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

Early Childhood Caries, Masticatory Function, Child Early Cognitive, and Psychomotor Development: A Narrative Review

Dental caries is known as a global public health issue that has been affecting general health apart from its painful nature. Hence, it is undeniable that caries affecting young children or known as early childhood caries, also have an effect on children's general health. One of the interesting findings about caries is that it can also affect child growth and development, specifically on their cognitive and psychomotor ability. Untreated caries are linked to cognitive development through both neural and vascular pathways, with masticatory function as the key. Meanwhile, its effect on psychomotor development might be related to nutritional intake, which might slightly decline on those with caries. This review is aimed to describe the current findings of caries effect on early child development, from masticatory disturbance to further impacts on cognitive and psychomotor development. The overall conclusion of this review is that untreated severe caries in children are potentially associated negatively with their growth and development.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

REGISTRATION INFORMATION

The PROSPERO registration number is CRD42023396380.

Chewing ability and associated factors in older adults in Germany. Results from GEDA 2019/2020-EHIS

BACKGROUND

Oral well-being is an important component of general well-being and quality of life, as it is greatly influenced by the ability to chew and speak, and thus by central factors of social interaction. Because quality of life and participation are important factors for health in older age, the aim of this article was to examine the chewing ability, including associated factors, for the older population in Germany on the basis of a nationally representative sample.

METHODS

Database is the German Health Update (GEDA 2019/2020-EHIS), a population based cross-sectional survey of the Robert Koch Institute. In the telephone interview, participants aged 55 years and older were asked: "Do you have difficulty biting and chewing on hard foods such as a firm apple? Would you say 'no difficulty', 'some difficulty', 'a lot of difficulty' or 'cannot do at all/ unable to do'?" Prevalences and multivariate prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI) from log-Poisson regressions. Sociodemographic, health-, behavioral- and care-related characteristics were investigated as associated factors.

RESULTS

The analyses were based on data from 12,944 participants (7,079 women, 5,865 men). The proportion of people with reduced chewing ability was 20.0%; 14.5% had minor difficulty, 5.5% had major difficulty. There were no differences between women and men. The most important associated factors for reduced chewing ability were old age (PR 1.8, 95% CI 1.5-2.1), low socioeconomic status (PR 2.0, 95% CI 1.7-2.5), limitations to usual activities due to health problems (PR 1.9, 1.6-2.2), depressive symptoms (PR 1.7, 1.5-2.1), daily smoking (PR 1.6, 95% CI 1.3-1.8), low dental utilization (PR 1.6, 95% CI 1.4-1.9), and perceived unmet needs for dental care (PR 1.7, 95% CI 1.5-2.1).

CONCLUSIONS

One fifth of adults from 55 years of age reported reduced chewing ability. Thus, this is a very common functional limitation in older age. Reduced chewing ability was associated with almost all investigated characteristics. Therefore, its prevention requires a holistic view in the living environment and health care context of older people. Given that chewing ability influences quality of life and social participation, maintaining or improving chewing ability is important for healthy aging.

Lower socio-economic status in adolescence is associated with poor oral health at an older age: Mediation by social and behavioural factors

AIM

To examine the mediators between lower socio-economic status (SES) in adolescence and oral health at an older age to uncover the underlying mechanisms of the association.

METHODS

Participants (n = 21 536) aged ≥65 years from the Japan Gerontological Evaluation Study were evaluated. The dependent variables were self-rated chewing difficulty and having ≤19 remaining teeth. The main independent variable was self-perceived SES in adolescence. The Karlson-Holm-Breen method was used for mediation analysis.

RESULTS

Mean age of the participants was 74.8 years (standard deviation = 6.4), and 51.5% were female. Overall, 5598 (26.0%) participants reported chewing difficulty and 9404 (43.7%) had ≤19 remaining teeth. Lower SES in adolescence was associated with a higher prevalence of chewing difficulty (odds ratio [OR] = 1.38, 95%confidence interval [CI] = 1.29-1.48; total effect). After controlling for mediators, OR for lower SES in adolescence was 1.22 (95%CI = 1.13-1.30; direct effect) and 1.13 (95%CI = 1.11-1.16; indirect effect). Mediators, prominently the number of teeth and income, explained 39.3% of the associations. Lower SES in adolescence increased the odds of ≤19 remaining teeth by OR = 1.23 (95% CI = 1.16-1.31; total effect). After controlling for mediators, the OR for lower SES in adolescence was 1.03 (95%CI = 0.97-1.10; direct effect) and 1.19 (95%CI = 1.16-1.23; indirect effect). Mediators, prominently educational attainment, explained 85.0% of the associations.

CONCLUSIONS

Lower SES in adolescence was associated with poor oral health at an older age through mediators. Approaches that consider social determinants from the beginning of the life course are required.

Adverse Childhood Experiences and Oral Health Conditions Among Middle-aged and Older Chinese Adults: Exploring the Moderating Roles of Education and Gender

This study aims to examine whether adverse childhood experiences (ACEs) are associated with oral health conditions (denture use, difficulty in chewing, and edentulism) among middle-aged and older adults in China and if gender and adulthood education moderate the associations. Data were obtained from the 2014 and 2018 surveys from the China Health and Retirement Longitudinal Study (N = 17,091) and logistic regressions were carried out. Results show that childhood hunger (OR = 1.12), loneliness (OR = 1.10) and family relations (OR = 1.07) were significantly associated with higher odds of denture use and there were significant associations between hunger (OR = 1.16) and difficulty in chewing. For the female subsample, education significantly moderated the adverse effect of childhood hunger on denture use and difficulty in chewing. Findings suggest that ACEs have long-lasting impacts on oral health conditions in later life and adulthood education might offer critical resources for females, helping them buffer the detrimental health impacts of ACEs.

Reflections on oral health inequalities: Theories, pathways and next steps for research priorities

Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.

Oral status is associated with chewing difficulty in Thai older adults: data from a National Oral Health Survey

BACKGROUND

The number of older adults in Thailand is increasing. Better chewing ability is associated with healthy aging. Although numerous studies have demonstrated the relationship between social backgrounds, dental service utilization, oral status and chewing difficulty, there is no study in Thailand using national oral health data to identify the variables involved with chewing difficulty among Thai older adults. Therefore, the aim of this study was to determine the association between oral status, and chewing difficulty, adjusting for social backgrounds, and dental service utilization among Thai older adults.

METHODS

This cross-sectional study used data from the eighth Thai National Oral Health Survey (TNOHS). A stratified multi-stage method was used for sample selection. The eighth TNOHS was conducted from June-August 2017. Data were collected using interviews and clinical oral examinations by trained interviewers and trained dentists, respectively. The bivariate analysis, chi-square test was used to explore the associations between social backgrounds, dental service utilization, oral status, and chewing difficulty. Dependent variables with p-values of < 0.2 for their association with independent variables in the bivariate analysis were entered into the multiple logistic regression models.

RESULTS

This study found that older adults with at least 27 teeth (p < 0.05), or at least eight occlusal pairs (p < 0.05) or income exceeding 15,000 baht per month (p < 0.05) were more likely to have less chewing difficulty (p < 0.001), while the elderly who utilized dental services in the past 12 months were associated with more chewing difficulty than those who did not utilize dental services in the past 12 months (p < 0.001).

CONCLUSIONS

We suggest that policymakers increase the number of preventive plans and set a goal for more than 20 remaining natural teeth and four posterior occlusal pairs in young and working aged people, especially in the low income group.

The Impact of Parental Education on Schoolchildren's Oral Health-A Multicenter Cross-Sectional Study in Romania

The present study is part of the first national oral health survey for children in Romania. The aim of this study was to determine caries prevalence in correlation with the level of the parents' education, preventive behavior, and socioeconomic parameters in 11-14-year-old schoolchildren in Romania. A cross-sectional epidemiological survey was designed and conducted in 2019-2020. The sampled children were selected from 49 schools distributed in rural and urban areas of Romania, including its capital. Data were collected using the Oral Health Questionnaire for Children developed by the World Health Organization and described in the WHO Oral Health Surveys-Basic Methods, 5th edition, 2013, after positive informed consent. To express prevalence and severity of carious lesions, International Caries Detection and Assessment System (ICDAS) criteria were recorded in school for 814 schoolchildren (388 boys and 426 girls) aged between 11 and 14 years old (mean age 12.29 ± 0.6). Elements regarding the specificity of the child (gender, age, and parental education) were tabulated against preventive behavior. The parents' education was correlated with three clinical indices in order to assess the existence or lack of certain significant differences among schoolchildren in Romania. In terms of correlation between the mother's education and preventive behavior, results showed a significant positive correlation in case of dental check-ups (r_s = 0.08 *, p < 0.05), brushing (r_s = 0.02 **, p < 0.01), and use of different types of dental hygiene aids (r_s = 0.06 **, p < 0.01) and a negative correlation with tooth pain or discomfort (r_s = -0.01 **, p < 0.01). A statistically significant positive relationship was highlighted between the mother's education and the presence of restorations (r_s = -0.09 **, p < 0.01). Regarding the father's education, there was a positive relationship with oral hygiene behavior (r_s = 0.18 **, p < 0.01) but a negative relationship with the D₃T index (r_s = -0.18 **, p < 0.01). In conclusion, there was a strong correlation between the parents' education, preventive behavior, and oral health status of Romanian schoolchildren.

Dental Caries, Oral Health Behavior, and Living Conditions in 6-8-Year-Old Romanian School Children

Dental caries still have a high prevalence in Romania. The aim of this paper is to determine the prevalence of caries in children (aged 6 to 8 years) correlated with individual-level predictors and socio-economic variables. A stratified, randomized nationally representative sample was established, taking into consideration the total number of preschool children and based on administrative units and residence. Self-assessment was performed by means of the Oral Health Questionnaire for Children (WHO). Examinations were conducted by 10 standardized examiners, with International Caries Detection and Assessment System (ICDAS) caries codes higher than 3 considered as dentinal caries, missing teeth as MT, and restorations as FT. DMFT and SiC indexes were calculated accordingly. The dataset for each outcome variable was analyzed by the Hurdle approach analyzed. The gender distribution was similar (47.22% male and 52.78% female), with 42.65% residing in rural areas. The mean DMFT value for the sample was 4.89 and SiC index 9.83. A negative association could be seen between DMFT and the father’s level of education (β = −0.33, SE = 0.07, p < 0.01) as well as the mother’s education (β = −0.25, SE = 0.07, p < 0.01). In conclusion, caries prevalence is very high in Romania as compared to the World Health Organization (WHO) recommendation for this age group in correlation with socio-economic factors and oral health behavior.

Causal Effect of Tooth Loss on Functional Capacity in Older Adults in England: A Natural Experiment

BACKGROUND/OBJECTIVES

Tooth loss is associated with reduced functional capacity, but so far, there is no relevant causal evidence reported. We investigated the causal effect of tooth loss on the instrumental activities of daily living (IADL) among older adults in England.

DESIGN

Natural experiment study with instrumental variable analysis.

SETTING

The English Longitudinal Study of Aging (ELSA) combined with the participants' childhood exposure to water fluoride due to the community water fluoridation.

PARTICIPANTS

Five thousand six hundred and thirty one adults in England born in 1945-1965 participated in the ELSA wave seven survey (conducted in 2014-2015; average age: 61.0 years, 44.6% men).

MEASUREMENTS

The number of natural teeth predicted by the exogenous geographical and historical variation in exposure to water fluoride from age 5 to 20 years old (instrumental variable) was used as an exposure variable. The outcome, having any limitations in IADL (preparing a hot meal, shopping for groceries, making telephone calls, taking medications, doing work around the house or garden, or managing money), was assessed by self-reported questionnaires.

RESULTS

Linear probability model with Two-Stage Least Squares estimation was fitted. Being exposed to fluoridated water was associated with having more natural teeth in later life (coefficient: 0.726; 95% confidence interval (CI) = 0.311, 1.142; F = 11.749). Retaining one more natural tooth reduced the probability of having a limitation in IADL by 3.1 percentage points (coefficient: -0.031; 95% CI = -0.060, -0.002).

CONCLUSION

Preventing tooth loss maintains functional capacity among older adults in England. Given the high prevalence of tooth loss, this effect is considerable. Further research on the mechanism of the observed causal relationship is needed.

Socioeconomic Life Course Models and Oral Health: A Longitudinal Analysis

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

Prevention and management of periodontal diseases and dental caries in the older adults

As a result of aging populations, in the future, dental practitioners will be caring for more older adults than ever before. These older adults, especially in developed countries, will demand a greater number of dental services, driven by increased tooth retention and an expectation of excellent oral healthcare throughout the life course. Further, the global rise in the prevalence and incidence of chronic diseases will increase the risk and/or severity of oral diseases and add a layer of complexity to the management of oral diseases in older adults. More older adults will be at a higher risk of periodontal disease and root caries as a result of reduced tooth loss and edentulism. This article reviews information on periodontitis and root caries, oral diseases which reflect the cumulative risk of the individual, and which are best addressed through prevention. Oral healthcare providers must embrace the concept of lifelong emphasis on prevention, as well as participation as active members of a healthcare team which provides healthcare for older adults in various settings (eg, hospital/clinic-based care, community-based settings, and long-term care facilities). National guidelines that address oral health are being considered by some countries, and if these are implemented they will increase the accessibility to oral health for older adults. In parallel to this, revisions of existing older adult insurance schemes (eg, the inclusion of routine oral healthcare in the US Medicare program) would promote the maintenance of a functional dentition that is pain-free and conducive to general health. The opportunity exists to implement a holistic approach to oral health that will align oral health with general health and emphasize that true health can only be achieved with the inclusion of oral health.

[Accumulated risk from poverty and tooth loss at 31 years of age: the 1982 live birth cohort in Pelotas, Rio Grande do Sul State, Brazil]

The objective was to estimate the effect of accumulated risk from poverty and tooth loss at 31 years, using longitudinal data from the 1982 live birth cohort in Pelotas, Rio Grande do Sul State, Brazil. The income trajectory variables were built with four time points: birth and 15, 24, and 30 years of age. Potential confounding factors were sex, maternal schooling, maternal skin color, and smoking at 24 years. Potential mediators used the history of dentistry services use and caries based on the Significant Index Caries (SIC). The trajectory variable in the accumulated risk model was created with group-based trajectory modeling. The target outcome was the number of missing teeth at 31 years. Mean number of missing teeth at 31 years was 1.25. In the accumulated risk model after adjusting for confounders and mediators, individuals that were poor at one or two time points showed risk ratio - RR = 1.92 (95%CI: 1.40-2.63), and those with three or four episodes of poverty showed RR = 1.97 (95%CI: 1.24-3.13) for tooth loss. The results highlight the effect of lifetime poverty on tooth loss. The effect was expanded in individuals that were exposed to poverty longer. Public policies aimed at improving income conditions also help reduce tooth loss.

Associations of Food-Chewing Discomfort with Health Behaviors and Cognitive and Physical Health Using Pooled Data from the Korean Health Panel (2010-2013)

Using 4 years of pooled data from the Korean Health Panel (2010-2013), the prevalence of food-chewing discomfort in adults over the age of 19 was investigated and the cross-sectional relationship between food-chewing discomfort and health behaviors and cognitive and physical health was identified. The prevalence of food-chewing discomfort was 31%: young adults (<40 years), 17.9%; middle-aged adults (40-64 years), 28.9%; and older adults (≥65 years), 57.1% (p < 0.0001). When food-chewing discomfort was sometimes, often, or always rather than never, odds ratios (ORs) were analyzed after controlling for sociodemographic characteristics. Significant OR results of target variables were smoking (OR 1.15, 1.37, 1.50), drinking (1.08, 0.87, 0.73), problem drinking (1.87, 1.67, 1.34), abstinence from drinking (1.23, 1.34, 1.42), nonphysical activity (OR 0.87 only significant, 0.94 nonsignificant, 1.10 nonsignificant), memory decline (2.07, 2.56, 3.31), decision-making difficulty (1.76, 2.78, 4.37), limitation of daily life due to illness (2.29, 3.60, 3.92), and the presence of a chronic disease (1.28, 1.62, 1.73), respectively. In conclusion, there were associations of food-chewing discomfort with increased smoking and decreased alcohol consumption, with increased difficulty in decision-making and memory decline, limitations in daily life due to disease, and the presence of chronic diseases. Therefore, it is necessary to investigate the causal relationship between chewing and health behaviors and cognitive and physical health through longitudinal studies.

Association of childhood socioeconomic status with edentulism among Chinese in mid-late adulthood

BACKGROUND

The aim of this study was to examine the association between childhood socioeconomic status (SES) and edentulism.

METHODS

The edentulous status of Chinese in mid-late adulthood was determined using self-reported lost all of teeth from the Health and Retirement Longitudinal Study (CHARLS). Childhood SES was determined based on the following parameters: the education, occupation and working status of the parents; financial situation of the family; relationship with the parents; care, love and affection from the mother; quarrels and fights between parents; primary residence; neighbors' willingness to help and with close-knit relationships. Adulthood SES was assessed by educational achievements. This study used principal component analysis (PCA) to select variables and binary logistic regression models to determine the association between childhood SES and edentulism.

RESULTS

Data were available from a total of 17,713 respondents, 984 of whom were edentulous (2.9%). The prevalence of edentulism in mid- to late-age Chinese individuals was higher in those with poor childhood SES. In final regression model, edentulism was significantly associated with willingness of neighbors to help with close-knit relationships (OR = 0.89, 95% CI = 0.79-0.99), parents with high school education or above (OR = 1.18, 95% CI = 1.01-1.39) and drinking and smoking habits of the father (OR = 1.10, 95% CI = 0.97-1.24).

CONCLUSION

Childhood SES was significantly associated with the prevalence of edentulism in mid- to late-age Chinese individuals. In particular, parents with high school education or above, unwillingness of neighbor to help with close-knit relationships, drinking and smoking habits of the father independent of adulthood SES were significantly associated with edentulism. Accordingly, the development of optimal recommendations and more effective intervention strategies requires considering the experiences in early life associated with poor SES contributes to poor oral health.

The impact of a prospective 4-year longitudinal school intervention for improving oral health and oral health inequalities in primary schoolchildren in Flanders-Belgium

BACKGROUND

Oral diseases and socio-economic inequalities in children are a persisting problem.

AIM

To investigate the 4-year longitudinal impact of an oral health promotion programme on oral health, knowledge, and socio-economic inequalities in primary schoolchildren.

DESIGN

The intervention was carried out between 2010 and 2014 within a random sample of Flemish primary schoolchildren (born in 2002). It consisted of an annual oral health education session. ICDAS/DMFT, care level, knowledge scores, and plaque index were used as outcome variables. Being entitled to a corrective policy measure was used as social indicator. Mixed model analyses were conducted to evaluate changes over time between intervention and control group and between higher and lower social subgroups.

RESULTS

A total of 1058 participants (23.8%) attended all four sessions. The intervention had a stabilizing effect on the number of decayed teeth and increased knowledge scores. No statistically different effect on the two social groups could be demonstrated. Socio-economic inequalities were present both at T₀ and T₄ .

CONCLUSION

The oral health promotion programme had a positive impact on oral health knowledge and stabilized the number of decayed teeth. No impact on inequalities could be demonstrated, although a higher dropout rate in children with a lower social status was seen.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Inequalities in dental caries in children within the UK: Have there been changes over time?

OBJECTIVES

To examine any change over time in the association between deprivation and caries experience between 2003 and 2013 in a nationally representative sample of UK children.

METHODS

Data from UK Children's Dental Health Surveys, 2003 and 2013, were used. The target population was 5-, 8-, 12- and 15-year-olds. A total of 9604 children in 2003 and 9866 in 2013 were included in the surveys. Outcome variables were any active caries, caries experience and total number of carious teeth. Family socio-economic position (SEP) or deprivation level was measured at school level using eligibility for free school meals (FSM) to identify children from low-income families. Incidence rate ratios (IRR) and pooled standardized incidence rates ratios were calculated to measure dichotomous outcome variables by year, age group and status of deprivation. The study continuous outcome was modelled using a zero-inflated Poisson regression while the dichotomous outcomes were modelled using logistic regressions. The multivariable analyses were run by age groups accounting for year, sex and deprivation status.

RESULTS

The percentage of those identified as deprived was significantly higher in 2013 (35.8% in 2013 vs 26.0% in 2003, P < 0.001). Among both deprived and non-deprived children, the prevalence of any active caries significantly dropped over the years, observed in all age groups. Comparing 2013 with 2003 and accounting for sex, deprivation level, "any active caries," "any caries experience" and "total number of carious teeth" significantly dropped were observed in all age groups. Comparing the years, the association of deprivation with caries outcomes mostly remained the same or decreased. This decrease was predominantly seen in "any caries experience." Only among the 5-year-olds, did the association between deprivation and total number of carious teeth over the years significantly increase. For all age groups, the likelihood of "any active caries" and "total number of carious teeth" by deprivation remained the same comparing the two points in time: 2003 and 2013. However, irrespective of year, deprivation was significantly associated with caries observed in all age groups.

CONCLUSION

In the UK, the prevalence of active dental caries and caries experience has decreased in the period between 2003 and 2013. Similarly, the likelihood of having dental caries by deprivation in 2013 was predominantly lower than that observed in 2003.

Does reduced mastication influence cognitive and systemic health during aging?

There is a growing body of literature which suggests that oral health and mastication can influence cognitive and systemic health during aging. However, it is currently unclear whether oral health, masticatory efficiency, cognitive health and systemic health merely deteriorate independently with age, or whether mechanisms exist linking mastication to cognitive and systemic health directly. The aim of this paper is to review the extent to which reduced mastication influences cognitive and systemic health during aging because this knowledge may underpin future interventions that improve quality of life. Current evidence suggests that a deterioration in mastication and oral health during aging can have: 1) direct effects on systemic health through mechanisms such as the migration of the oral microbiota into the systemic environment, and 2) indirect effects on systemic health through changes nutrient intake. A loss of teeth and reduction in masticatory efficiency during aging can have: 1) direct effects on cognitive performance and potentially impact cognitive health through mechanisms such as enhanced adult hippocampal neurogenesis, and 2) indirect effects on cognitive health through changes in nutrient intake. It is concluded that oral health and masticatory efficiency are modifiable factors which influence the risk poor cognitive and systemic health during aging, although it is currently premature to propose chewing-based interventions to slow the rate of cognitive decline and improve cognitive health during aging. Future research should include large-scale longitudinal studies which control for the types of confounding factors which concurrently influence the association between mastication and cognitive and systemic health.

Childhood socioeconomic conditions and teeth in older adulthood: Evidence from SHARE wave 5

OBJECTIVES

Dental diseases are the most common chronic diseases worldwide. Healthy teeth are vital for quality of life, particularly diet and nutrition. However, little information exists to inform health policymakers about potentially long-lasting influences of early-life conditions. The purpose of this study was to investigate the relation between early-life socioeconomic conditions and number of natural teeth at age 50 and above.

METHODS

Analyses were conducted on cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE wave 5), which includes information on 41 560 respondents aged 50 years or older from 14 European countries and Israel. Using SHARE life history information, a series of regression models (OLS, Tobit) were estimated to analyse the relationship between socioeconomic conditions in earlier life and the number of teeth at age 50+.

RESULTS

Childhood socioeconomic background was associated with the number of natural teeth at age 50 and above, even after controlling for current determinants of oral health. Respondents who had had more than 25 books in their childhood household had a mean 1.4 (95% CI: 1.2-1.5) more teeth than respondents with fewer books. Respondents who reported poor financial conditions during childhood had a mean 0.6 (95% CI: 0.3-0.9) fewer teeth than respondents who reported better financial conditions in childhood.

CONCLUSION

These findings substantiate the association between socioeconomic conditions in the early years of life and tooth retention to older adulthood and highlight the long-lasting relation between childhood living conditions and oral health through the lifecourse.

Socioeconomic inequalities in caries experience, care level and dental attendance in primary school children in Belgium: a cross-sectional survey

OBJECTIVES

Oral health inequality in children is a widespread and well-documented problem in oral healthcare. However, objective and reliable methods to determine these inequalities in all oral health aspects, including both dental attendance and oral health, are rather scarce.

AIMS

To explore oral health inequalities and to assess the impact of socioeconomic factors on oral health, oral health behaviour and dental compliance of primary school children.

METHODS

Data collection was executed in 2014 within a sample of 2216 children in 105 primary schools in Flanders, by means of an oral examination and a validated questionnaire. Intermutual Agency database was consulted to objectively determine individuals' social state and frequency of utilisation of oral healthcare services. Underprivileged children were compared with more fortunate children for their mean DMFt, DMFs, plaque index, care index (C, restorative index (RI), treatment index (TI), knowledge and attitude. Differences in proportions for dichotomous variables (RI100%, TI100% and being a regular dental attender) were analysed. The present study was approved by the Ethics Committee of the University Hospital Ghent (2010/061). All parents signed an informed consent form prior to data collection. All schools received information about the study protocol and agreed to participate. Children requiring dental treatment or periodic recall were referred to the local dentist.

RESULTS

Underprivileged children had higher D1MFT (95% CI 0.87 to 1.36), D3MT (95% CI 0.30 to 0.64), plaque scores (95% CI 0.12 to 0.23) and lower care level (p<0.02). In the low-income group, 78.4% was caries-free, compared with 88.4% for the other children. Half of the low-income children could be considered as regular dental attenders, while 12.6% did not have any dental visit during a 5-year period.

CONCLUSION

Oral health, oral hygiene, oral healthcare level and dental attendance patterns are negatively affected by children's social class, leading to oral health inequalities in Belgian primary school children.

Social Determinants of Pediatric Oral Health

Social determinants of health are defined as conditions in which people are born and live and the role these conditions play on health outcomes. Research indicates that risk factors and their interactions are far more complex than originally thought. This article outlines social determinant constructs and their role in understanding oral health promotion. Due to the complex interactions, oral health must be promoted using a multilevel chronic disease model or common risk factor approach. An understanding of social determinants is particularly important for the pediatric population because optimum oral health and general health in adulthood are heavily influenced by childhood.

Preventive dental visiting: a critical interpretive synthesis of theory explaining how inequalities arise

BACKGROUND

In many countries, those with lower socioeconomic status are disproportionately affected by poor oral health. This can be attributed, at least in part, to differences in preventive dental visiting. While several theories have been applied to the area, they generally fail to capture the recursive nature of dental visiting behaviour, and fall short of informing the design of complex interventions to tackle inequalities.

OBJECTIVE

To undertake a systematic review and synthesis of theory in order to provide an overview of the pathways which bring about socioeconomic inequalities in early dental visiting, and identify possible intervention points.

METHODS

Electronic searching identified 8947 titles and abstracts. Paper screening and citation snowballing left 77 included papers. Drawing on the tenets of Critical Interpretive Synthesis, data extraction involved capturing concepts and relationships and translating these sometimes into synthetic constructs.

RESULTS

We theorize that at the individual (micro-level), dental visiting behaviour is influenced by: the 'Importance of obtaining care', 'Emotional response' and 'Perceived control', which feed into a balancing of 'Competing Demands' against 'Internal resources' (coping, self-identity), although attendance is tempered by the effective 'Affordability and Availability of services'. Positive Care experiences are theorized to lower the demands and increase internal resources associated with dental visiting. We also outline meso-level factors 'Social norms and sanctions', 'Obligations, expectations and trust', 'Information channels', 'Social structures' and theorize how these can exert an overwhelming influence in deprived areas.

CONCLUSIONS

Socioeconomic inequalities in early dental visiting emerge from several stages in the care-seeking process. Dental visiting behaviour should be viewed not just as a one-off event, but extending over time and social space. Since there is recursivity in peoples' most recent dental experience any future visits we identify that interventions which make care a positive experience for low socioeconomic patients may be particularly beneficial in reducing inequalities.

Association between Number of Teeth and Chronic Systemic Diseases: A Cohort Study Followed for 13 Years

Background

There is growing evidence of an association between oral health, specifically dental status, and chronic systemic diseases. However, varying measures of dental status across different populations and low study sample has made comparison of studies and conclusion of findings unclear. Our aim is to examine whether the number of teeth as a measure of dental status is associated with incident chronic diseases in a cohort setting.

Methods

We conducted a cohort study among 24,313 middle-aged Germans followed up for 13 years. Data on number of teeth as a measure of dental status were obtained through self-reports. Outcomes were clinically–verified incident non–fatal myocardial infarction, stroke, type 2 diabetes mellitus, and cancer. Hazard ratio (HR) and 95% confidence intervals (CI) were obtained from Cox regression models.

Results

Increasing number of teeth is inversely related to risk of myocardial infarction (HR: 0.97; 95% CI: 0.96, 0.99). The full multivariate model of teeth groups showed a strong linear trend for myocardial infarction, a less strong trend for stroke, and no relation with type 2 diabetes mellitus and cancer in a competing risk model. Participants with 18–23 teeth and those without teeth were at 76% (95%CI: 1.04, 3) and 2.93 times (95%CI: 1.61, 5.18) higher risk of myocardial infarction compared to those with nearly all teeth (28–32 teeth).

Conclusions

Number of teeth is specifically associated with myocardial infarction and not with other chronic disease indicating that dental status further strengthens the link between oral health and cardiovascular diseases.

Dental health among older Israeli adults: is this a reflection of a medical care model inadequately addressing oral health?

OBJECTIVES

Israel's health-care system is considered as one of the most efficient worldwide. The purpose of the present study was to assess oral health outcomes, dental care use and respective social inequalities among the older segment of the Israeli population.

METHODS

Secondary analyses were conducted of recently available data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Israel, wave 2), which specifically includes information on chewing ability, denture wearing and dental care use obtained from more than 2,400 Israeli people, 50+ years of age. Multivariate logistic regressions and concentration indices were used to analyse determinants of oral health and dental care use.

RESULTS

Seventy per cent of respondents reported being able to bite/chew on hard foods and 49% of respondents reported wearing dentures. Forty-three per cent of respondents had visited a dentist within the past 12 months, with about half of all dental visits being made for solely nonpreventive reasons. Significant income-related inequalities were identified, with higher income being associated with greater dental care use (particularly preventive dental visits), better chewing ability and less denture wearing.

CONCLUSIONS

For the older segment of the Israeli population and compared with other countries, the findings of the present study suggest a relatively low level of chewing ability, a high extent of nonpreventive dental visiting, as well as considerable inequalities in oral health and care. It seems that the Israeli health-care system may be improved even further by more comprehensive inclusion of dental care into universal health coverage.

Cost-related dental non-attendance in older adulthood: evidence from eleven European countries and Israel

BACKGROUND

Although relevant for health policy, so far only little is known about the extent to which persons avoid dental attendance because of associated costs.

OBJECTIVES

To examine the cost-relatedness of dental non-attendance in various older adulthood populations.

MATERIAL AND METHODS

Secondary analyses were conducted of data from wave 1 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), which includes unique information on recent dental non-attendance and care foregone due to costs by persons aged 50+ from eleven European countries and Israel. Multivariate logistic regression analysis was used to detect differences in the extent to which dental non-attendance is attributable to associated costs.

RESULTS

The study sample comprised 13 935 persons who did not access dental care within the past year. Levels of cost-related non-attendance differed between the twelve examined countries, ranging from 6.8% in Israel to 0.5% in Austria. Cost-related non-attendance was 47% less likely among persons with good as compared to compromised chewing ability (Odds Ratio: 0.53; 95% CI: 0.43-0.66). Cost-related non-attendance was 33% less likely among persons with tertiary as compared to (pre-) primary educational attainment (Odds Ratio: 0.67; 95% CI: 0.47-0.96). Cost-related dental non-attendance was significantly more likely among persons with low levels of general health (Odds Ratio for lowest vs. highest level of general health: 3.05; 95% CI: 1.88-4.95).

CONCLUSIONS

The findings of the present study suggest that a relatively small proportion of dental non-attendance in older adulthood is cost-related. For specific population subgroups in various countries, however, dental care costs may still pose a relevant barrier to dental care.

Oral health conditions and cognitive functioning in middle and later adulthood

Background

The purpose of the present study was to examine the impact of oral health conditions on cognitive functioning on basis of data samples from several European countries.

Methods

Secondary analyses were conducted of data from wave 2 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) which includes 14 European countries and is intended to be representative of each country’s middle and later adulthood population. Information on word recall, verbal fluency, and numeracy as well as information on chewing ability and denture wearing status was available for a total of 28,693 persons aged 50+. Multivariate regression analysis was used to detect influences of oral health parameters on cognitive functioning (p < 0.05).

Results

Persons with good chewing ability or without dentures had significantly better word recall, verbal fluency, and numeracy skills than persons with chewing impairment or with dentures. The observed patterns of parameter estimates imply differential oral health impacts on numeracy compared to word recall and verbal fluency.

Conclusions

The present study provides novel large-scale epidemiological evidence supportive of an association between oral health and cognitive functioning. Future research should intend to verify the precise causal links between oral health conditions, various cognitive dimensions, and their neural correlates.