Disparities in edentulism and tooth loss between Māori and non-Māori New Zealand women

Periodontal disease inequities among Indigenous populations: A systematic review and meta-analysis

The prevalence of periodontal disease varies considerably between Indigenous and general populations. The aim of this systematic review was to assess the global prevalence of periodontal disease among Indigenous populations in comparison with non-Indigenous populations. A systematic electronic search of databases and grey literature sources was conducted of all records through to February 2021. Study selection criteria included original data that reported the prevalence of periodontal diseases among an Indigenous population and compared with a non-Indigenous population, without any restriction on age, sex, language or geographical location. Critical appraisal was conducted with the Joanna Briggs Institute (JBI) tool for prevalence studies. A random-effects model using standardised mean difference (SMD) as the effect measure was used to estimate the pooled prevalence of periodontitis. Subgroup analysis of study location and publication source was also performed. Publication bias was assessed using Egger's test, and funnel plots were used for visualisation. A total of 19 articles were included for descriptive and meta-analysis. The overall prevalence of periodontitis was 35% (95% CI: 0.18, 0.52) higher among the Indigenous population than the non-Indigenous population. The pooled prevalence of periodontitis was consistently higher among the Indigenous populations when stratified according to periodontitis definition employed, study location and publication source. Indigenous populations have a higher prevalence of periodontitis than non-Indigenous populations. To decrease oral health inequities, more emphasis should be given to oral health promotion and specific culturally safe interventions working in partnership with Indigenous populations.

The residual dentition among home-based older New Zealanders receiving living support

BACKGROUND

There have been no detailed descriptions of residual dentition patterns among older people living in the community.

OBJECTIVES

To describe the residual dentition and associated oral health-related quality of life among older New Zealanders living in their own homes with government-funded assistance.

MATERIALS AND METHODS

Using nationally representative data, we determined the residual dentition arrangement and Kennedy classification for each dental arch. Individuals were categorised according to their maxillary-mandibular dental configuration and prosthesis use. Data were weighted to make the estimates generalisable to the source population.

RESULTS

Of the 895 clinically examined participants, 47.8% were dentate. One-quarter of those had maxillary tooth-bound saddles opposing a partially dentate mandible. Pasifika (people of Pacific Islands ethnicity) were most likely to have retained all of their dentition, while only the Māori ethnic group had no participants with a dentate arch. Only one in three of those with partially dentate upper and lower arches wore any maxillary denture; one in ten wore some form of mandibular denture. Partial dentures were common among those with an opposing edentulous jaw. Maxillary partial dentures were twice as common as their mandibular counterparts.

CONCLUSION

Residual dentition patterns in older people are diverse and complex, and meeting their prosthodontic needs is not straightforward.

Periodontal health in an indigenous Sámi population in Northern Norway: a cross-sectional study

Background

The aim of the study was to describe prevalence, severity and distribution of periodontal disease as well as associated risk factors in an indigenous Sámi population in Northern Norway, and to investigate differences between the indigenous Sámi and the non-Sámi population.

Methods

This cross-sectional study included data from the Dental Health in the North study (N = 2078; 18–75 years). Data on Ethnicity, household income, education, smoking habits, dental attendance, and tooth brushing habits were collected by a questionnaire. Periodontal conditions were assessed by clinical examination. A modified version of the new AAP/EFP classification system of periodontal disease was used to estimate the severity of periodontitis. Three stages were used: ‘Non-severe periodontitis’, ‘Stage II’, and stage ‘III/IV’.

Results

Of the total study population 66.5% reported Sámi affiliation. The total prevalence of periodontitis was 49.7%, with 20.1% in Stage III/IV, but no differences between Sámi and non-Sámi. When controlled for sex, age, education, smoking and dental attendance the Sámi had higher probability of having more severe stages of periodontitis; Odds Ratio_{Stage II} (OR) = 1.3; 95% CI: 1.1–1.7; and OR_{Stage III/IV} (OR) = 1.6; 95% CI: 1.1–2.2) compared to non-Sámi. The Sámi had higher prevalence of periodontal pocket depth (PD) ≥ 4 mm (t = 1.77; p <  0.001) and PD ≥ 6 mm (t = 1.08; p = 0.038) than the non-Sámi.

Conclusions

The prevalence of periodontitis was high in communities in the core area of Sámi settlement in Northern Norway, regardless of ethnicity. People with Sámi ethnicity had more deep periodontal pockets and an increased odds of having severe stages of periodontitis. Future studies should address possible explaining factors behind the potential higher risk of having more severe periodontitis among indigenous people in Sámi settlements.

Prevalence and geographic distribution of edentulism among older Ghanaians

OBJECTIVES

Edentulism has important health implications for aging individuals and is used as an indicator of the oral health of a population. Its distribution is unequal within populations, with the greatest burden on disadvantaged and socially marginalized populations. With an increasing older adult population in Ghana, its burden may increase; however, there is no nationwide information on edentulism in Ghana. Focusing on adults 50 years and older, this study assessed the prevalence of edentulism among older Ghanaians and its distribution across the country.

METHODS

Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable.

RESULTS

The overall prevalence was 2.8%, varying by sex (men had lower rates; OR = 0.67, 95% CI = 0.47-0.97); by location, being more prevalent in urban areas (3.6%) and the Western Region (4.7%); by education levels (rates were higher among those with no formal education; OR = 1.626, 95% CI = 1.111-2.380); and by marital status (those living without a partner had higher rates; OR = 1.980, 95% CI =1.366-2.870). On multivariate logistic regression, the variables positively associated with edentulism were older age (OR = 0.945) and urban residence (OR = 0.582). Living in the Brong Ahafo (OR = 3.138), Central (OR = 2.172), Eastern (OR = 2.257), or Volta regions (OR = 3.333) was negatively associated with edentulism.

CONCLUSION

Edentulism is unequally distributed across Ghana. Future aged cohorts are likely to follow the same patterns of geographic and social disadvantage if needed interventions are not carried out. This study provides nationwide data to assist service planning.

Factors associated with edentulousness in an elderly population in Valencia (Spain)

OBJECTIVE

To determine the prevalence of edentulism and its association with various socioeconomic factors and oral health habits in the population aged 65-74 years old in the region of Valencia.

METHODS

A cross sectional study was designed. Thirty-four primary health centers and five nursing homes were chosen at random in the region of Valencia (10-15 voluntary participants per sampling point). Clinical examinations were carried out by three calibrated dentists (kappa>0.85) in the same centers. The total sample consisted of 531 individuals (235 men and 296 women).

RESULTS

The percentage of toothlessness was 20.7% and the mean number of natural teeth present was 14.92. The prevalence of edentulism was significantly higher (p <0.05) in men, institutionalized persons, those with no schooling, those with poor oral hygiene, those who visited the dentist regularly and those living in peri-urban/rural areas. In a multivariate logistic regression model with edentulism as the dependent variable, the following factors were identified as significant independent variables: institutionalization (odds ratio [OR]=2.88), poor oral hygiene (OR=2.35), regular visits to the dentist (OR=2.34) and age (OR=1.19).

CONCLUSION

Edentulousness is a complex phenomenon that involves distinct social and economic factors.

Edentulism risk indicators among Mexican elders 60-year-old and older

The objective of this study was to determine the prevalence of edentulism in Mexican elders aged 60 years and older, and the associated risk indicators. A cross-sectional study was undertaken in 139 elders living in either of two long-term care (LTC) facilities, or attending an adult day center (ADC) in Pachuca, Mexico. A subject was edentulous when natural teeth were completely absent, determined through a clinical examination. Risk indicators were collected using questionnaires. Analyses were performed using binary logistic regression in STATA 9.0. Mean age was 79.0±9.8 years. Many subjects were women (69.1%). The prevalence of edentulism was 36.7%. In multivariate analysis, after adjusting for age and sex, the variables that were inversely associated (p<0.05) with edentulism were living with a spouse (odds ratio=OR=0.31), and lacking health insurance (OR=0.70). Variables associated with higher risk of being edentate were lower educational attainment (OR=1.61), having received radiation therapy (OR=4.49), being a smoker (OR=4.82), and having diabetes (OR=2.94) or other chronic illnesses (OR=1.82) (with hypertension approaching significance, p=0.067). In this sample of Mexican elders, diverse variables were associated with edentulism, in particular smoking and past radiotherapy. Oral health programs within and outside LTC/ADC should take into account risk factors specific to the older population.

The future of complete dentures in oral rehabilitation. A critical review

Based on available investigations and current trends in oral rehabilitation published in the dental literature, an attempt is made to describe the possible future role of complete dentures. For edentulous patients, complete dentures have for long been the only prosthodontic treatment option. Whereas a large number of edentulous patients report satisfaction with denture usage, a smaller number are unable to adapt; for such patients, sophistication of clinical and technical processes or quality of denture-supporting tissues, appear to have little influence on patient-perceived outcomes. Since the 1980s, osseointegrated dental implants have dramatically improved the therapeutic possibilities, especially so for maladaptive patients. Those able to access such treatment can expect significant improvements in oral functional status and quality of life. While there is a downward trend in edentulism in several countries, it is region-specific, confirming the overriding influence of socio-economic factors on health status. In most societies, despite ageing populations, the need for complete dentures is not likely to reduce in the near future. Whereas a two- or even a one-implant overdenture for the edentulous mandible is increasingly regarded as a minimum standard of care in many developed countries, its routine prescription for the majority in the world who are disadvantaged is unrealistic; for them, even 'low-tech' therapies like conventional dentures are beyond their reach. Improving the conventional management of edentulous patients is a necessity and requires a keener focus by researchers, educators and clinicians in the developed world on the needs of populations with fewer resources.