulcers (55.8%), thrush (49.2%), and toothache (33.3%). The results did not differ by metropolitan location and SES (Chi-squared, Fisher’s Exact, p > 0.05), with the exception of toothache and mouth sores. Community pharmacists are an important part of an interdisciplinary team, and play a definite role in the early detection of oral health conditions, namely, caries, HIV and oral cancer. Training on common oral health conditions should be included in undergraduate pharmacy curricula and continuous professional development courses.Gemeenskapsaptekers word gereeld genader vir advies rakende mondgesondheid, hoofsaaklik mondsere wat ’n aanduiding kan wees van mondkanker, MIV en verskeie sistemiese siektes. Gemeenskapsaptekers moet weet hoe om hierdie kwessies te hanteer. Die ligging van die area en die sosio-ekonomiese status (SES) van die apteek moet in ag geneem word aangesien dit ’n invloed mag hê op die hantering van die pasiënt. ’n Studie van hierdie aard is nog nie in die Wes-Kaap Provinsie van Suid-Afrika onderneem nie. Die doel van hierdie studie is om die voorkoms en herhaling van klagtes oor mondsiektes by gemeenskapsapteke te bepaal en of hierdie parameters verskil na gelang van metropolitaanse ligging en SES. ’n Deursnee-opname van 162 ewekansig geselekteerde privaat sektor-apteke is onderneem. Die steekproef (n = 121) is gestratifiseer ten opsigte van SES en metropolitaanse ligging. ’n Oopeinde gestruktureerde vraelys is aan apteke gefaks. ’n Telefoniese onderhoud is ’n dag later gevoer. Gemeenskapsaptekers is gevra na die herhaling van en die tipe mondgesondheidsprobleme wat hulle teëgekom het. Die meeste aptekers (91%) het dikwels met mondprobleme te doen gekry, meestal mondsere (55.8%), mondsproei (49.2%) en tandpyn (33.3%). Die bevindinge het nie verskil na gelang van metropolitaanse ligging en SES (Chi-kwadraat, Fisher se eksakte toets, p > 0.05) nie, met die uitsondering van tandpyn en mondsere. Gemeenskapsaptekers vorm ’n belangrike deel van ’n interdissiplinêre span, en speel ’n definitiewe rol in die vroeë opsporing van mondgesondheidstoestande, naamlik tandverrotting, MIV en mondkanker. Opleiding in algemene mondgesondheidstoestande behoort deel te vorm van voorgraadse aptekerskurrikulums en voortgesette professionele ontwikkelingskursusse.

Reduction of social inequalities in utilization of dental care in Brazil from 1998 to 2008

OBJECTIVE

To analyze access to and utilization of dental care services in Brazil.

METHODS

We used data from the 2003 and 2008 Brazilian National Household Surveys, which we compared to data from the 1998 survey. We investigated access and utilization variables at ages three, six, nine, 12, 15, and 19 years in the first (Q1) and fifth (Q5) quintiles of per capita family income. All analyses took into account the complex sampling strategy.

RESULTS

The proportion of subjects that had never seen a dentist decreased during the period (18.7% in 1998, 15.9% in 2003 and 11.7% in 2008). There was an important reduction in the absolute difference in failure to use dental care services after age nine years between Q1 and Q5 from 1998 to 2008, which decreased to about half its value at 15 (30.3 percentage points - pp to 16.1 pp) and 19 years (20.4 pp to 9.9 pp). Q5/Q1 ratios for recent dental appointments fell across all age groups, especially between zero and six years (Q5/Q1 from 3.2 to 2.6); utilization of the National Health Care System for dental care increased in Q1 and Q5, with a reduction in the Q1/Q5 ratio of approximately 20%. Use of the National Health Care System for dental care increased by approximately 8% in Q1 and 35% in Q5 between 2003 and 2008.

CONCLUSIONS

There have been considerable advances in terms of reducing inequalities in access to, and increasing the utilization of, dental care services in Brazil between 1998 and 2008. However, inequality between social groups remains substantial.

Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey

AIM

To investigate oral hygiene and periodontal status of 12- and 15-year old Greek adolescents, in relation to sociodemographic and behavioural parameters.

METHODS

A stratified cluster sample of 1,224 12-year old and 1,257 15-year old adolescents of Greek nationality were selected and examined by calibrated examiners. Periodontal and oral hygiene status were assessed using the Community Periodontal Index (CPI) and the simplified Debris Index (DIs) respectively. The socio-demographic and behavioural data collected included region, location, gender, parental educational level, tooth brushing frequency and reason for dental attendance.

RESULTS

The majority of adolescents aged 12 (75.0%) and 15-years (61.4%) had fair oral hygiene levels. The most frequently observed condition in both ages was calculus with or without bleeding (42.8% in the younger and 53.3% in the older age group). Bleeding on probing was found in 41.5% of the 12-year-olds and in 30.0% of the 15-year-olds. The occurrence of shallow and/ or deep periodontal pockets was very low (0.2%). Multivariable modelling revealed that gender, location and tooth brushing frequency were strongly associated with oral hygiene status in both ages; girls, those living in urban areas and brushing teeth more frequently had significantly lower DI-s. Tooth brushing frequency was also associated with periodontal status in both ages, while living in urban areas was associated with better periodontal health only in the 15-year-olds.

CONCLUSIONS

The study demonstrated that oral hygiene conditions among Greek children and adolescents are not satisfactory and that the occurrence of gingivitis is high. More efforts on oral health education and oral hygiene instruction are needed to improve their periodontal and oral hygiene status.