Inequalities in Untreated Root Caries and Affordability of Dental Services among Older American Adults

Understanding poor oral health among older adults in Türkiye: socioeconomic and healthcare access challenges

BACKGROUND

Oral health is an integral part of overall well-being, and older individuals are particularly vulnerable due to age-related changes and barriers to healthcare access. Despite Türkiye's comprehensive public health insurance system, significant disparities in oral health persist, highlighting the need for targeted research and interventions. This study assesses the oral health of people aged 65 and older in Türkiye and explores the factors linked to poor oral health, such as individual characteristics, lifestyle, socioeconomic status, social support, overall health, and access to healthcare services.

METHODS

A secondary analysis was performed using the cross-sectional 2022 Türkiye Health Survey, which gathered data from 3,144 individuals aged 65 and above. Oral health was self-reported, with poor oral health defined as participants rating their dental and gum condition as 'bad' or 'very bad.' Factors assessed included age, gender, education, social support, healthcare access, and the presence of chronic diseases.

RESULTS

Among the participants, 25.8% reported poor oral health. Key factors associated with this included being older, female, having lower levels of education, difficulty communicating in one's mother tongue, experiencing limitations in daily activities, and facing cost-related barriers to dental care. Multivariable analysis found that cost related barriers and limitations in daily activities had the strongest impact on oral health. The study also highlighted the importance of social support in maintaining better oral health.

CONCLUSIONS

Poor oral health in older adults in Türkiye is strongly influenced by cost-related barriers, limitations in daily activities, and lack of social support. Expanding public dental services, reducing out-of-pocket costs, and integrating oral health into chronic disease programs are critical steps. Providing culturally sensitive and mobile care options can also address mobility challenges and enhance oral health outcomes for the elderly.

Factors associated with the use of dental services in older adults in Peru

BACKGROUND

The use of dental services by older adults in Peru faces various challenges that impact both their oral and overall health. Several factors play a crucial role in obtaining adequate dental care.

AIMS

To evaluate the factors associated with the use of dental services in older adults in Peru.

METHODS

This study was an observational, analytical, and cross-sectional investigation that utilized data from multiple years (2018-2022) of the Demographic and Family Health Survey (ENDES, by its Spanish acronym). The use of dental services was assessed through a specific survey question and analyzed in association with various socio-demographic variables, employing both descriptive and analytical statistical methods.

RESULTS

In the multivariable analysis, the likelihood of not utilizing dental services was higher among men aPR: 1.53 (95% CI: 1.45-1.61), those without health insurance aPR: 1.44 (95% CI: 1.36-1.53), those who self-identified as other races aPR: 1.22 (95% CI: 1.13-1.33), Afro-descendants aPR: 1.10 (95% CI: 1.01-1.19), whites aPR: 1.12 (95% CI: 1.01-1.25) according to education level, those with a physical limitation aPR: 1.24 (95% CI: 1.15-1.33), and increased as they were poorer; it was lower among the rich but more pronounced among the middle-income, poor, and very poor, adjusted for five variables.

CONCLUSION

It was reported that 15% of older adults did not use dental services, and this was associated with significant socio-demographic variables.

Teeth, Health, and Mind: Understanding the Interplay of Social Determinants and Cognitive Decline in Older Adults

The study examines the association between social determinants of health, tooth loss, and cognitive decline. Using regression models, the 2020 Behavioral Risk Factor Surveillance data examined the study objective; it included 32,663 older adults who reported on cognitive status. Results suggested that older adults missing more than five teeth or unable to work are 1.61 times and 6.84 times more likely to report cognitive decline, respectively. Older adults with higher education and higher household incomes are less likely to report cognitive decline. Results suggested that older adults with no diabetes or who never smoked are 31% and 39% less likely to report a cognitive decline. The results suggested a significant association between tooth loss and cognitive decline among social determinants of health. A comprehensive approach to affect cognitive decline should include oral and social health strategies.

CPP-ACP paste's effect on salivary conditions in patients with removable dentures

PURPOSE

Older adults with removable dentures experience high rates of both caries (when the natural dentition remains) and salivary gland dysfunction. While many commercial dental therapeutic agents target these two interrelated problems, none have been labeled for use on the fitting surface of removable dentures. Off-label use of MI Paste (GC America, Alsip, IL), a dental therapeutic containing casein-phosphopeptide-amorphous-calcium-phosphate (CPP-ACP), was investigated following its application to the fitting surface of complete denture(s) with subsequent effects on salivary conditions measured.

MATERIALS AND METHODS

Salivary flow rate and pH were recorded at baseline and 15 min following the application of 1 mL of CPP-ACP paste to the fitting surface of each participant's denture through whole saliva collection. To assess buffering capacity, equivalent volumes of 0.01 M lactic acid were added to the collected saliva samples, and pH reduction was measured. Comparisons of salivary parameters between baseline and post-CPP-ACP paste application and between subjects with and without self-reported xerostomia were conducted using a paired-sample t-test, Wilcoxon signed-rank test, or two-sample t-test as appropriate.

RESULTS

Of the 28 participants (mean age = 70.3 ± 13.7 years, 17 males), 11 reported xerostomia. CPP-ACP-paste application was associated with decreased pH reduction during acid challenge compared to baseline (0.95 ± 0.24 vs. 1.54 ± 0.53, p < 0.001), and a higher final pH following acid challenge (5.93 ± 0.34 vs. 5.40 ± 0.66, p < 0.001). While the flow rates observed at post-CPP-ACP paste application were greater than those at baseline, the difference was not statistically significant (0.67 ± 0.44 mL/min vs. 0.55 ± 0.34 mL/min, p = 0.053). No significant differences were found in any salivary parameters between participants with or without self-reports of xerostomia.

CONCLUSIONS

The findings highlight potential positive effects on salivary conditions following the application of the CPP-ACP-containing product, MI Paste, to the fitting surface of a removable complete denture as a potential caries-risk-management tool when natural dentition remains. Determining the caries-preventive clinical significance will require longer-term trials.

Prevalence, and Risk Indicators of Coronal and Root Caries in Mexican Older Adults in Nursing Homes

Background

Several factors are associated with coronal and root caries in older persons. The purpose of this study was to determine the experience, prevalence, and risk indicators (socioeconomic, sociodemographic, and dental variables) of coronal and root caries in older persons residing in nursing homes in Mexico.

Methods

A cross-sectional study was carried out in 227 dentate participants with natural teeth. Convenience sample, where all dentate residents were invited to participate. The dependent variables were coronal caries and root caries, which were determined through an oral clinical examination. The independent variables were sociodemographic factors, location, type of center, surfaces free of dental biofilm and calculus, surfaces with recession, retainers in contact with surfaces with recession, xerostomia, smoking, and the previous use of dental services. The binary logistic regression model was used in the analysis.

Results

The mean age of the participants in this study was 77.7±8.8 years, and 69.2% were women. Moreover, 71.8% live in long-term care facilities, and 48.0% live in Mexico City. The prevalence of coronal and root caries was found to be 67.8% and 50.7%, respectively. Being male and living in Mexico City were risk indicators for coronal caries, and with a 1% increase in surfaces with no biofilm, the risk decreased by 2%. Being widowed, having government or no social security, denture retainers, and coronal caries were risk indicators for root caries, while the utilization of dental services indicated lower risk.

Conclusion

Several variables that differ in nature were found to be risk indicators for coronal and root caries. Coronal caries increases the risk of root caries. Prevention should be aimed at identifying persons at higher risk, and dental care should be improved for persons living in long-term care institutions.

Association of Interdental Cleaning and Untreated Root Caries in Adults in the United States of America

PURPOSE

This study aimed to evaluate the association between interdental cleaning and untreated root caries amongst middle-aged and older adults in the US.

MATERIALS AND METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) (2015-2016 and 2017-2018). Adults aged ≥40 years who underwent full mouth examination and root caries assessment were included. Participants were classified based on their interdental cleaning frequency as none, 1-3 d/wk, and 4-7 d/wk. Associations between interdental cleaning and untreated root caries were assessed using a weighted multivariable logistic regression model adjusted for sociodemographics, general behaviour, general health condition, oral conditions, oral health behavior, and dietary factors. Subgroup analyses stratified by age and sex were performed after adjusting for covariates in the logistic regression models.

RESULTS

The prevalence of untreated root caries was 15.3% amongst 6217 participants. Interdental cleaning for 4-7 d/wk was a significant risk factor (odds ratio, 0.67; 95% confidence interval, 0.52-0.85). It was associated with a 40% reduction in the risk of untreated root caries in participants aged 40 to 64 years and a 37% reduction in women. Untreated root caries was also significantly associated with age, family income, smoking status, root restoration, number of teeth, untreated coronal caries, and recent dental visit.

CONCLUSIONS

Interdental cleaning for 4-7 d/wk was associated with fewer untreated root caries amongst middle-aged adults and women in the US. The risk of root caries increases with age. Low family income was a risk indicator for root caries amongst middle-aged adults. Additionally, smoking, root restoration, number of teeth, untreated coronal caries, and recent dental visits were common risk factors for root caries in middle-aged and older people in the US.

Interplay of health literacy, healthcare access and health behaviors with oral health status among older persons

This study contributes to the ongoing debate on social determinants of oral health of older persons. Specifically, it examines the direct and indirect effects of health literacy and access to healthcare on oral health status of older persons. The study also investigates whether general health status and health behavior (routine medical check-ups) explain the association of health literacy and healthcare access with oral health status. The gender dimensions of these relationships are also explored. Data were derived from 522 participants aged 50 years and older located in five regions in Ghana. Path analyses in structural equation modeling (SEM) were used to analyse the data. General health status (β = -0.049, p < 0.005), medical check-up (β = 0.124, p < 0.01), and health literacy (β = 0.133, p < 0.01) were positively associated with oral health status. General health status mediated the positive relationship between health literacy and oral health status (β = 0.048, p < 0.01). General health status (β = 0.016, p < 0.05) and medical check-ups (β = 0.025, p < 0.05) mediated the association between access to healthcare and oral health status. The mediational role of routine medical check-up in the association between access to healthcare and oral health status was significantly stronger (B = 0.063, p < 0.01) among men (β = 0.051, p < 0.01) than women (β = 0.003, p > 0.05). Analyses of oral health issues among older persons in Ghana and settings alike must recognize the complex interplay among critical social determinants to initiate pragmatic health and social policy interventions.

Application of a Caries Treatment Difficulty Assessment System in Dental Caries Management

Dental caries is one of the most common chronic diseases caused by progressive bacteria, affecting all age groups. Today, restorative fillings are widely used for dental caries treatment, but the restorative treatment has a high failure rate. Meanwhile, many researchers have discovered the differences of caries risk among populations by using the caries risk assessment and put forward a new standpoint that caries should be treated individually. Therefore, our research group established a Dental Caries Treatment Difficulty Assessment system in a previous study. This time, we combined the caries risk assessment with the caries treatment difficulty assessment, then used Python to design a Dental Caries Management Software. The purpose of this case report is to present a case applying this software in dental caries management and other data collected in Chengdu, China, with this software on the assessment of caries treatment difficulty. Patients with personalized assessment and management can achieve good treatment results, including reducing the risk and treatment difficulty of dental caries. At the same time, other cases show that the software has good application potential in individual management and group information collection. These cases indicate that the software enables dentists to carry out both the risk assessments and the treatment difficulty assessment of patients, and it has the potential as a tool for epidemiological investigation. It also enables dentists and patients to have a basic understanding of the dental health status of patients and create personalized dental caries treatment, so as to achieve the goal of controlling the progression of dental caries and rebuilding the structure and restoring the function of teeth.

A Global Perspective of Racial-Ethnic Inequities in Dental Caries: Protocol of Systematic Review

Though current evidence suggests that racial-ethnic inequities in dental caries persist over time and across space, their magnitude is currently unknown from a global perspective. This systematic review aims to quantify the magnitude of racial/ethnic inequities in dental caries and to deconstruct the different taxonomies/concepts/methods used for racial/ethnic categorization across different populations/nations. This review has been registered in PROSPERO; CRD42021282771. An electronic search of all relevant databases will be conducted until December 2021 for both published and unpublished literature. Studies will be eligible if they include data on the prevalence or severity of dental caries assessed by the decayed, missing, filled teeth index (DMFT), according to indicators of race-ethnicity. A narrative synthesis of included studies and a random-effects meta-analysis will be conducted. Forest plots will be constructed to assess the difference in effect size for the occurrence of dental caries. Study quality will be determined via the Newcastle-Ottawa Scale and the GRADE approach will be used for assessing the quality of evidence. This systematic review will enhance knowledge of the magnitude of racial/ethnic inequities in dental caries globally by providing important benchmark data on which to base interventions to mitigate the problem and to visualize the effects of racism on oral health.