Oral health, sense of coherence and dental anxiety among middle-aged women

Sense of coherence in a general adult population in Northern Norway and its associations with oral health

BACKGROUND

Sense of coherence (SOC) is a global orientation to life that may affect a person's way of acting and living within his or her life context, which can have an impact on general and oral health. The aims of this study were (i) to describe the distribution of SOC in a general adult population; (ii) to explore whether sociodemographic characteristics, oral health-related behaviours, self-reported oral health, and clinical oral status were associated with SOC; and (iii) to explore whether SOC was associated with self-reported oral health, controlling for sociodemographic characteristics, oral health-related behaviours, and oral clinical status.

METHODS

This study was based on data from the cross-sectional population-based study Oral Health in Northern Norway (N = 1819 individuals, 923 women, mean age 47.1 ± 15.2 years). Data were collected between October 2013 and November 2014 in Troms County. Participants answered a questionnaire that included items on SOC, sociodemographic characteristics, oral health-related behaviours, and self-reported oral health. Clinical oral status (number of teeth, dental caries, and periodontal status) was determined through oral and radiographic examination. Linear regression analysis was used to examine factors associated with SOC. Logistic regression analysis was used to examine SOC and its association with self-reported oral health adjusted for sociodemographic characteristics, behaviours, and clinical oral status.

RESULTS

The mean SOC score was 68.5 (standard deviation 10.5). The younger age groups (20-29 and 30-39 years) had mean SOC scores of 64.0 (95% CI: 62.7,65.3) and 67.2 (95% CI: 66.0,68.5), respectively, and the older age groups (40-79 years) had mean SOC scores between 69.8 and 70.1 (95% CI: 68.2,71.3). A higher mean SOC score was associated with older age, higher education level, higher income (all p < 0.001), being married/cohabiting (p = 0.005), and toothbrushing ≥ 2 times/day (p = 0.008). Approximately 49% of participants reported good oral health. SOC was positively associated with self-reported good oral health in the adjusted model (odds ratio:1.03 [95% CI: 1.02,1.05] p < 0.001).

CONCLUSIONS

SOC was associated with sociodemographic characteristics and toothbrushing habits. There was no significant association between SOC and clinical oral status; however, SOC was positively associated with self-reported good oral health. This indicates that a person's SOC might have an impact on how an individual perceives their oral health, independent of sociodemographic characteristics and the presence of oral diseases.

Psychopathologies and socioeconomic status as risk indicators for periodontitis: a survey-based investigation in German dental practices

OBJECTIVES

Periodontitis is a highly prevalent multifactorial disease associated with various mental disorders. However, study results about this association are still contradictory. One methodological reason could be the neglect of potential confounders, such as socioeconomic factors or mental comorbidity. Our study examined a wide range of potential psychosocial risk indicators to identify those with relevant associations to periodontitis.

MATERIALS AND METHODS

In a cross-sectional study, 111 patients with periodontitis (PERIO) (> 30% teeth with approximal attachment loss ≥ 5 mm) and 110 patients without periodontitis (NON-PERIO) were recruited in four dental practices in Germany. Clinical attachment loss, pocket depth, plaque, bleeding on probing, and DMFT were measured. Psychopathologic symptoms and socioeconomic status were recorded using self-report questionnaires (DAS, PHQ-8, GAD-7, CTS, SCOFF, AUDIT, FTND, SSS-8, SES).

RESULTS

The PERIO group reported significantly lower socioeconomic status (Cohen's d = 0.49) and higher psychopathological symptom burden than the NON-PERIO regarding dental anxiety (d = 0.86) and avoidance behavior, nicotine dependency (d = 0.84), depressiveness (d = 0.46), general anxiety (d = 0.45), somatic symptoms (d = 0.42), and childhood traumatization (d = 0.34). No significant group differences existed for alcohol abuse and eating disorders. Dental anxiety was the strongest predictor of periodontitis and showed significant correlations with other psychopathologies and social status.

CONCLUSIONS

Out of all psychosocial factors, socioeconomic status and dental anxiety showed the greatest association with periodontitis.

CLINICAL RELEVANCE

Dentists should encourage socially disadvantaged and dentally anxious patients in the utilization of prevention and dental care. Furthermore, physicians and psychotherapists can contribute to the early detection of dental anxiety, oral diseases, and avoidance behavior.

Sense of coherence and dental fear/dental anxiety: A systematic review and meta-analysis

AIM

The aim of this systematic review and meta-analysis was to evaluate the association between sense of coherence (SOC) and dental fear/dental anxiety.

METHODS

Computerized searches were performed in six databases. Gray literature and manual searches were also conducted. Study selection, risk of bias assessment, and meta-analyses were performed. The results of meta-analyses were reported in odds ratio (OR), mean difference (MD), and confidence interval (CI).

RESULTS

After removing duplicates, 131 references were retrieved and the full texts of 12 were evaluated. Nine references met the eligibility criteria and were included. The results of meta-analyses demonstrated that individuals with a weaker SOC had a score in the dental anxiety/dental fear scale 6.04 times higher than individuals with a stronger SOC (OR = 6.04, CI = 2.62-13.91). Individuals with no dental anxiety/dental fear had a mean score of the SOC scale higher than individuals with dental anxiety/dental fear (MD = 5.39, CI = 2.21-8.56). Sensitivity analysis demonstrated that the result of a higher mean score of the SOC scale among individuals with no dental anxiety/dental fear remained (MD = 7.38, CI = 3.79-10.98). Risk of bias ranged from low to high. The certainty of evidence was very low.

CONCLUSION

Individuals with stronger SOC have lower levels of dental fear/dental anxiety.

Effect of sense of coherence on oral health behavior and status: A systematic review and meta-analysis

The sense of coherence (SOC) is defined as a personal orientation to life. People with higher SOC are better at dealing with stressful situations, psychological stress, and problems and are more able to manage them, leading to better general health. The purpose of this study was to evaluate the effect of SOC on the oral health status of people in different age groups. A systematic search up to May 2019 was carried out in PubMed,Scopus, Psycho info, and Persian sources. Studies were included if they evaluated the relationship between SOC and oral health behaviors (OHBs) or oral health status including dental caries. The Newcastle-Ottawa checklist was used to appraise the selected articles and meta-analysis of included studies were performed using Comprehensive Meta-Analysis software. Value of P < 0.05 was considered to be statistically significant. Odds ratio (OR) was used to measure effect size with 95% confidence interval (CI). The random-effects model was chosen in the presence of heterogenicity. I ² index and Q index were used to measure the heterogeneity present between the studies. Fifteen articles received the minimum score of criticism. In general, SOC could significantly affect the oral health and OHBs of adults independently of the underlying factors. There was a significant relationship between SOC and tooth decay in adolescents, but this association was poor after adjusting for the underlying factors. In children, only one article revealed an association with OHBs. Meta-analysis revealed that SOC was significantly associated with the caries rate (OR = 0.78, CI 95% = 0.9-0.67, P = 0.001) and tooth brushing frequency (OR = 1.22, CI 95% = 1.1-1.31 and P < 0.001). Sense of coherence appears to be one of the effective factors in predicting oral health behaviors and ultimately oral health, especially in adults. The number of articles available for children and adolescents was not sufficient in this regard.

Associations between mental and oral health in Spain: a cross-sectional study of more than 23,000 people aged 15 years and over

BACKGROUND

This study aimed to investigate associations between mental health and several parameters of oral health, controlling for a variety of important covariates, in a large representative sample of Spanish people.

METHODS

Data from the Spanish National Health Survey 2017 were analysed. Mental (i.e., depression, chronic anxiety, other psychiatric disorders) and oral health (i.e., dental caries, dental extraction, dental filling, gingival bleeding, tooth movement, dental material, missing tooth) were evaluated. Control variables included sex, age, marital status, education, smoking, alcohol consumption, and physical multimorbidity. Associations between psychiatric conditions (independent variables) and the number of poor oral health outcomes (dependent variable) were assessed using Poisson regression models. The associations were investigated in the overall population, in married participants and in those who were single/widowed/divorced/separated.

RESULTS

There were 23,089 participants [54.1% women; mean (standard deviation) age 53.4 (18.9) years]. The prevalence of at least one psychiatric condition was 15.4% in the overall sample, while the mean (standard deviation) number of poor oral health outcomes was 2.9 (1.4). There was a positive association between any psychiatric condition and the number of poor oral health outcomes [incidence rate ratio (IRR)=1.10; 95% confidence interval: 1.07-1.12], and there was a significant interaction between any psychiatric condition and marital status. The association was stronger in those participants who were single/widowed/divorced/separated.

LIMITATIONS

Cross-sectional study. Oral and mental health were assessed with Yes/No questions. Exposure, outcome and covariates were self-reported.

CONCLUSIONS

Those with poor mental health have worse oral health but being married has some protective benefits.

Validity of self-reported periodontal measures, demographic characteristics, and systemic medical conditions

BACKGROUND

The objective of the present study was to assess self-reported periodontal screening questions, demographic characteristics, systemic medical conditions, and tobacco use for predicting periodontal disease among individuals seeking dental therapy in a university dental clinic.

METHODS

In this retrospective study, a total of 4,890 randomly selected dental charts were evaluated from among patients who had attended the University of Minnesota School of Dentistry clinics for treatment. Radiographic bone loss measurements were used to assess the severity of periodontal disease. Demographic characteristics as well as medical history of the patients were also recorded. Five self-reported periodontal screening questions were included, with answers limited to Yes/No. Generalized logit models were used to assess the association between bone loss and the predictors.

RESULTS

The sample's mean age was 54.1 years and included 52.6% males and 14.9% smokers, with a mean of 3.5 missing teeth. Self-reported tooth mobility, history of "gum treatment," and the importance of retaining teeth as well as age, tobacco use, and cancer were statistically significant predictors (P < 0.05) of a radiographic diagnosis of moderate and severe periodontal disease. With respect to severe periodontal disease, significant associations (P < 0.05) were also found with "bleeding while brushing," gender, diabetes, anxiety, and arthritis.

CONCLUSIONS

Self-reported periodontal screening questions as well as demographic characteristics, smoking, and systemic medical conditions were significant predictors of periodontal disease, and they could be used as valid, economic, and practical measures.

Association between sense of coherence and dental caries: systematic review and meta-analysis

Sense of coherence (SOC) is regarded as the individuals' capacity for managing the stressors over their lifespan. The aim of this systematic review and meta-analysis was to evaluate the association between SOC and dental caries. Electronic searchers were conducted in six databases: PubMed, Medline, Scopus, Web of Science, Lilacs and Proquest from their date of inception until November/2017. An update took place in August/2018. A hand search in the reference list of the included articles and gray literature search were also carried out. Retrieved titles/abstracts were screened by two review authors. Data of the included articles were extracted and quality assessment was also conducted. The first search retrieved 346 titles/abstracts. The update retrieved 33 records. Following the removal of 70 duplicates, 309 references were screened and 17 were included. The quality assessment ranged from low quality articles to high quality articles. High quality study showed that adult individuals with lower SOC were more likely to have dental caries. Meta-analysis showed that adolescents with low SOC were 5.41 times more likely to present dental caries than adolescents with high SOC (CI = 2.15–13.59). Mothers with low SOC were 5.55 times more likely to have children/adolescents with dental caries than mothers with high SOC (CI = 2.92–10.57). The subgroup analysis exploring continuous data showed that the SOC of mothers of children/adolescents without dental caries was significantly higher than the SOC of mothers of children/adolescents with dental caries (CI = 0.10–0.51). Higher levels of SOC seem to be associated with lower levels of dental caries.

Tooth loss in middle-aged adults with diabetes and hypertension: Social determinants, health perceptions, oral impact on daily performance (OIDP) and treatment need

BACKGROUND

This study aimed to explore the association between tooth loss and social determinants, health self-perceptions, OIDP and self-concept of dental treatment need in middle-aged adults with diabetes and hypertension.

MATERIAL AND METHODS

A cross-sectional study was developed with 212 hypertensive and diabetic middle-aged adults (50-65 years). Data were collected from clinical examinations (DMFT) and a questionnaire regarding socioeconomic status, dental health assistance, self-perceptions of oral and general health, OIDP, and the self-concept of dental treatment need. Tooth loss was dichotomized considering the cutoff point of 12 (Model I) or 24 missing teeth (Model II). Data were analyzed using Chi-square, Fisher's exact test and logistic regression (p≤0.05).

RESULTS

Tooth loss was significantly associated with variables such as last dental visit, reason for dental visit, OIDP, perception of dental treatment need, and general self-perception (Model I). Schooling, last dental visit, oral health self-perception and perception of dental treatment need were significantly associated with tooth loss in the Model II. When Model 1 and 2 were adjusted, they demonstrated that last dental visit and perception of dental treatment need were predictor variables.

CONCLUSIONS

The annual dental visit and the self-concept of dental treatment need were associated with tooth loss, demonstrating that these variables reduce the tooth loss prevalence.

[Difficulty influence factors of dental caries clinical treatment]

Dental caries is a major disease that threaten human's oral healthy severely with the characteristics of high incidence, low rate of treatment and high rate of retreatment. At present, restorative treatment remains the main method for caries treatment. With the development of the Minimally Invasive Cosmetic Dentistry (MICD), reasonable application of various treatment technologies, maximum preservation of tooth tissues and realizing the maximization of treatment effects become problems that call for immediate solution in dental clinics. In addition, there still exist a large number of old restorations that need standard retreatments. Here, some difficulty influence factors of dental caries clinical treatment such as systemic and oral factors, individual caries susceptibility, treatment technologies and materials, retreatment methods of old restorations and technique sensitivity are analyzed, and corresponding processing strategies are also put forward.

The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis

BACKGROUND

Many psychological disorders are associated with comorbid physical illness. There are less data on dental disease in common psychological disorders such as depression and anxiety in spite of risk factors in this population of diet, lifestyle or antidepressant-induced dry mouth.

METHODS

We undertook a systematic search for studies of the oral health of people with common psychological disorders including depression, anxiety and dental phobia. We searched MEDLINE, PsycInfo, EMBASE and article bibliographies. Results were compared with the general population. Outcomes included partial or total tooth-loss, periodontal disease, and dental decay measured through standardized measures such as the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS).

RESULTS

There were 19 papers on depression and/or anxiety, and seven on dental phobia/anxiety (total n=26). These covered 334,503 subjects. All the psychiatric diagnoses were associated with increased dental decay on both DMFT and DMFS scores, as well as greater tooth loss (OR=1.22; 95%CI=1.14-1.30). There was no association with periodontal disease, except for panic disorder.

LIMITATIONS

Cross-sectional design of included studies, heterogeneity in some results, insufficient studies to test for publication bias.

CONCLUSION

The increased focus on the physical health of psychiatric patients should encompass oral health including closer collaboration between dental and medical practitioners. Possible interventions include oral health assessment using standard checklists that can be completed by non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth, and early dental referral. Mental health clinicians should also be aware of the oral consequences of inappropriate diet and psychotropic medication.

Sense of coherence and periodontal health outcomes

OBJECTIVE

Sense of Coherence (SOC) has been associated with perceived oral health measures, but the contribution of SOC to clinical measures is still unclear. The aim of the present cross-sectional study was to evaluate the potential association between periodontal health outcomes, such as periodontal clinical parameters and perceived periodontal health, and SOC.

MATERIALS AND METHODS

The study sample comprised 276 individuals, aged 18-60 years, from Belo Horizonte, Brazil. Participants answered questionnaires covering sociodemographic variables, self-perceived periodontal health and SOC. Full-mouth periodontal examinations were performed. The sample was divided into three groups according to SOC score: (a) SOC1 = weak (24-46); (b) SOC2 = moderate (47-51); (c) SOC3 = strong (52-65). Multivariate analyses including appropriate logistic or linear regression models were performed to evaluate the association between periodontal health outcomes and biological, sociodemographic and behavioural variables.

RESULTS

Perceived general oral health was associated with family income bracket (p = 0.010), smoking (p = 0.004), dental flossing (p = 0.017) and SOC (weak SOC: p = 0.005). Perceived gum disease and perceived periodontal disease were associated with SOC (weak SOC: p = 0.001 and p = 0.015, respectively).

CONCLUSIONS

Overall, perceived periodontal health outcomes were associated with SOC. However, no association between clinical periodontal health outcomes and SOC were observed.

Associations between dental anxiety, sense of coherence, oral health-related quality of life and health behavior--a national Swedish cross-sectional survey

Background

Dental anxiety (DA) is a common condition associated with avoidance of dental care and subsequent health-related and psychosocial outcomes, in what has been described as the vicious circle of DA. Also, recent studies have found an association between the psychosocial concept of sense of coherence (SOC) and DA. More studies are needed to verify the relationship between DA and SOC, especially using population-based samples. There is also a need for studies including factors related to the vicious circle of DA, such as oral health-related quality of life (OHRQoL), in order to further establish the correlates of DA in the general population. Therefore, the aim of this study was to investigate the relationship between DA and SOC, OHRQoL and health-related behaviour in the general Swedish population.

Methods

The survey included a randomly selected sample of the adult Swedish population (N = 3500, age 19 – 96 years.). Data was collected by means of telephone interviews. Dental anxiety was measured with a single question. The SOC measure consisted of three questions conceptualising the dimensions of the SOC: comprehensibility, manageability and meaningfulness. The data collection also included the five-item version of the Oral Health Impact Profile (OHIP-5), as a measure of OHRQoL, as well as questions on oral health-related behaviour and socioeconomic status. Statistical analyses were made with descriptive statistics and inference testing using Chi-square, t – test and logistic regression.

Results

High DA was associated with low OHRQoL, irregular dental care and smoking. There was a statistically significant relationship between the SOC and DA in the bivariate, but not in the multivariate, analyses. Dental anxiety was not associated with oral health-related behaviour or socioeconomic status.

Conclusions

This cross-sectional national survey gives support to the significant associations between high dental anxiety, avoidance of dental care and health-related outcomes, which may further reinforce the model of a vicious circle of dental anxiety. The results further indicate a weak relationship between dental anxiety and sense of coherence.

Oral health-related resources - a salutogenic perspective on Swedish 19-year-olds

The aim was to explore health-oriented resources among 19-year-olds and, specifically, how these resources interact with oral health-related attitudes and behaviour. To represent individuals with various psychosocial environments and socioeconomic areas, the participants were selected from different geographical locations of the Public Dental Service clinics in the county of Jönköping, Sweden. A structured questionnaire was distributed, including the instrument 'sense of coherence', for description of the study group, followed by a semi-structured thematized interview. The qualitative method used for sampling and analyses was grounded theory. Data sampling and analysis were performed in parallel procedures and ended up in a sample of ten informants (five women). In the analysis of interview data, a core category was identified, 'Resources of Wealth and Balance in Life - a Foundation for Healthy Choices', describing the central meaning of the informants' perceptions of resources with an essential beneficial impact on oral health. The core category was built on five themes, which in turn had various subthemes, describing different dimensions of resources interacting with beneficial oral health-related attitudes and behaviour: 'Security-building Resources and Support', 'Driving force and Motivation', 'Maturity and Insight', 'Health Awareness' and 'Environmental influences.' The results elucidate personal and environmental health-oriented resources with influence on oral health-related attitudes and behaviours of young individuals. Such beneficial recourses should be recognized by dental personnel to promote oral health.

Fear of dental treatment--an underrecognized symptom in people with impaired mental health

BACKGROUND

In industrialized countries, about 5% to 15% of all adults have a pathologically severe fear of dental treatment, and some 3% avoid going to the dentist altogether. The affected persons may, in turn, suffer from severe dental diseases and their psychosocial effects. Many people with dental phobia have other mental disorders as well. These facts motivated us to study the prevalence of fear of dental treatment in a group of patients being treated by our psychosomatic service.

METHOD

212 patients of our psychosomatic service and 95 healthy controls were studied with the Hierarchical Anxiety Questionnaire (HAQ) to determine the intensity of their fear of dental treatment. Mental disorders were diagnosed with structured clinical interviews according to DSM-IV.

RESULTS

Nearly one patient in three (30.5%, n = 64) suffered from pathologically severe fear of dental treatment; 24 of them (38.5%) had avoided visiting a dentist for longer than one year. Only 4 (4.2%) of the healthy controls were greatly afraid of dental treatment. Certain types of mental disorder were especially highly associated with fear of dental treatment: in particular, anxiety disorders (relative risk [RR] 7.44, 95% confidence interval [CI] 2.68-20.70) and depressive disorders (RR 4.92, 95% CI 1.73-14.05). Patients with post-traumatic stress disorder were affected most commonly: 34 (42%) of these patients were greatly afraid of dental treatment (RR 9.97, 95% CI 3.69-26.90). 75 of the 134 study participants who were afraid of dental treatment (56%) had cancelled a dental appointment, or failed to appear for a scheduled appointment, because of their fears.

CONCLUSION

Fear of dental treatment commonly accompanies certain types of mental disorder. Patients at high risk should be asked about such fears so that the problem can be recognized early and appropriately treated.

Dental fear and sense of coherence among 18-yr-old adolescents in Finland

The aim was to investigate whether dental fear was associated with the sense of coherence (SOC) among 18-yr-old adolescents (n = 777). Cross-sectional data from a prospective cohort of a random sample of families from Finland and their first-born children were used. Dental fear was measured using the Modified Dental Anxiety Scale and categorized as high dental fear for scores of 19-25 and as no to moderate dental fear for scores of 5-18. Sense of coherence was measured using a 13-item version of Antonovsky's Sense of Coherence Questionnaire, dichotomized as scores 13-63 for weak SOC and as scores of 64-91 for strong SOC. Gender and education were included as background factors in the logistic regression analyses. The prevalence of high dental fear was 8%. Those reporting high dental fear reported more often a weaker SOC than did those with no to moderate dental fear (69% vs. 31%, OR = 2.5, 95% CI = 1.4-4.4), also when adjusted for gender and education (OR = 2.2, 95% CI = 1.2-3.9). According to the theory of salutogenesis, as proposed by Antonovsky, SOC is a resource instrument especially in situations of tension or strain and hence a strong SOC might protect against high dental fear.