Differences between racial groups in the impact of oral disorders among older adults in North Carolina

Perceived oral health beliefs, traditional practices, and oral health status of nomads of Tamilnadu: A cross-sectional study

Aim:

To assess the perceived oral health beliefs, traditional practices, and oral health status of nomads.

Methods:

A cross-sectional study was conducted among 115 nomads residing in various places of Tamilnadu. Information regarding socio-demographics such as age, gender, occupation, and place of residence were obtained. Study participants were interviewed with a pre-tested questionnaire consisting questions related to oral health beliefs and oral health practices. Clinical examination was carried out to record the oral health status using a proforma.

Results:

A significant Chi-square association was found with oral health-related beliefs (P < 0.01). However, 30.9% had perceived strong beliefs, 64.3% of the subjects used toothbrush, and 20% had at least one oral mucosal lesion.

Conclusion:

A significant proportion of nomads had perceived oral health beliefs, which had a significant association with their traditional practices and their oral health was much deteriorated.

Assessment of the Effect of Oral Health on Quality of Life and Oral-Health Indicators among ESRD Patients in Southwest Florida: A Pilot Study

Purpose

To determine and compare OHRQoL (oral-health-related quality of life) using the Geriatric Oral Health Assessment Index (GOHAI-12) and Oral Health Impact Profile (OHIP-14) among patients receiving hemodialysis (HD).

Methods

Face-to-face interviews and intraoral examinations were conducted among 70 patients. Mann-Whitney U test and Kruskal-Wallis test were used to compare each item score with demographics and dental and overall health status.

Results

The mean number of years on dialysis was 4.7 ± 7.5 yrs; the mean number of teeth present was 19.7 ± 11.04; median values of OHRQoL using GOHAI-12 and OHIP-14 were 52 and 64. Within GOHAI-12, limiting food (p 0.043), uncomfortable eating in front of people (p 0.045), limiting contact with people (p 0.046), and eating without discomfort (p 0.011) were significantly associated with females. Being worried (p 0.040) and self-conscious (p 0.048) were significant for age groups ≤65 years. Prevented from speaking was associated with >20 teeth (p 0.016). Being worried about oral health was associated with number of years on dialysis (p 0.042). Within OHIP-14, speech was associated with number of teeth present (p 0.024). Total inability to function was significantly associated with race (p 0.018), number of teeth (p 0.028), and edentulousness (p 0.031).

Conclusions

GOHAI-12 was more effective than OHIP-14 in assessing OHRQoL. However, most subjective experiences did not correlate with clinical findings. Systemic health issue like end-stage renal disease affecting QoL might have taken precedence over dental problems. Clinical assessments should be inherent in oral-health evaluation and there should be cooperation between nephrologists and dentists in promoting oral health and treating systemic conditions among HD patients.

Correlation between upper limb function and oral health impact in stroke survivors

[Purpose] The aim of the present study was to evaluate the relationship between upper limb impairment and oral health impact in individuals with hemiparesis stemming from a stroke. [Subjects and Methods] The study subjects were conducted with a sample of 27 stroke survivors with complete or partial hemiparesis with brachial or crural predominance. The 14-item short version of the Oral Health Impact Profile was used to evaluate perceptions of oral health. The Brazilian version of the Stroke Specific Quality of Life Scale was used to evaluate perceptions regarding quality of life. [Results] A statistically significant association was found between the upper extremity function subscale of the SSQOL-Brazil and the impact of oral health evaluated using the OHIP-14, with a strong correlation found for the physical pain subscale, moderate correlations with the functional limitation, psychological discomfort, physical disability, social disability and social handicap subscales as well as a weak correlation with the psychological disability subscale. Analyzing the OHIP-14 scores with regard to the impact of oral health on quality of life, the most frequent classification was weak impact, with small rates of moderate and strong impact. [Conclusion] Compromised upper limb function and self-perceived poor oral health, whether due to cultural resignation or functional disability, exert a negative impact on the quality of life of individuals with hemiparesis stemming from a stroke.

Level of oral health impacts among patients participating in PEARL: a dental practice-based research network

OBJECTIVES

To determine whether participants of a dental practice-based research network (PBRN) differ in their level of oral health impact as measured by the Oral Health Impact Profile (OHIP) questionnaire.

METHODS

A total of 2410 patients contributed 2432 OHIP measurements (median age = 43 years; interquartile range = 28) were enrolled in four dental studies. All participants completed the Oral Health Impact Profile (OHIP-14) during a baseline visit. The main outcome of this study was the level of oral health impact, defined as follows: no impact ('Never' reported on all items); low ('Occasionally' or 'Hardly ever' as the greatest frequency score reported on any item); and high ('Fairly often' or 'Very often' as the greatest frequency reported on any item). Polychotomous logistic regression was used to develop a predictive model for the level of oral health impact considering the following predictors: patient's age, gender, race, practice location, type of dentist, and number of years the enrolling dentist has been practicing.

RESULTS

A high level of oral health impacts was reported in 8% of the sample; almost a third (29%) of the sample reported a low level of impacts, and 63% had no oral health impacts. The prevalence of impacts differed significantly across protocols (P < 0.001). Women were more likely to be in the high oral impact group than in the no impact group compared to men (OR = 1.46; 95% CI = 1.06-1.99). African Americans were more likely to report high oral impacts when compared to other racial/ethnic groups (OR = 2.11; 95% CI = 1.26-3.55). Protective effects for being in the high or in the low-impact groups were observed among patients enrolled by a solo practice (P < 0.001) or by more experienced dentists (P = 0.01). A small but highly significant statistical association was obtained for patient age (P < 0.001). In the multivariate model, patient's age, practice size, and gender were found to jointly be significant predictors of oral health impact level.

CONCLUSIONS

Patients' subjective report of oral health impact in the clinical setting is of importance for their health. In the context of a dental PBRN, the report of oral health-related quality of life (OHRQoL) was different across four dental studies. The observed findings validate the differential impact that oral health has on the patients' perception of OHRQoL particularly among specific groups. Similar investigations to elucidate the factors associated with patient's report of quality of life are warranted.

Toothache pain: behavioral impact and self-care strategies

A computer-assisted telephone interview in Maryland of adults who had low income and were Hispanic, Black, and White and who had experienced a toothache during the previous 12 months was conducted. Respondents reported a high prevalence of toothaches, with 44.3% having experienced more than five toothaches during the preceding 10 years. Pain intensity associated with the most recent toothache was high with 45.1% of the respondents reporting the highest pain possible. Pain interfered with many aspects of normal functioning. Self-care strategies generally took precedence over professional health services. Pain sufferers used a combination of self-care and formal care strategies. Initial strategies most often focused on nonprescription medicines(home remedies and prayer. The majority of respondents ultimately sought pain relief from a dentist. We identified a number of significant differences in the strategies used across racial/ethnic groups.

Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature

BACKGROUND

The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino) were chosen as exemplar populations.

METHODS

The dental literature published in English for the period 1980-2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied.

RESULTS

Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base.

CONCLUSION

The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.

Factors associated with oral health-related quality of life in community-dwelling elderly persons with disabilities

OBJECTIVES

To examine, in community-dwelling elderly persons with disabilities, the association between oral health-related quality of life (OHRQOL) as measured using the 14-item Oral Health Impact Profile (OHIP-14) and specific oral health, health, and disability status variables; life satisfaction; living alone; and low income.

DESIGN

Observational cross-sectional.

SETTING

A Medicare demonstration conducted in 19 counties in three states.

PARTICIPANTS

Six hundred forty-one disabled, cognitively intact, community-dwelling individuals aged 65 and older.

MEASUREMENTS

The subjects' OHRQOL was assessed using the OHIP-14, which was scored using three different methods. Data on oral health, health and functional status, life satisfaction, prior health services use, and sociodemographics were collected using interviewer-administered questionnaires.

RESULTS

The participants' mean age was 79.1, and they were dependent in an average of 1.8 activities of daily living (ADLs); 43.1% were edentulous, 77.4% wore a denture, 40.4% felt that they were currently in need of dental treatment, and 64.7% had not had a dental examination in the previous 6 months. Seven of the 16 variables of interest had significant bivariate relationships using three OHIP scoring methods. Logistic regression analysis found that poor OHRQOL was significantly associated with perceived need for dental treatment (odds ratio (OR)=2.61), poor self-rated health (OR=2.29), poor (OR=2.00) and fair (OR=1.73) mental health, fewer than 17 teeth (OR=1.74), and relatively poor cognitive functioning (OR=1.52).

CONCLUSION

OHRQOL is associated with some (perceived need for dental treatment, poor self-rated health, worse mental health, fewer teeth, and relatively poor cognitive status) but not all (e.g., ADL and instrumental ADL dependence) measures of oral health, health, and disability status and not with life satisfaction, living alone, or low income.

Oral health-related quality of life: a critical appraisalof assessment tools used in elderly people

OBJECTIVE

The purpose of this study was to undertake a critical appraisal of oral health-related quality of life (OHRQoL) measurements used for research in the elderly.

BACKGROUND

A variety of OHRQoL measurements have been developed in the past 20 years as a result of increased concern about the impact of oral conditions on a person's quality of life. There is need for an assessment aimed at prioritising the recommended measurements to be used for different purposes in the elderly.

MATERIALS AND METHODS

Original English language papers using measurements to assess OHRQoL in the elderly were identified from Web of Science, EMBASE, PubMed, Medline and Lilacs databases. The search included all papers published from 1985 to February 2007. The criteria of assessment were: (i) measurement criteria (number of items and domains, and classification of the results found for each measurement); (ii) quantitative-qualitative criteria (frequency, acceptability, reproducibility, reliability, sensitivity and capability of being reproduced in other language versions).

RESULTS

In a total of 152 papers selected, 20 measurements were identified. However, only seven fulfilled all the measurement and quantitative-qualitative criteria.

CONCLUSION

Geriatric Oral Health Assessment Index, Subjective Oral Health Status Indicators, Oral Health Impact Profile-49, Dental Impact on Daily Living, Oral Health Impact Profile-14, Oral Impact on Daily Performances and German Version of the Oral Heath Impact Profile were considered as instruments of choice to assess OHRQoL in the elderly. The other 13 instruments identified require further research aimed at a validation process and the use of a language other than English.

The relationship between sociodemographic factors and oral health-related quality of life in dentate and edentulous community-dwelling older adults

OBJECTIVES

To quantify the associations between sociodemographic factors and oral health-related quality of life (OHRQoL) in dentate and edentulous community-dwelling older adults.

DESIGN

Cross-sectional study using a 54-item OHRQoL questionnaire.

SETTING

Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural).

PARTICIPANTS

Two hundred eighty-eight participants (Dental Study subjects) aged 65 and older were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in older African Americans and non-Hispanic whites.

MEASUREMENTS

Dental Study subjects were queried on their OHRQoL and sociodemographic status and classified into two categories: dentate and edentulous. Bivariate analyses were used to quantify associations between sociodemographic variables and OHRQoL after excluding participants with severe depression. Variables included age, sex, race, marital status, veteran status, residence, income, education, and transportation difficulties.

RESULTS

Dentate and edentulous subjects had similar OHRQoL across age, sex, marital status, veteran status, and residence. Analyses suggested a strong association between OHRQoL and race, education, income, and transportation difficulties in dentate subjects. Sociodemographic factors were less strongly associated with OHRQoL in edentulous participants.

CONCLUSION

OHRQoL decrements were prevalent in dentate and edentulous subjects. Of dentate persons, African Americans and those with a 6th-grade education or less, with income less than 16,000 dollars/year, and with transportation difficulties were more likely to have decrements in OHRQoL. In edentulous persons, these associations were not statistically significant or were weaker. These findings suggest differential associations between sociodemographic factors and OHRQoL when stratified according to dentate status.

Perceptions of dental care need among African-American elders: implications for health promotion

The aim of this study was to assess perceived dental care need, actual clinical need and the relationship between these variables and care-seeking behavior among community residing African-American elders. A convenience sample of 146 elders responded to a survey and participated in oral screenings at six senior centers. Elders were categorized as needing routine dental care, some dental care, or urgent dental care. Most (61%) required dental care with one-fourth having urgent dental care needs. Elders reporting a problem tended to seek dental care more often within a year (38%) than those not reporting a problem (27%). Sixty-four percent did not currently have a dental provider. The majority (83%) rated their general health as being fair or good and few (9%) reported oral pain. These findings suggest developing health promotion programs that emphasize non-painful oral signs and symptoms, accompanied by associated general health implications that may compromise overall health.

Self-rated oral health as an independent predictor of self-rated general health, self-esteem and life satisfaction

Self-rated health (SRH) is a useful summary measure of people's general health and was found to predict future health outcomes. Self-rated oral health (SROH) is a similarly useful summary measure of people's oral health. Both are related to quality of life, especially at old age. The objectives of the study were: (1) to assess the independent contribution of SROH to concurrent and future SRH of elderly people, controlling for sociodemographics and health measures, and, (2) to assess whether SROH adds unique information not captured by SRH by testing their independent associations with self-esteem and life satisfaction. Participants were 850 residents of a retirement community (mean age 73) interviewed in their homes at baseline and 5 years later. The interview included single-item self-ratings of general and oral health, self-reports of medical history, recent chronic diseases, medication usage, functional disability, self-esteem and life satisfaction. Multiple regression analyses showed that SROH had an independent effect on concurrent and future SRH, controlling for age and other measures of health status. Both SRH and SROH independently explained a significant amount of variance in concurrent ratings of self-esteem and life satisfaction. SROH has a unique role in people's perceptions of their overall health yet is not fully captured by SRH. Therefore, it should be considered by general health care providers in their assessments of the health status of older adults.

[Psycometrics properties of subjetive indicator in children]

OBJECTIVE

To evaluate the psychometric properties of the Oral Heath Impact Profile (OHIP-14) to measure oral health in children.

METHODS

The OHIP-14 questionnaire was applied to 312 schoolchildren aged 12 years residing in Sabará, Brazil, in 2001. OHIP-14's reliability was evaluated using Cronbach's alpha and correlation intraclass coefficient. For examining content validity, Pearson's correlation and logistic regression analysis were applied. For construct validity, Student's t-test and Tukey-Kramer test were used.

RESULTS

Tooth loss among the subjects was low in this study (between 85% and 100%). Caries prevalence was very low and not detectable in 59.0% of the sample. The logistic regression model showed high predictive values for reporting treatment need and intermediate values for dental caries perception. The comparison between different OHIP average scores, according to the DMF-S index's three categories of decayed, missing, filled surfaces, indicated significant difference only for the categories social disability and deficit.

CONCLUSIONS

The study results indicated that the adolescents did not report high prevalence of oral conditions. The OHIP was associated with perceived treatment need, reporting of dental caries and increased DMF-S index. These results suggest that the OHIP has good psychometric properties when applied to children and could be a promising instrument for screening priority care groups.

How do age and tooth loss affect oral health impacts and quality of life? A study comparing two national samples

Age and loss of teeth can be expected to have a complex relationship with oral health-related quality of life. This study aimed to explain how age and tooth loss affect the impact of oral health on daily living using the short form, 14-item Oral Health Impact Profile (OHIP-14) on national population samples of dentate adults from the UK (1998 UK Adult Dental Health Survey) and Australia (1999 National Dental Telephone Interview Survey). After correcting for key covariables, increasing age was associated with better mean impact scores in both populations. Those aged 30-49 years in Australia showed the worst (highest) scores. In the UK, those aged under 30 showed the highest scores. In both countries, adults aged 70+ showed much better scores than the rest (P < 0.001). When corrected for age, the independent effect of tooth loss was that the worst scores were found where there were fewer than 17 natural teeth in the UK and fewer than 21 teeth in Australia. People with 25 or more teeth averaged much better scores than all other groups (P < 0.001), although there were differences in pattern between countries. When Australians were analysed by region of birth, the pattern of scores by tooth loss for British/Irish immigrants was strikingly similar to that for the UK sample. First-generation immigrants from elsewhere showed much worse overall scores and a profoundly different pattern to the Australian- and British-born groups. Age, number of teeth and cultural background are important variables influencing oral health-related quality of life.

Edentulism and nutritional status in a biracial sample of well-functioning, community-dwelling elderly: the health, aging, and body composition study

BACKGROUND

Edentulism may affect dietary intake in older adults, but the relation between edentulism and nutritional status is not completely understood.

OBJECTIVE

The present study examined whether edentulism is associated with nutritional status and whether there is an interaction between race and edentulism on nutritional status among well-functioning, community-dwelling elderly.

DESIGN

The study cohort included 3075 elderly aged 70-79 y (52% women, 42% black) in the Health, Aging, and Body Composition Study. Dietary intake, anthropometric variables, weight change, and serum albumin and lipid concentrations were compared between edentate and dentate participants by the use of multiple linear and logistic regressions.

RESULTS

Edentulism was not associated with total energy or food intake but was associated with the food groups consumed, particularly fat, micronutrients, and hard-to-chew foods. Edentulism was more strongly linked to dietary intake in whites than in blacks. Unlike black edentate elderly, white edentate elderly consumed significantly lower energy-adjusted amounts of vitamin A and beta-carotene, higher amounts of energy-adjusted total and saturated fat and cholesterol, and higher percentages of energy from fat than did white dentate elderly. Anthropometry and biochemical indexes were not significantly different by edentulism status in both races. Edentulism was associated with weight gains of >5% in 1 y in both races.

CONCLUSIONS

Edentulism was associated with differences in the nutritional status of well-functioning, community-dwelling elderly, more so in whites than blacks. Edentate elders may benefit from dental, medical, and nutrition interventions targeted to addressing these findings.

Validation of a Sinhalese translation of the Oral Health Impact Profile-14 for use with older adults

OBJECTIVE

To test the psychometric properties of a Sinhalese translation of the OHIP-14 scale for use among older adults in Sri Lanka.

DESIGN

A cross-sectional survey. The English version of the OHIP-14 was translated in to Sinhalese, pre-tested and subsequently administered to the subjects by a trained interviewer.

SETTING

Moratuwa--a densely populated urban area in the Western province of Sri Lanka.

SUBJECTS

585 individuals aged 60 years and above.

MAIN OUTCOME MEASURES

Reliability of the translated scale was assessed in terms of internal consistency using Cronbach's alpha. Construct validity was evaluated by examining the associations between perceived oral health status, perceived need for dental care and the OHIP scores.

RESULTS

Cronbach's alpha of the translated scale was 0.93. Corrected item-total correlation coefficients ranged from 0.53-0.80. The highly significant associations between perceived oral health status, perceived need for dental care and the OHIP scores support the construct validity of the translated scale.

CONCLUSION

The Sinhalese translation of the OHIP-14 is a valid and reliable instrument to measure oral health related quality of life in older adults of Sri Lanka.

The New York State Minority Health Survey: determinants of oral health care utilization

OBJECTIVES

To determine the factors associated with visits to a dentist and more specifically the role of dental insurance coverage and to explore the reasons for not visiting a dentist among minorities in New York State.

METHODS

The Minority Health Survey was a one-time, statewide, random digit-dialed telephone survey. We drew a directed acyclic graph (DAG) of the potential determinants of oral health care utilization for our population of interest and modeled the independent variables as determinants of oral health care utilization. The data for this study were analyzed in SUDAAN using appropriate weights and variance adjustments that accounted for the complex sampling design. Hence, this report is generalizable to the New York State adult "minority" population.

RESULTS

About 63 percent respondents had visited a dentist in the past one year. Having dental insurance (adjusted odds ratio [adj OR]=2.5), having more than high school education (adj OR=1.9), being younger (adj OR=2.3 for 18-25 years vs age 40 years or older), being married (adj OR=1.7), being dentate (adj OR=0.3 for edentulousness), and having higher income (adj OR=0.5 for middle vs high income) were significantly associated with having visited a dentist in the past year. Cost and awareness-related factors were the most common reasons for not visiting a dentist. Most of the year 2000 oral health objectives measurable in this survey were not met.

CONCLUSION

Increasing dental insurance coverage and increasing awareness about oral health care would be the two biggest factors in meeting the goals of year 2010.

Socioeconomic and demographic disparities in symptoms of orofacial pain

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

The self-assessed oral health status of individuals from White, Indian, Chinese and Black Caribbean communities in South-east England

OBJECTIVES

To determine the level of self-assessed oral symptoms and the impact of such symptoms among individuals from four ethnic groups resident in South-east England and the relationship between self-assessed oral health status, age, gender, employment status, educational level and ethnicity.

METHOD

Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups.

MEASURES

Subjective Oral Health Status Indicators (SOHSI).

PARTICIPANTS

Individuals were recruited through community groups. All participants self-classified their ethnicity. Only completed questionnaires from participants categorising themselves as White, Black Caribbean, Chinese or Indian were included in the data analysis.

FINDINGS

Univariate statistical analysis revealed significant differences between ethnic groups in all but one of the SOHSI scales. Age and ethnicity (in particular membership of the Chinese community) emerged as significant predictors of SOHSI scale scores.

CONCLUSIONS

Within the limitations imposed by convenience sampling, it has been found that differences exist among four ethnic groups in the UK in their reporting of self-assessed oral health status. Ethnicity and age, in particular, predict the reporting of self-assessed oral symptoms and the impact of such symptoms.

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Testing a model of the relationship between gender, ethnicity, clinical status and impact in older adults from minority ethnic groups

OBJECTIVE

To identify the relationship between indicators of self-assessed symptom status, the reported impact of oral conditions and clinical indices, and the extent to which this relationship was moderated by gender and ethnicity.

DESIGN

Secondary analysis of data from an oral health survey of minority ethnic groups.

PARTICIPANTS

Purposive sample of 376 individuals from minority ethnic groups in the United Kingdom recruited through community groups.

MEASURES

Numbers of decayed, missing and filled teeth. Measures of self assessed symptoms, and impact upon quality of life.

RESULTS

Impact of oral conditions upon lifestyle was predicted by the number of missing teeth, the presence of pain on eating certain foods and the presence of toothache in the previous four weeks. Social variables (gender and ethnicity) did not predict impact either singly or through interaction with symptoms.

CONCLUSIONS

The findings support a linear model of the relationship between the experience of oro-facial symptoms and impact on everyday life amongst older adults.

Racial differences in predictors of dental care use

OBJECTIVE

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

DATA SOURCES/STUDY SETTING

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

STUDY DESIGN

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

DATA COLLECTION/EXTRACTION METHODS

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

PRINCIPAL FINDINGS

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

CONCLUSIONS

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

Validation of a Chinese version of the Oral Health Impact Profile (OHIP)

OBJECTIVES

To translate the original English version of Oral Health Impact Profile (OHIP) into a Chinese version, to validate the translated instrument for use among the elderly in Hong Kong and to derive a Chinese short-form OHIP.

METHODS

The original English version of OHIP was translated into Chinese. Elderly persons aged 60-80 years were interviewed by two trained interviewers and examined clinically by one of two calibrated dentists. Information on subjects' demographic background and oral health conditions were collected.

RESULTS

A total of 586 elderly persons were interviewed and clinically examined. Cronbach's alpha of the translated OHIP subscales ranged from 0.69 to 0.84 and the test-retest correlation coefficient ranged from 0.72 to 0.92. Construct validity of the translated Chinese version was supported by the finding that the OHIP-49 and subscale scores increased as the subject's perceived oral health status changed from healthy to unhealthy. Also, those who had a perceived dental treatment need had higher mean OHIP-49 and subscale scores compared to those who did not. The short-form OHIP derived in this study demonstrated comparable validity and reliability with the full version of OHIP.

CONCLUSION

The translated Chinese version of OHIP demonstrated good validity and reliability. It is available for use by researchers in oral health-related quality of life studies in Chinese elderly populations. In situations where a Chinese short-form of OHIP is desirable, there are now two validated Chinese versions for researchers to choose.

Orofacial pain: racial and sex differences among older adults

OBJECTIVES

This study investigated racial differences in orofacial pain symptoms in a sample of older adults. Orofacial pain prevalence, persistence, severity, and behavioral impact were assessed. We also tested whether sex and race interact, such that racial differences are only observed for a single sex, or whether sex differences only occur within a single racial group.

METHODS

Telephone interviews were conducted with a stratified random sample of 1,636 community-dwelling older (age 65+ years) north Floridians.

RESULTS

Racial differences were not found for 12-month prevalence or pain ratings for any painful oral symptom, or in the total number of symptoms. The most consistent racial differences were in behavioral impact associated with pain. Blacks reported greater behavioral impact as defined by pain having reduced their daily activities or motivating them to take some action in response to pain. For toothache pain, that action was more likely to have been some form of self-medication. These relationships persisted after controlling for socioeconomic status, approach to health care, and pain intensity in multivariable models.

CONCLUSION

Although pain prevalence is an important public health variable, this study suggests that other pain-related variables, such as behavioral impacts, are useful when describing disparities associated with orofacial pain.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Racial differences in orofacial pain

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

The prevalence of dental impacts on daily performances in older people in Northern Thailand

OBJECTIVE

To assess the prevalence of oral related impacts on the quality of daily life in older Thais.

DESIGN

A cross-sectional study on a non-random sample.

SETTING

Metropolitan area of Chiang Mai, Thailand Subjects: 707 older individuals living independently, aged 60 to 74 years, 549 were dentate, 158 were edentate.

METHODS

Clinical examination and questionnaire for the Oral Impacts on Daily Performances (OIDP) index and on dental behaviours.

RESULTS

About one half of the older people interviewed (52.8%) had at least one OIDP oral impact. The most common performance affected was eating (47.2%). The two main symptoms that caused oral impacts in the total sample were functional limitation and pain. The majority of older people had low OIDP scores below 8.0 (76.4%). Almost one in 10 had OIDP scores above 16.0. Individuals with a high income were more likely to have lower OIDP score (p<0.001). Subjects who had attended a dentist were more likely to have no oral impacts (p=0.02). There was a significant difference between OIDP scores related to some clinical variables; dental status (p=0.002), having mobile teeth (p=0.005), periodontal attachment loss (p<0.001), missing anterior and posterior teeth (p<0.001).

CONCLUSIONS

Oral impacts that affected quality of life of older people were relatively common but not severe. The impacts were related to some social and clinical variables.

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

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

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

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

Multidimensionality of oral health in dentate adults

OBJECTIVES

An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein.

METHODS

The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination.

RESULTS

The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health.

CONCLUSIONS

The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.

Dietary implications of oral health decrements among African-American and white older adults

OBJECTIVE

Older African-Americans are at disproportionate risk of chronic, nutritionally-related diseases. To begin to understand factors that may contribute to the disproportionate prevalence of life-threatening illnesses among African-Americans, this study investigates ethnic differences in the prevalence of oral health decrements.

DESIGN

The Florida Dental Care Study (FDCS), a longitudinal study of changes in the oral health of 873 subjects age 45+, was used to explore a broad range of oral health status differences between African-Americans and White adults in the United States. The FDCS consists of clinical and self-reported measures of oral health, sociodemographic information, and other indicators of oral functional status.

RESULTS

The prevalence of oral health decrements in this sample using a broad range of clinical and self-reported measures was substantial. African-American elders were at a heightened risk of poor oral health profiles, including having fewer teeth and being more likely to have a carious surface, fractured cusp or incisal edge, severely mobile teeth and severe periodontal levels than their White counterparts. Furthermore, the African-American respondents in our sample were significantly more likely to report a lower self-rated oral health and functioning than their White counterparts. These findings persist regardless of poverty status or educational level, two factors commonly thought to confound racial differences in health outcomes.

CONCLUSION

Our study provides evidence that the widespread prevalence of oral health decrements and accompanying functional disability among this sample of dentate older adults impacts their daily lives. Of particular concern is the oral heath status of older African-Americans who may be nutritionally vulnerable due, in part, to these oral health decrements and disabilities. We suggest enhancing the access of health services in order to prevent those oral health decrements that presumably undermine adequate dietary intake.

Oral disadvantage among dentate adults

Oral disadvantage can be defined as the avoidance of certain daily activities because of decrements in oral health. These decrements include oral disease and tissue damage, pain, and functional limitation. The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least 1 tooth, were 45 years old or older, and who participated for an interview and clinical examination. Three objectives of the FDCS are: (1) to describe selected psychometric properties of the measurement of oral disadvantage; (2) to describe oral disadvantage in a diverse sample of dentate adults; and (3) to describe the relationship between disadvantage and other aspects of oral health, such as disease/tissue damage, pain, and functional limitation. The prevalence of oral disadvantage within the previous 6 months, using eight self-reported measures, ranged from 5% to 25%, depending upon the measure. Factor analysis suggested that oral disadvantage is best described as three factors: disadvantage due to (1) oral disease/tissue damage, (2) oral pain, and (3) oral functional limitation. Irregular dental attenders, poor persons, and blacks had the highest prevalence of oral disadvantage. Clinical measures of oral disease/tissue damage, self-reported measures of oral disease/tissue damage, oral pain, and oral functional limitation were strongly associated with the presence of oral disadvantage. In multivariate analyses that accounted for differences in clinical measures of disease/tissue damage, self-reported disease/tissue damage, oral pain, and oral functional limitation, females were more likely to report disadvantage due to disease/tissue damage, and middle-aged persons and irregular dental attenders were more likely to report oral disadvantage due to pain. In these same regressions, differences in disadvantage due to race, poverty status, socioeconomic status, and rural/urban area of residence were not evident. These results have implications regarding the use of oral disadvantage to assess the long-term effectiveness of dental care.

Derivation and validation of a short-form oral health impact profile

Growing recognition that quality of life is an important outcome of dental care has created a need for a range of instruments to measure oral health-related quality of life. This study aimed to derive a subset of items from the Oral Health Impact Profile (OHIP-49)-a 49-item questionnaire that measures people's perceptions of the impact of oral conditions on their well-being. Secondary analysis was conducted using data from an epidemiologic study of 1217 people aged 60+ years in South Australia. Internal reliability analysis, factor analysis and regression analysis were undertaken to derive a subset (OHIP-14) questionnaire and its validity was evaluated by assessing associations with sociodemographic and clinical oral status variables. Internal reliability of the OHIP-14 was evaluated using Cronbach's coefficient alpha. Regression analysis yielded an optimal set of 14 questions. The OHIP-14 accounted for 94% of variance in the OHIP-49; had high reliability (alpha = 0.88); contained questions from each of the seven conceptual dimensions of the OHIP-49; and had a good distribution of prevalence for individual questions. OHIP-14 scores and OHIP-49 scores displayed the same pattern of variation among sociodemographic groups of older adults. In a multivariate analysis of dentate people, eight oral status and sociodemographic variables were associated (P < 0.05) with both the OHIP-49 and the OHIP-14. While it will be important to replicate these findings in other populations, the findings suggest that the OHIP-14 has good reliability, validity and precision.

Clinical measures and treatment needs

Clinically evaluated oral health outcome variables from the ICS-II USA data set were examined in the diverse ethnic groups, for two adult age cohorts (35-44 and 65-74 years). These measures were derived from epidemiological examinations and include the DMFT components, loss of attachment, and an indicator of treatment need--the ratio of decayed teeth over decayed and filled teeth. The ratio of decayed over decayed and filled teeth was used in multivariate analysis, since this measure represents an area where public policy could have an impact if determinants were understood. The most important independent variables were race-ethnicity, educational attainment, no fear of dental visits because of pain, and oral hygiene practices. Having a usual source of dental care and visiting the dentist within the past 12 months did not appear to be as important in predicting unmet needs as these other variables. To bridge the gap between the oral health status of majority and minority populations, health educators in minority communities need to become more accessible, have a pro-active interest in oral health, and also be cognizant of the various socio-cultural issues influencing oral health. The problems regarding Native American adults are more complex and require more careful study.

Evaluation of bias and logistics in a survey of adults at increased risk for oral health decrements

OBJECTIVES

Designing research to include sufficient respondents in groups at highest risk for oral health decrements can present unique challenges. Our purpose was to evaluate bias and logistics in this survey of adults at increased risk for oral health decrements.

METHODS

We used a telephone survey methodology that employed both listed numbers and random digit dialing to identify dentate persons 45 years old or older and to oversample blacks, poor persons, and residents of nonmetropolitan counties. At a second stage, a subsample of the respondents to the initial telephone screening was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We assessed bias due to: (1) limiting the sample to households with telephones, (2) using predominantly listed numbers instead of random digit dialing, and (3) nonresponse at two stages of data collection.

RESULTS

While this approach apparently created some biases in the sample, they were small in magnitude. Specifically, limiting the sample to households with telephones biased the sample overall toward more females, larger households, and fewer functionally impaired persons. Using predominantly listed numbers led to a modest bias toward selection of persons more likely to be younger, healthier, female, have had a recent dental visit, and reside in smaller households. Blacks who were selected randomly at a second stage were more likely to participate in baseline data gathering than their white counterparts. Comparisons of the data obtained in this survey with those from recent national surveys suggest that this methodology for sampling high-risk groups did not substantively bias the sample with respect to two important dental parameters, prevalence of edentulousness and dental care use, nor were conclusions about multivariate associations with dental care recency substantively affected.

CONCLUSIONS

This method of sampling persons at high risk for oral health decrements resulted in only modest bias with respect to the population of interest.

Indicators of oral health in diverse ethnic and age groups: findings from the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations

Racial-ethnic group differences are assessed using a standardized set of oral health indicators, as well as various predisposing, enabling and need characteristics collected in the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. The unique data set contains comparable data on African-American, Native American, Hispanic, primarily Mexican-American, and White adults. Age group differences in oral health indicators are also compared in two adult age cohorts (35-44 and 65-74 years). Since data were collected from geographically diverse regions of the United States, differences in oral health indicators are considered within the context of different dental care delivery systems and external environments. Results indicate that the gap in oral health between Whites and ethnic minority groups is pervasive across research locations and age cohorts. Variation in regional dental care delivery systems and the varying effects of race-ethnicity and age cohort suggest that alternative health promotion strategies will be needed for improving oral health in diverse populations.

Variations in the social impact of oral conditions among older adults in South Australia, Ontario, and North Carolina

Previous studies among older adults have demonstrated that oral disease frequently leads to dysfunction, discomfort, and disability. This study aimed to assess variations in the social impact of oral conditions among six strata of people aged 65 years and older: residents of metropolitan Adelaide and rural Mt Gambier, South Australia; residents of metropolitan Toronto-North York and non-metropolitan Simcoe-Sudbury counties, Ontario, Canada; and blacks and whites in the Piedmont region of North Carolina (NC), United States. Subjects were participants in three oral epidemiological studies of random samples of the elderly populations in the six strata. Some 1,642 participants completed a 49-item Oral Health Impact Profile (OHIP) questionnaire which asked about impacts caused by problems with the teeth, mouth, or dentures during the previous 12 months. The percentage of dentate people reporting impacts fairly often or very often was greatest among NC blacks for 41 of the OHIP items. Two summary variables of social impact were used as dependent variables in bivariate and multivariate least-squares regression analyses. Among dentate people, mean levels of social impact were greatest for NC blacks and lowest for NC whites, while people from South Australia and Ontario had intermediate levels of social impact (P < 0.01). Missing teeth, retained root fragments, root-surface decay, periodontal pockets, and problem-motivated dental visits were associated with higher levels of social impact (P < 0.05), although there persisted a two-fold difference in social impact across the six strata after adjustment for those factors Among edentulous people, there was no statistically significant variation in social impact among strata. The findings suggest that there are social and cultural factors influencing oral health and its social impact, and that those factors differ most between dentate blacks and whites in NC.