Edentulism and associated factors in people 60 years and over from urban, rural and remote Western Australia

Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde

OBJECTIVE

The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde.

MATERIAL AND METHODS

This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated.

RESULTS

The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m²' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors.

CONCLUSIONS

The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Impact of severity of tooth loss on oral-health-related quality of life among dental patients

Background

Tooth loss has a negative impact on the person's life so this study was done to assess the impact of tooth loss on oral-health-related quality of life (OHRQoL) in adult patients seeking dental care in private university dental clinics using Arabic version of 14-item Oral Health Impact Profile (OHIP-14) questionnaire in Saudi Arabia.

Materials and Methods

A cross-sectional study was conducted among 152 patients seeking dental care at a private university dental clinics in Riyadh city, Saudi Arabia. A structured and close-ended OHIP-14 questionnaire was self-administered by the study participants. Descriptive statistics, Kruskal-Wallis, Mann-Whitney, and Spearman's correlation tests were applied to the data.

Results

Patients with categories 1-5, 6-10, and >10 teeth loss showed a mean OHIP-14 scores of 10.51 ± 10.36, 13.46 ± 10.06, and 21.46 ± 14.41, respectively. A statistically significant difference in OHIP-14 score was observed among different categories of tooth loss (P = 0.005). Participants with >10 teeth loss showed significantly higher OHIP-14 score compared with 1-5 and 6-10 teeth loss categories (P < 0.05). Teeth loss significantly affected the functional limitation (P = 0.000) and social disability (P = 0.044) subscales.

Conclusion

Tooth loss adversely affected the OHRQoL among the dental patients. As the severity of teeth lost increased, the OHIP-14 score also increased with higher oral health impairments.

Oral Health Related Quality of Life and Dental Status of Adult Patients

Background: The aim of this study was to assess the oral health-related quality of life in adult patients who visit the Dental Clinic of the Faculty of Stomatology, Pancevo, using a Serbian version of 14-items Oral Health Impact Profile (OHIP14) Questionnaire. Material and Methods: A total of 89 respondents (42 women and 47 men, mean age 52.83 ± 13.74 years) filled in the questionnaire themselves. Three calibrated dentists recorded the oral health status of the respondents (number of healthy, decayed, filled and missing teeth), the type and time of wearing prosthodontic replacements, if they existed, and assessed the need for prosthodontic treatment. The total OHIP-14 score was calculated by adding scores for all fourteen items; OHIP-14 subscale scores were calculated by adding the scores for the two items in each of the seven subscales. Results: Mean total OHIP score was 10.25 ± 8.89. Patients with less than eight extracted teeth, wearers of fixed prosthodontic appliances and patients without replacements who did not need prosthodontic treatment reported better oral health-related quality of life. The most severe oral impacts assessed by the subscale OHIP14 scores were recorded in psychological discomfort (2.44 ± 2.18), physical pain (1.87 ± 1.73) and psychological disability subscale (1.83 ± 1.88). Women more often than men were dissatisfied with their diet and had been irritable in contact with other people. Conclusion: Further studies using the OHIP14 questionnaire in a larger sample will permit identification of key factors related to poor oral health and planning of treatment protocols and preventive programs for the adult population in Serbia.

Factors Associated with Dental Pain in Mexican Schoolchildren Aged 6 to 12 Years

OBJECTIVE

To identify dental pain prevalence and associated factors in Mexican schoolchildren.

METHODS

This cross-sectional study included 1,404 schoolchildren aged 6 to 12 years from public schools in the city of Pachuca de Soto, Hidalgo, Mexico. Data were collected through a questionnaire that addressed sociodemographic and socioeconomic factors, eating and dental hygiene habits, and behavior variables. The dependent variable was self-reported dental pain in the 12 months prior to the survey. Data were analyzed using nonparametric statistics and a binary logistical regression model.

RESULTS

Dental pain prevalence among the studied children was 49.9%. The variables associated in the final model (p < 0.05) were younger mother's age, higher socioeconomic level, absence of an automobile in the home, fried food, fruit intake, lower tooth brushing frequency, never having used mouthwash or not knowing about it, and parents/guardians with regular to high levels of knowledge about oral health and a regular or good/very good perception of their child's oral health.

CONCLUSIONS

One in two children in the study had experienced dental pain in the twelve months prior to the survey. The association of socioeconomic variables with dental pain suggested inequalities among the children in terms of oral health.

Influence of oral health behavior and sociodemographic factors on remaining teeth in Korean adults: 2010-2012 Korea national health and nutrition examination survey

In this study, the number and location of remaining teeth were analyzed according to sociodemographic variables, anthropometric measurements, and oral health behavior patterns. The hypothesis was that the number and location of remaining teeth would be affected by oral health behavior and by sociodemographic factors, such as education levels, household income, and urban/rural residency.This nationwide cross-sectional study was performed with a total of 36,026 representative Korean adults aged 19 and older. The data were taken from the 2012-2012 Korea National Health and Nutrition Examination Survey.Men had, on average, significantly more remaining teeth than women did. Women brushed their teeth more often than men per day and were more likely to brush their teeth after meals. The participants with higher education levels or household income had significantly more remaining teeth; the number of daily tooth brushing was positively associated with the number of remaining teeth; urban residents had significantly more remaining teeth than rural residents; and elderly adults had fewer remaining teeth than younger adults had (all with P < 0.05). The participants were more likely to retain their incisors (especially their canines) for their entire lifetimes than do so for their molars. From the incisors to the second premolars, they had more mandibular teeth than maxillary teeth, but among molars, they had more maxillary teeth than mandibular teeth. Elementary graduates with low household income had fewer remaining teeth than did university graduates with high household income (P < 0.0001). Finally, participants with high socioeconomic status were more likely to lose their molar teeth than anterior teeth compared to those with low socioeconomic status.The participants who brushed their teeth fewer times per day, those with low household incomes and/or education levels, and those who lived in rural districts had significantly higher prevalence of tooth loss than did other groups in Korean adults. Participants had more anterior and premolar teeth on mandible, but they had more molars on maxilla. In addition, participants with high socioeconomic status were more likely to lose their molar teeth than anterior teeth compared to those with low socioeconomic status.

Edentulism and associated factors among community-dwelling middle-aged and elderly adults in China

OBJECTIVE

To investigate the prevalence of self-reported edentulism and its associated risk factors among community-dwelling adults aged 45 years and older in China.

MATERIALS AND METHODS

Data from the national baseline survey (2011-2012) of the China Health and Retirement Longitudinal Study (CHARLS) were used for this study (N = 17 167). Bivariate and multivariate logistic regressions were conducted to assess the predictors of edentulism. Models 1 and 2 were based on the whole sample. Models 3 and 4 were based on the subsample (N = 9933) from whom anthropometric and blood biomarker data were available.

RESULTS

The prevalence of edentulism was 8.64% among Chinese adults aged 45 and above. As shown by Model 1, older age was a robust predictor for edentulism (odds ratio [OR] = 3.81 for people aged 55-64; OR = 11.22 for people aged 65-74; OR = 24.05 for people aged 75 and above). Other factors positively associated with edentulism included being female (OR = 1.25), rural residence (OR = 1.30), asthma (OR = 1.48), depression (OR = 1.20), reduced physical function (OR = 1.37) and current smoking status (OR = 1.36). People with higher educational levels (OR = 0.75 for people who can read and write; OR = 0.64 for people who obtained a junior high school education or above) and better-off economic status (OR = 0.80) were less likely to be edentate. The association between edentulism and age, educational level, economic status and physical function remained significant in Model 3, and in addition, being underweight appeared as another strong predictor (OR = 1.93).

CONCLUSIONS

The estimated prevalence of edentulism and the identified associated factors will provide epidemiologic evidence for future research and interventions in the target population in China.

Clinical oral health of Australia's rural children in a sample attending school dental services

OBJECTIVE

To examine the association between children's clinical oral health status and their residential location using the latest available data (2009) and to ascertain whether poor oral health among rural children is related to being Indigenous, having less access to fluoridated water or being of lower socioeconomic status (SES), than children from urban areas.

DESIGN

Cross-sectional survey.

SETTING AND PARTICIPANT

Data were collected on 74, 467 children aged 5-12 years attending school dental services in Australia (data were not available for Victoria or New South Wales).

MAIN OUTCOME MEASURES

Clinical oral health was determined by the mean number of permanent teeth with untreated caries, missing and filled permanent teeth, and the mean decayed, missing and filled permanent teeth index (DMFT) of 8 to 12-year-old-children and the mean number deciduous teeth with untreated caries, missing and filled deciduous teeth, and the mean decayed, missing and filled deciduous teeth index (dmft) of 5-10-year-olds.

RESULTS

The multivariable models that included coefficients on whether the child was Indigenous, from an area with fluoridated water and SES, were controlled for age and sex. The mean DMFT of 8-12-year-old children and the mean dmft of 5-10-year-old-children were significantly higher in rural areas compared with urban centres after accounting for Indigenous status, fluoridated water and SES.

CONCLUSION

Children's oral health was poorer in rural areas than in major city areas.

Diabetes and tooth loss: an analysis of data from the National Health and Nutrition Examination Survey, 2003-2004

BACKGROUND

The authors conducted an analysis of data from the National Health and Nutrition Examination Survey (NHANES) to understand the association between diabetes and tooth loss in the United States.

METHODS

The authors analyzed the oral examination and self-reported diabetes data obtained from the NHANES 2003-2004 cycle and included 2,508 participants representing a civilian, noninstitutionalized U.S. population 50 years and older. The authors calculated the prevalence of edentulism and the number of missing teeth among dentate people, and they used multiple regression analyses to assess the association between diabetes and tooth loss.

RESULTS

The prevalence of edentulism was 28 percent and 14 percent among people with and without diabetes, respectively. The multiple logistic regression analysis revealed that people with diabetes were more likely to be edentulous than were those without diabetes (adjusted odds ratio = 2.25; 95 percent confidence interval, 1.19-4.21). Among dentate adults, those with diabetes had a higher number of missing teeth than did adults without diabetes (mean [standard error {SE}] = 9.8 [0.67]), mean [SE] = 6.7 [0.29]); P < .01).

CONCLUSIONS

These study results revealed that adults with diabetes are at higher risk of experiencing tooth loss and edentulism than are adults without diabetes. One of every five cases of edentulism in the United States is linked to diabetes. Practical Implications. Although the association between diabetes and periodontal disease is well established, health care professionals also need to recognize the risk of tooth loss and its effect on quality of life among people with diabetes.

Is poor access to dental care why people outside capital cities have poor oral health?

BACKGROUND

Why oral health status outside capital cities is poorer than that in capital cities has not been satisfactorily explained. The aim of this study was to determine if the reason was poorer access to dental care.

METHODS

Data were obtained from the Australian National Survey of Adult Oral Health (2004-06). Oral health status was measured by DMFT Index, and numbers of decayed, missing and filled teeth. A two-step analysis was undertaken: comparing the dependent variables by location, socio-demographic confounders and preventive dental behaviours, and then including six access to dental care variables.

RESULTS

Of the 14 123 people interviewed, 5505 were examined, and 4170 completed the questionnaire. With socio-economic parameters in the first regression model, non-capital city people had higher DMFT (regression coefficient = 1.15, p < 0.01), more decayed (0.42, p < 0.01) and missing teeth (0.85, p < 0.01), but not filled teeth (-0.11, p = 0.71), than capital city based people. In the second step analysis, non-capital city people still had a greater DMFT (1.01, p < 0.01), more decayed (0.27, p = 0.03) and missing teeth (0.74, p < 0.01), but not filled teeth (0.00, p = 0.99) than capital city based people.

CONCLUSIONS

Access to dental care was not the only reason why people outside capital cities have poorer oral health than people living in capital cities.

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.

Tooth loss and edentulism in the Turkish elderly

The aim of this study was to evaluate partial and complete tooth loss and some related demographic factors, and oral health behaviors among Turkish elderly. According to recent censuses, elderly population of Turkey is rapidly growing. There is no nationwide information related to edentulism and natural teeth retention among 65-74 year-old people in Turkey. In this nationwide representative cross-sectional study, 1545 subjects aged 65-74 years were evaluated using the proportional stratified cluster sampling method. The data were collected via a structured, pre-tested face to face administered questionnaire and an oral examination. Chi-square test and binary logistic regression analyses were used to determine the significance of explanatory variables. 48.0% of elderly were edentate. The mean DMF-T was 25.8±8.5. These values were higher in women (p=0.016), older age (p<0.001) and rural individuals (p<0.001). Only 12.4% of the subjects had functional dentition. Age, visiting dentist, and health security were associated with edentulism. Female sex (OR=1.37), 70-74 age group (OR=2.08) and illiteracy (OR=3.25) were the independent factors of not having functional dentition. A reduction in edentulism in elderly may be achieved by the implementation of community programs promoting oral health for the prevention and treatment.

Dental multisection CT for the placement of oral implants: technique and applications

Dental computed tomography (CT) is a diagnostic examination for the preoperative evaluation of patients who will undergo placement of oral implants. It can be performed with multidetector CT or more recently with cone-beam CT. The growing older population and the consequent development of edentulism have increased the number of imaging studies performed for preoperative evaluation of dental implantation. Thus, radiologists are becoming more frequently involved in this type of testing. Dental CT is superior to conventional x-ray techniques because superimposition and distortion are eliminated; therefore, possible complications such as injury of the neurovascular bundle and perforation of the maxillary sinuses can be avoided. This noninvasive and fast method provides accurate information about the positions of important structures to allow one to determine the implant required. Dental CT enables analysis of the state, quality, and quantity of bone on two-dimensional and three-dimensional reformatted images, and its high spatial resolution allows exact measurements of the length and width of the alveolar ridge. Inclusion of all this information in the radiology report facilitates achievement of a successful implantation.

Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly

OBJECTIVE

To investigate the association of socio-demographic and systemic health factors according to the normative conditions of oral health care (dental caries, edentulism, periodontal disease and oral mucosal lesion) in elderly individuals.

MATERIAL AND METHODS

A cross-sectional study was carried out in a group of elderly with access to community health care (n = 200). The normative conditions of oral health were then investigated according to the WHO and the SB Brazil criteria. Bivariate analyses were evaluated by the chi-square test and Fisher's exact test. An estimation of prevalence for the covariates was performed using Poisson's regression models.

RESULTS

The prevalence of edentulism and oral mucosal lesions was detected in 58% and 21.5% of elderly patients, respectively. In the dentate subjects, the prevalence of dental caries and periodontal disease was 51.2% and 20.8%, respectively. Older men and individuals from lower-income groups exhibited a higher prevalence of dental caries. Elderly women, illiterate individuals, and individuals over the age of 65 years exhibited a higher prevalence of edentulism. Elderly 60-64 years old and those who are employed had a significant association with periodontal disease.

CONCLUSION

Socio-demographic factors were associated with some notable oral diseases in the elderly.

National survey on edentulism and its geographic distribution, among Mexicans 18 years of age and older (with emphasis in WHO age groups)

To determine the prevalence of edentulism in adults aged 18 years and older in Mexico and to describe its distribution in 20 of the 32 States in Mexico, highlighting the experience in the WHO age groups. A secondary analysis of the National Performance Evaluation Survey 2002-2003 (representative at the state level and part of the Word Health Survey) was undertaken. The sample design was probabilistic, stratified and through conglomerates. Data on dental conditions were available only for 20 of the 32 states of Mexico, leading to a total of 24 159 households (N = 54 638 654). The percentage of edentulism was determined as the proportion of subjects that self-reported complete loss of teeth. Data were analyzed using the SVY module for complex surveys in STATA 8.2. The mean age was 41.3 +/- 17.0 years (range 18-99). An estimated 6.3% (N = 3 437 816) of the population > or =18 years was edentulous. Lowest prevalences were observed in the states of Tlaxcala, Puebla and the Estado de Mexico with 3.4%, 3.8% and 4.5%, respectively. Highest prevalences were observed in San Luis Potosí, Colima, and Michoacán with 10.3%, 10.2% and 10.1%, respectively. Following the WHO age groups, the prevalence ranged from 2.4% in the 35-44 group through 25.5% in the 65-74 group. No obvious association between socio-economic and socio-demographic indicators at the state level and prevalence of edentulism was found. The prevalence of complete tooth loss observed in the present study varied greatly across states, although no straightforward association was found with socio-economic and socio-demographic indicators at the state level. This study could serve as a baseline to enable future evaluations of the oral status of Mexican adults and elders, following WHO age groups.

Edentulism among Mexican adults aged 35 years and older and associated factors

We used National Performance Evaluation Survey data to estimate the prevalence and associated factors of edentulism among noninstitutionalized adults aged 35 years and older in Mexico. Statistically, the variables positively associated with edentulism were older age (odds ratio [OR]=1.08) and female gender (OR=1.79). Nonsmoking status (OR=0.70) and having a higher wealth index score (OR=0.72) were negatively associated. This information constitutes the first large-scale evaluation in Mexico for one of the World Health Organization's priority oral health problems.

Trends in prevalence of complete tooth loss among Australians, 1979--2002

Edentulism is a key indicator of the oral health status of populations and is associated with reduced quality of life.

OBJECTIVE

To describe temporal trends in the prevalence of edentulism in the Australian adult population.

METHODS

Data were obtained from four national surveys of persons aged 15 years and over conducted in 1979, 1987/88, 1994 and 2002. Prevalence estimates and standard errors were calculated for each survey for males and females and each State/Territory. Birth cohort analysis was undertaken to track changes in prevalence across successive surveys. Data from the 1987/88, 1994 and 2002 surveys were age-standardised to the 1979 resident population estimates for each State and Territory and crude and adjusted prevalence estimates were compared.

RESULTS

The crude prevalence of edentulism declined from 20.5% (95% CI 20.1-20.7) in 1979 to 8.0% (95% CI 7.2-8.8) in 2002. The 2002 age-standardised estimate of 7.1% (95% CI 6.5-7.7) was only marginally lower. There were substantial reductions in prevalence of edentulism in all ages, sexes and State/Territories of Australia during the 23-year period. There were no significant changes in edentulism prevalence in three birth cohorts born since 1915.

CONCLUSION

Edentulism prevalence at least halved between 1979 and 2002 among all ages, sexes and States/Territories of Australia. There was no significant change in prevalence of edentulism in cohorts born since 1915, refuting the notion that the risk of edentulism increases due to ageing, suggesting instead today's elderly had historically high rates of extraction prior to the 1950s that have not been experienced by subsequent cohorts.

Dental visits in older Western Australians: A comparison of urban, rural and remote residents

OBJECTIVE

It has been reported that the aged in rural areas may not access regular dental care. The aim of this study was to describe dental visits for those 60 years of age and older living in urban, rural and remote locations in Western Australia and to determine factors associated with such visits. The main outcome was having had a dental visit in the previous 12 months.

DESIGN

A cross-sectional telephone survey was conducted.

SETTING

Urban, rural and remote locations in Western Australia.

SUBJECTS

A total of 2100 participants, 60 years of age and older.

RESULTS

The present study demonstrated that people in rural and remote areas of Western Australia had a longer time since their last dental visit than people in urban areas. Within each sex, age, country of birth, income, occupation and education group, the highest proportion of people having attended a dentist in the previous 12 months was in urban areas and the lowest was in remote areas. Controlling for sex, age, education and oral health status, compared to urban residents, rural residents were 14% less likely to have seen a dentist and remote residents were 27% less likely.

CONCLUSION

The present study demonstrated that for the aged sector of the Western Australian population, geographical location is a major factor in the frequency of use of dental services and the reasons for dental visits. This raises concerns that improvement of oral health by prevention and early detection of tooth and gum problems is less likely to occur in rural and remote areas than in urban areas.