Social determinants of health for moderate and severe periodontal disease in rural and urban populations

OBJECTIVE

We assessed the prevalence of moderate and severe periodontitis and its association with social determinants of health in rural and urban population from the State of Chiapas, in Southern Mexico.

MATERIAL AND METHODS

A cross-sectional population-based study was conducted in 2013 comprising people 20 years and older. The determinants were categorized as proximal (age, sex, indigenous origin, diabetes, smoking, diet), intermediate (level of schooling, occupation, medical and dental care), and structural (type of institution of health care provision, residence area). Periodontal status was assessed using the Periodontal Screening and Recording (PSR) Index.

RESULTS

In total, 467 persons (72.4% women; mean age 43.0 years [s.d 14.7]) participated. Of them, 76.5% lived in rural areas and 56.7% were of indigenous origin. Participants with moderate and severe periodontitis had a significantly lower toothbrushing frequency (44.1% and 44.8%, respectively), and poorer oral hygiene (90% and 90.3%, respectively) compared with people without periodontitis (29.4% for toothbrushing frequency and 74.5% for oral hygiene). Moderate periodontitis was associated with poor oral hygiene (OR=2.63) and no schooling (OR=1.86). Severe periodontitis was associated with age (OR=1.05), poor oral hygiene (OR=3.99), no schooling (OR=2.08), and the interaction term of rural area and indigenous origin (RM=5.23).

CONCLUSIONS

Social determinants of health play an important role in the development of periodontitis. Preventive oral health programs should thus focus on the specific social, economic, and geographical context of the population.

The Coyoacán Cohort Study: Design, Methodology, and Participants' Characteristics of a Mexican Study on Nutritional and Psychosocial Markers of Frailty

BACKGROUND

"Frailty" has emerged as a condition associated with an increased risk of functional decline among the elderly, which may be differentiated from aging, disability, and co-morbidities.

OBJECTIVE

The Mexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly has emerged to help answer many questions about frailty among the older adults. This report presents the design of the study and baseline data of its participants.

DESIGN

The "Coyoacan cohort" is a longitudinal observational study developed in Mexico City.

PARTICIPANTS

A representative sample of 1,294 non-institutionalized men and women aged 70 years and older were randomly recruited to undergo a face-to-face interview and a comprehensive geriatric assessment (including clinical evaluations and blood samples) between 2008 and 2009.

MEASUREMENTS

Data collected included socio-demographic and economic characteristics, medical history, oral health, drug use, cognitive function and mood, nutritional status, physical performance and functional status, physical activity, quality of life, social networks, and biological data. Frailty was defined as the presence of ≥3 of the following components: slowness, poor muscle strength, low physical activity, exhaustion and unintentional weight loss.

RESULTS

A total of 1,124 participants completed the interview. The mean age was 79.5 ± 7.1 years, and 55.9% were female. Nine hundred and forty-five subjects completed the clinical evaluation and 743 blood samples were collected. The baseline prevalence of frailty was 14.1%.

CONCLUSIONS

Understanding the medical, biological, and environmental factors that contribute to the phenomenon of frailty is the goal of the current research in the field.

Frailty from an Oral Health Point of View

Frailty commonly affects older persons, increasing their risk for adverse outcomes. Oral health is affected by those conditions related to the mouth and teeth, including caries, periodontal diseases, dysgeusia, presbyphagia and oral cancer among others. Oral health problems can be classified as development defects and acquired problems. These latter are related to infection or trauma, have a cumulative effect throughout life and their consequences are lifelong. Such acquired problems can be classified as primary or secondary, both interacting in a complex manner. Recovery to a previous state of tissue integrity is often impossible from these conditions. These complex interactions have negative impacts on the individual's general health and quality of life. Oral status is an important contributor to general health, and has been linked to several chronic conditions such as cognitive impairment, diabetes, cardiovascular diseases, strokes, and cancer. An individual's oral health is mostly stable throughout life. Tooth loss may be considered as the final outcome, resulting as a consequence of history of caries and periodontitis, as well as failure of prevention and treatment. The loss of a tooth may thus represent the first step of a vicious cycle. In fact, without intervention, one missing tooth may lead to further teeth loss, thus reducing the capability to chew and consume nutrients (essential for life and adequate physiological function), and finally contributing to the development of age-related chronic diseases.

Oral-health-related quality of life in schoolchildren in an endemic fluorosis area of Mexico

OBJECTIVE

To evaluate the oral-health-related quality of life (OHRQoL) of children living in an endemic hydrofluorosis area.

METHODS

Schoolchildren aged 8-10 years living in an area with 3.38 ppm F water concentration completed a validated Spanish version of the Child Perceptions Questionnaire (CPQ(8-10ESP)). World Health Organization (WHO) criteria were applied for the diagnosis of dental caries and malocclusion. Additionally, the Thylstrup and Fejerskov Index (TFI) was used for fluorosis diagnosis. CPQ(8-10ESP) scores and oral health status were analyzed using non-parametric tests and logistic regression models.

RESULTS

Two hundred and twelve schoolchildren participated in this study. The mean CPQ(8-10ESP) score was 12.98 (SD 11.4). General oral health was rated as "poor" in 14.6%, "fair" in 41.5%, "good" in 25.9%, and "very good" in 17.9% of the children. Regarding overall well-being, half (51.6%) of the children perceived that the condition of their mouths disturbs their quality of life (QoL). Children with dental fluorosis (TF >4) had a high CPQ(8-10ESP) score in all domains (P < 0.005). Additionally, children with DMFS + dmfs >5 had higher scores in the oral symptoms, functional limitation, and emotional well-being CPQ(8-10ESP) domains (P < 0.05). Applying a CPQ(8-10ESP) cutoff point of 32, the OR values for severe malocclusion, caries, and fluorosis were 5.2 (P = 0.034), 4.6 (P = 0.006), and 5.1 (P = 0.007), respectively.

CONCLUSIONS

Malocclusion, caries, and fluorosis were associated with a negative impact on children's QoL.

Anterior Open Bite and Speech Disorders in Children with Down Syndrome

Objective: To estimate the prevalence and to determine if there is an association between anterior open bite and the presence of speech disorders in a group of Mexican children with Down syndrome (DS).

Materials and Methods: The subjects were a group of Mexican children with Down syndrome (DG) and a control group (CG) of Mexican pediatric patients without disabilities matched by age. The children in both groups came from families having children with anterior open bite and children without it. A parental questionnaire, dental study casts, and a speech test were used to measure the studied variables. Data were analyzed using the chi-square test (χ2 test), and one-way analyses of variance (ANOVA), followed by the Tukey post hoc test.

Results: Prevalence of anterior open bite was 31.6% in the DG and 22.8% in the CG. The total speech errors by omissions, substitutions, distortions, and additions indicated that there were significant differences between both groups (F = 31.68, P &lt; .001). In general, no significant difference in speech disorders was observed between the DG and the CG regardless of the presence of anterior open bite.

Conclusions: No association existed between speech disorders and anterior open bite in the samples studied.

Prevalence of bruxism among Mexican children with Down syndrome

This study sought to determine the prevalence of bruxism in a Mexican community of children with Down syndrome, and to evaluate bruxism's relationship with age, sex, intellectual disability level, and type of chromosomal abnormality of trisomy 21. Using a cross-sectional design, 57 boys and girls (3 to 14 years old) were examined. Three approaches to establish presence or absence of bruxism were employed: parental questionnaire, clinical examination, and dental study casts. Data were analysed using bivariate analyses and conditional logistic regression. We found that the overall prevalence of bruxism was 42%. No statistically significant associations between bruxism and age, sex, or intellectual disability level were found. There was, however, a significant association between bruxism and type of chromosomal abnormality, with mosaicism being more frequently associated with bruxism.

Barriers to the treatment of childhood caries perceived by dentists working in different countries

OBJECTIVE

To explore whether dentists' beliefs and attitudes to providing preventive and restorative dental care for young children can form a barrier to the provision of care.

BASIC RESEARCH DESIGN

The Barriers to Childhood Caries Treatment (BaCCT) Questionnaire, a standardised international measure was developed and applied.

PARTICIPANTS

Through a research consortium, each site was asked to recruit 100 dentists. The sample participating was not intended to be nationally representative. Dentists were mainly randomly selected and contacted by mail with one or more mailings depending on site.

RESULTS

2,333 dentists in 14 countries and 17 sites participated. Factor analysis identified four factors as potential barriers. Two factors were found to be barriers in many sites. First, in most countries, dentists agreed that young children's coping skills limit their ability to accept dental care. Secondly, dentists with negative personal feelings, for example, that providing care can be stressful and troublesome and that they feel time constrained. Differences in dentists' beliefs can be partly explained by their work profile, with those treating children often, and those working under systems where they feel they can provide quality care being least likely to identify barriers to providing care for children.

CONCLUSIONS

The BaCCT Questionnaire was determined to be a valid psychometric measure. Separately, it was found that health systems do impact on dentists' ability to deliver preventive and restorative care for children but that these effects vary across countries and further work is needed to determine how best these should be examined.

Perceptions of the importance and control of professional problems in the clinical setting

The objective of this study was to identify the relative importance of culturally relevant professional problems and the degree of control over them, as perceived by dentists and dental students in Mexico City, Mexico. The dentists and students ranked 13 problems according to importance and then according to the perceived degree of control over each one. Novice clinicians were less secure about their ability to cope with the legal, financial, and clinical performance problems, whereas experienced clinicians were more concerned about occupational hazards and the dental market and culture. Both reported similar perceptions of their control of the problems. This preliminary information should support introducing into dental schools relevant practice-management courses, targeting continuing education efforts, and instituting professional counseling measures to meet the challenges posed by these problems.

Survey on attitudes toward HIV-infected individuals and infection control practices among dentists in Mexico City

BACKGROUND

The teaching of infection control is gradually being introduced at dental schools in Mexico. However, most practicing dentists have limited access to current infection control standards. Deficiencies of knowledge with regard to blood-borne pathogens such as HIV and hepatitis B virus may influence attitudes toward infected individuals and reduce compliance with infection control recommendations.

OBJECTIVE

The purpose of this study was to assess (1) attitudes toward HIV-infected patients and hepatitis B virus-infected patients and (2) infection control knowledge and practices among dental practitioners in Mexico City.

METHOD

A total of 196 dentists were interviewed by means of a questionnaire with Likert-type scales and open-ended questions (response rate, 86.1%).

RESULTS

Most respondents had no previous social or professional contact with HIV-positive individuals. Nine percent indicated that they had knowingly treated HIV-positive patients. Perceived professional and moral obligations to treat HIV-positive patients were high. Thirty-five percent of the respondents perceived the risk of HIV infection as "considerable" to "very strong." The risk of hepatitis B infection was considered significantly higher than the risk of HIV infection (P <.01); however, 78% of the respondents had not been immunized against hepatitis B. Reported use of personal protective equipment was high. Most respondents used dry heat sterilization. The principal disinfectants used were quaternary ammonium compounds, bleach, and glutaraldehyde. Fifty-four percent of the respondents acknowledged that clinical precautions reduced occupational risks.

CONCLUSIONS

This survey revealed contradictory attitudes toward HIV-positive individuals and limited understanding of infection control recommendations. Educational and regulatory efforts are needed to promote better adherence to current infection control standards.

[Use of health services by a population of 60-year olds and older in Mexico]

OBJECTIVE

To describe the sociodemographic characteristics and determinants of health services utilization by the Mexican population of 60 years of age or more.

MATERIAL AND METHODS

Information obtained from the National Health Survey II (ENSA-II) allowed analysis of 4,628 elderly people. Prevalence of chronic diseases was analyzed and the determinants of individuals who had used the health services in the two weeks prior to the interview.

RESULTS

The chronic diseases most frequently reported were: hypertension, diabetes and heart disease. The utilization and hospitalization rates of that age group were 11.4 and 5.5%, respectively. The services most frequently used were: the private physician, social security (IMSS, ISSSTE) welfare services (Ministry of Health--SSA- and IMSS-Solidaridad). Interestingly, 25 to 45% of social security insurance holders did not use the services, instead they consulted a private physician. The most important explanatory variables for health services utilization were: the perceived illness, not having worked for the previous week and being a social security insurance holder. Gender, area of residence and level of education were not significant in the explanation of health services utilization.

CONCLUSIONS

This study demonstrates the need to strengthen preventive and support programs for the elderly population, since they only demand health services when they feel sick.

[Use of hospital services by the aged population of Mexico City]

OBJECTIVE

The purpose of this study was to determine the characteristics of hospital utilization by the elderly in three hospitals in Mexico City during 1992 and 1993. Main reason for admission, average length of stay and type of treatment received were some of the variables studied.

MATERIAL AND METHODS

A random sample of 820 clinical files were selected, 308 from the Instituto Nacional de la Nutrición Salvador Zubirán (INNSZ), 189 from the Hospital General Manuel Gea González (HGMGG) and 323 from the Hospital Regional Adolfo López Mateos (HRALM). The principal reasons for admission, average days spent in the hospital and type of treatment received were identified for patients 60 years and older. Univariate and bivariate analysis was performed with hypothesis test for differences between sexes.

RESULTS

Diabetes mellitus and hypertension were the principal reasons for admission length of stay varied considerably and was the longest at the INNSZ (median: 12 days) and the shortest at the HRALM (median: 8 days). Most of the patients were admitted through the emergency service, except in the INNSZ where most came for ambulatory visit.

[Consumption of prescription drugs in 60-65 years old population in Mexico. National Survey on Addictions, 1993]

OBJECTIVE

To estimate the prevalence of consumption of medical drugs among the population 60 to 65 years old identified in the National Survey on Addictions 1993 and obtain data on the demographic characteristics of these consumers.

MATERIAL AND METHODS

A cross-sectional, probabilistic, stratified and cluster sample of subjects between 12 and 65 years old living in urban areas of the country was selected.

RESULTS

Of the 911 elderly subjects identified, 218 (23.9%) were consumers of prescription drugs, constituting 17% of men and 28% of women. The most frequently used drugs were central nervous system depressants (22% of women and 13% of men) followed by opiates (7% of women and 5% of men). The onset age of consumption was 60 years old and men started earlier than women. Of prescription drug users, 85% use depressors and opiates by prescription, 3% self-medicate themselves and 5% follow a friend's recommendation. Nine per cent use prescription drugs longer than the prescribed time.

CONCLUSIONS

More extensive, specific studies of drug consumption by the elderly should be carried out to explore prevalence of use, which are used most frequently, frequency of adverse effects, effects on quality of life and social support networks for the elderly, among other topics.

[Attitudes and habits for the control of HIV and hepatitis B in dental students]

HIV infection has had great impact on dental practice, mainly because public and professional perceptions about HIV-AIDS contagion are conflictive due to fear and ignorance. Since the practices of infection control have not been adequately studied in Mexico, the present survey explored some attitudes towards HIV infection, stated knowledge on HIV transmission and manifestations, and infection control procedures reportedly used by dental students. A questionnaire was administered to 262 final-year students (95% were 20 to 30 years old; 71% female) in Mexico City (July-August 1992), with emphasis on the clinical risk posed by HIV and hepatitis B (HBV) infections. Data were analyzed with Student's t-test and one-way ANOVA (Scheffé test). Results showed a mixed response as a general rule, with most respondents believing they had a moral (83%) and professional (78%) duty to treat HIV+ patients but few having a sympathetic approach to them. Only a minority have had a direct experience with HIV+ patients (5%) or high-risk groups (24%). Students seemed to use adequate infection control barriers as most wore gloves, gowns, masks and glasses while treating patients, but only 20 per cent had been vaccinated against hepatitis. Some contradictions in the use of disinfecting/sterilization equipment and agents were detected. The most important reasons given to refuse to treat HIV+ patients were the lack of appropriate facilities and the risk of becoming infected. The sources of information on HIV most frequently resorted to were reported to be professional education and short courses of continuing education.

[The prevalence of caries in marginal rural and peripheral urban areas]

A descriptive study of caries prevalence in peripheral urban and rural underprivileged groups was undertaken in self-selected populations demanding basic dental therapy in seven states of Mexico. Dental therapy services were delivered as part of a mobile oral health care program in the Mexican countryside implemented by the Dental School of Universidad Nacional Autónoma de México, during 1990 and 1991. Partial examination of clinical histories of 2,596 patients (mean age 21.8 years) revealed a mean DMFT (the sum of decayed, missing and filled teeth) of 9.21. Only 6.3 per cent of patients had DMFT = 0 and 10.7 per cent were caries-free. The largest component of DMFT were decayed teeth and the smallest one filled teeth. In general, results suggested that caries prevalence was high within the study populations, highlighting the little restorative treatment previously undertaken. The convenience of implementing oral health care schemes to deal with caries morbidity is discussed from the perspective of both the traditional dental treatment approach and preventive public health policies, taking into account the background of complex treatment needs present in these population groups.