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Abstract
To assess the relationship between self-perceived change in oral health status and the provision of dental treatment in an older adult population.
A longitudinal study with data collection at baseline and after three years. Information on change in oral health was obtained by interviews with study subjects and information on dental treatment over three years was obtained from subjects' dentists.
Nine hundred and seven subjects took part at baseline and 611 at follow-up. Of the latter, 495 reported at least one dental visit during the three-year observation period and dental treatment information was available for 408. Outcome measures Global transition judgements and change scores derived from four oral health indexes were used to assess change in oral health status.
Over the three-year period, one-tenth of subjects reported that their oral health had improved and one-fifth that it had deteriorated. Those who improved made significantly more dental visits and received significantly more dental services that those who deteriorated or did not change (P<0.0001). They also received a broader range of diagnostic, preventive and therapeutic services. The association between change and dental service provision remained after controlling for other potential determinants of oral health.
The study suggests that improvements in the oral health of older adults depend upon access to comprehensive dental treatments which can address fully their clinical and self-perceived needs.
... The issue of lack of regular dental healthcare utilization by older adults has been a dilemma of many governments around the globe as a substantial amount of human capital and GDP (gross domestic product) is invested in the production and distribution of resources [6,[18][19][20][21]. In order to improve the utilization of dental services in terms of regular dental attendance and regular audit of dental services for the older adult patient it would be imperative to look into issues pertaining to lack of utilization of essential dental healthcare services by older adults [22]. ...
... socio-economic parameters for e.g. income [2,12,[23][24][25][26]; race/ethnicity [4,12,[27][28][29]32]; gender [30]; social background [21,24,25]; residence in different geographical areas (urban/rural) [4,12]; public/private dental health care services [30]; lack of self-perceived dental needs [7,12,31,50,54] etc. ...
... A study done in Australia [23] elaborates on the need to untangle the concept of supply, need and utilization especially in urban and rural areas and that supply has emerged as a key component in variation in use of services [21,52]. Most of the studies on utilization of services are based on statistical analytical modelling using unambiguous indicators [23] therefore no clear formula can be developed to study the use of the services in either the rural or urban sector or public private divide in health services provision among the older adults. ...
Background: In most countries regular utilization of dental healthcare services by older adults (≥ 60 years) is a matter of concern as they seem to use the services less than any other age group. Therefore this review hopes to look at the factors affecting regular utilization of dental healthcare services among older adults.
Keywords: Utilization of Dental Health Care Services; Older Adults; Geriatric Dentistry, Dental Visit
Method: Relevant studies were retrieved by means of electronic databases; dated 1982 onwards; using pre-determined inclusion criteria mostly age specific for patients 60 years and above, preferably with a mentioned history of regular and/or irregular dental attendance pattern. For the purpose of this study, attenders were categorized as patients’ with atleast one dental visit in the past 12 months and non- attenders with a dental visit more than a year. The data was analysed using CASP (Critical Appraisal Skills Programme Tool) for quality appraisal in the oral health field. Narrative synthesis was used to comprehend and understand the study data. Main Results: The key factors of attenders were -being dentate; geographical location i.e. patients from urban areas; better education; women; higher social class; higher income; patients with dental insurance; non-smokers etc. Crucial features of non- attenders included being of lower social class; living in rural or remote areas; smokers; edentate; transport issues; problem only visit; cost of treatment; poor cognition and physical function; dental fear etc. Conclusion: As perceived earlier, being of an older age group i.e. 60 years and over, is not a deterrent to a regular dental visit but it appears that lack of proper transportation, income, location of the dental healthcare facility, lack of awareness of the importance of oral hygiene, cost of dental treatment that poses as a barrier for a regular dental visit among this age group.
... OHRQoL as the outcome. It was concluded that people who reported a perceived improvement in their oral health had visited the dentist more and also received more services compared to those having oral health deteriorated or unchanged (Locker, 2001). Importantly, Locker also suggested that dental services might have dual effects resulting in positive as well as negative oral health outcome (Locker, 2001). ...
... It was concluded that people who reported a perceived improvement in their oral health had visited the dentist more and also received more services compared to those having oral health deteriorated or unchanged (Locker, 2001). Importantly, Locker also suggested that dental services might have dual effects resulting in positive as well as negative oral health outcome (Locker, 2001). ...
... That study (5) focused on frequency of dental visits and did not consider any reason for dental attendance in terms of being problem or preventively motivated (2). Locker (6) surveyed an older Canadian population across 3 years and found that subjects whose oral health status improved had made significantly more dental visits than those whose oral status was unchanged or deteriorated. Similar findings have been reported elsewhere (7,8). ...
... Consistent with previous research, perceived treatment need and perceived accessibility to dental care were key predictors of major tooth loss and OHRQoL in this study independent of long-term routine dental attendance (6,34). As the coverage of public and private dental care for adults has historically been good in Sweden, difficult access, as perceived by the participants, might reflect financial barriers to attend a dentist or to achieve all the treatments recommended, rather than lack of dental healthcare personnel in the resident areas. ...
Objectives:
Few studies have investigated the effect of long-term routine dental attendance on oral health between middle-aged and older adults, using a prospective cohort design. This study aimed to assess routine dental attendance (attending dentist in the previous 12 months for dental checkups) from age 50 to 65 years. Moreover, this study examined whether long-term routine dental attendance contributes to oral health-related quality of life, OHRQoL, and major tooth loss independent of social factors and the type of treatment sector utilized. Whether oral health impacts of long-term routine attendance varied with type of treatment sector utilized was also investigated.
Method:
In 1992, a census of the 1942 cohort in two counties of Sweden participated in a longitudinal questionnaire survey conducted at age 50 and again after 5, 10, and 15 years. Information was collected on a wide range of health- and oral health-related aspects. Of the 6346 subjects who completed the 1992 survey, 4143 (65%) completed postal follow-ups in 1997, 2002, and 2007.
Results:
Routine dental attendance decreased from 69.1% at age 50-64.2% at age 65. Adjusted logistic regression analyses revealed that individuals reporting long-term routine attendance (routine attendance in both 1992 and 2007) were 0.3 (95% CI 0.2-0.5) times less likely than their counterparts who were nonroutine attenders to report oral impacts. According to generalized estimating equations (GEE), individuals who reported long-term routine attendance were 0.6 (95% CI 0.4-0.7) times less likely than nonroutine attenders to have major tooth loss across the survey years. The effect of long-term routine attendance on OHRQoL was stronger in public than in private dental healthcare attenders.
Conclusion:
Routine attendance decreased from age 50-65 years. Long-term routine attendance had positive impact on major tooth loss and OHRQoL supporting the principle of encouraging annual dental attendance for preventive checkups among older people.
... HRQoL started to receive attention in the field of dentistry only in the 1980s and was formally introduced as the "oral HRQoL" (OHRQoL) by Locker in 1988 (3) . OHRQoL is defined as a standard health status measurement of oral tissues that contributes to overall well-being by enabling individuals to eat, communicate, and socialize without discomfort or distress (4) . It also emphasizes the positive sense of dentofacial selfconfidence, and absence of negative impacts of oral conditions on social life (5) . ...
... Oral health, being a crucial component of general well-being, significantly impacts an individual's quality of life [1], and their chosen social roles [2]. The significance of personal perceptions of oral health becomes particularly crucial in assessing the social and psychological ramifications it engenders [3] and can play a decisive role in public oral health [4]. ...
Background/Objectives: To better understand the impact of different oral conditions on children, several instruments are available to measure oral health-related quality of life (OHRQoL). To adapt and validate cross-culturally the Child Oral Health Impact Profile—Short Form 19 (COHIP-SF19) questionnaire to the Portuguese language. Methods: The COHIP SF-19 was translated and back-translated, and tested for its reliability and for psychometric properties in children who were aged between 8 and 17 years old. The COHIP-19-PT was tested for its internal consistency, construct validity, content validity, and test–retest reliability. Results: The COHIP-19-PT revealed good internal consistency (Cronbach’s alpha = 0.88) and test–retest reliability (interclass correlation = 0.78). The CFA analysis confirmed the structure of COHIP-19-PT. The first-order model showed an adequate fit: GFI = 0.878; CFI = 0.812; RMSEA = 0.083 (90% CI: 0.077–0.090). No invariance was found for the gender-based groups. The correlation between the sub-scales was also assessed, confirming significant correlations between all subdomains. Conclusions: The COHIP-19-PT is a valid and reliable scale for measuring children’s oral health-related quality of life.
... [11] Thus, dental care can improve the oral health-related quality of life (OHRQoL). [12] Influences on an individual's perception such as awareness, beliefs, and experiences are modifiable. [6,7] Dental care through its component designed to mold behavior can bring about a whole new package of life experiences, which can affect perception in an individual. ...
... Oral health is linked to a person's mental and physical health (Locker 2001). Malocclusions are oral conditions that can affect the aesthetics and function of the face (Almeida et al., 2014). ...
... Oral health is defined as physical, psychological, and social wellbeing related to the status of the oral cavity and is characterized by the absence of pain, discomfort, and abnormalities of the mouth and face (Locker, 2001;Glick et al., 2016). An imbalance in oral health can exerts a physical and psychological impact on functional aspects of speech, chewing, and taste as well as social aspects, such as wellbeing, subjective happiness, and self-esteem (Zucoloto et al.,2016;Blanco Aguilera et al., 2017;Bitiniene et al., 2018). ...
The aim of this cross-sectional study was to assess the impact of temporomandibular disorder (TMD) on oral health-related quality of life (OHRQoL) of adolescents. The OHRQoL of adolescents undergoing dental treatment at a University clinic in 2019 was measured using the Brazilian version of the Oral Heath Impact Profile – 14 (OHIP-14). The diagnosis of TMD was performed using Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD). The patients were examined for other oral conditions and the parents/guardians answered questions addressing socioeconomic/demographic characteristics and the general health of the adolescents. Statistical analysis involves simple and multiple logistic regression models. Ninety male and female adolescents between 13 and 18 years of age participated in the study. The prevalence of negative impact on OHRQoL was 34%. In the unadjusted analysis, negative impact on OHRQoL was associated with a poorer self- perception of general and oral health of the adolescent, nonspecific symptoms including pain, and generalized anxiety disorder, caries, reports of dental pain, muscle disorders and disc displacement, and chronic pain related to TMD. In the adjusted model, negative impact on OHRQoL was associated with all diagnoses related to TMD on the RDC/TMD, except signs of depression. Adolescents with at least one diagnosis related to TMD were 4.13-fold more likely (95% CI:1.08-15.80) to have negative impact on OHRQoL than adolescents without a diagnosis of TMD. The different diagnostic categories of TMD had a negative impact on the OHRQoL of the adolescents analyzed in the present study.
... Several reasons have been reported for failure to access dental services promptly and regularly. These are feelings that symptoms will resolve on its own, trying other medications, financial constraints, feelings of no dental problems, bad dental experience, fear of dental treatments, among others [20,21]. ...
Maintenance of good oral hygiene practice is the key to having a good oral health and invariably, an improved quality of life. Consecutive consenting medical practitioners attending the 2019 National Medical Association Annual General Meeting were recruited for this study. Data was analyzed using the Statistical Package for Social Sciences version 20.0 (IBM SPSS Statistics Armonk New York). One hundred and fifty-six participants were recruited. Ninety-four (60.3%) were male and 62(39.7%) females. Age ranged between 23 and 72 years with a mean age of 41.6±11.18 years. Almost all participants cleaned their teeth with toothbrush and fluoridated toothpaste. More males, more consultants and more participants in the federal hospital brushed their teeth twice daily and used medium bristled toothbrushes. Equal number of males and females used dental floss and interdental brushes. More consultants than all other cadre of participants and more participants in the federal hospital used dental floss (p=0.02). More participants in the federal hospital visited the dentist in the past (p=0.05); however, more males and more consultants did not have time to visit. Twice the participants with six to ten years of practice compared to those with more than fifteen years of practice did not access dental service because they felt they had no dental problem (p=0.248). The longer the year of medical practice, the better the oral hygiene practice. One out of every 5 participants regularly visit the dentists; a consultant will likely visit more regularly than other designated participants.
... "Limit the type of food" and "trouble biting/chewing" were the most frequently reported problems. These findings were similar to the study done by Sarah M. Osman et al. 7 Psychosocial impacts such as "limit contact with other", "worried", "nervous" and "medication for pain" were the least reported oral problems. Our result provides additional support to Locker's theoretical model of oral health, which indicates that social disability and handicap are least frequent. ...
... Studies have shown the importance of dental service utilization in improving oral health of older adults (Locker, 2001). Failure to engage in preventive dental care may lead to serious consequences such as tooth decay, tooth pain, tooth loss, and inflammation . ...
This study examines racial/ethnic disparities of dental service utilization for foreign-born and U.S.-born dentate residents aged 50 years and older. Generalized linear mixed-effects models (GLMM) were used to perform longitudinal analyses of five-wave data of dental service utilization from the Health and Retirement Study (HRS). We used stratified analyses for the foreign-born and U.S.-born and assessed the nonlinear trend in rates of dental service utilization for different racial/ethnic groups. Findings indicate that Whites had higher rates of service utilization than Blacks and Hispanics regardless of birthplace. For all groups, the rates of service utilization decreased around age 80, and the rates of decline for Whites were slower than others. The U.S.-born showed the trend of higher rates of service utilization than the foreign-born for all racial/ethnic groups. These findings suggest the importance of developing culturally competent programs to meet the dental needs of the increasingly diverse populations in the United States.
... Notably, only 27% of employees at baseline had visited a dentist within the last year, less than half the Australian national estimate of 59.3% (Spencer & Harford, 2007) and closer to estimates for other disadvantaged populations such as the homeless (Ford, Cramb, & Farah, 2014). The benefits suggested by dental treatment in this study further underline the importance of routine dental care for the subpopulation of people with special needs, as has been demonstrated in several studies for the general population (Crocombe, Brennan, & Slade, 2011) and older adults (Gagliardi, Slade, & Sanders, 2008;Locker, 2001). ...
This pilot study evaluated a dental intervention for employees with disabilities by measuring changes in self-rated oral health, dental behaviours and oral health-related quality of life (OHRQol). Consenting employees with disabilities (≥ 18 years) at two worksites in South Australia underwent dental examinations at baseline, three and six months. Referrals were arranged as needed to public dental clinics. At one and two months a dental hygienist provided group oral health education to the employees. Employees’ demographics, self-rated oral health, dental behaviours and OHRQol were collected via face-to-face interviews. Of the 39 referred employees, 28 (72%) of them completed the recommended treatment. Self-rated oral health improved and there were significant reductions in the prevalence of oral health impact on quality of life (percentage of employees reporting 1+ items fairly/very often) from 27% to 11% (McNemar’s test, p < 0.05); the extent of impact (mean number of items reported fairly/very often) from 1.3 to 0.6 and the severity of impact (mean of summed OHIP item scores) from 3.6 to 1.8 (paired t tests, p < 0.01). As this pilot study indicates that enabling urgent referral for treatment and regular oral health education can improve OHRQol and self-rated oral health among employees with disabilities, a larger study with a control group should be undertaken.
... OHRQoL has been defined as "a standard of the oral tissues which contributes to overall physical, psychological and social wellbeing by enabling individuals to eat, communicate and socialise without discomfort, embarrassment or distress and which enables them to fully participate in their chosen social roles" [21]. It seemed as if it should be relatively easy to determine the effects on children (and their families) of treatment under GA. ...
Early childhood caries (ECC) has negative psychosocial effects on children, with chronic pain, changed eating habits, disrupted sleep and altered growth very common, and it disrupts the day-to-day lives of their families. The treatment of young children with ECC places a considerable burden on health systems, with a considerable amount having to be provided under general anaesthesia (GA), which is resource-intensive. Justifying its use requires evidence of the efficacy of treatment in improving the lives of affected children and their families. This paper discusses the available evidence and then makes some suggestions for a research agenda.
... Previous studies have reported the relationship between oral function and healthy life expectancy (Nasu and Saito, 2006), and between masticatory ability and quality of life (Takata et al., 2006). Receiving dental preventive treatment at regular intervals is recognized to be effective in maintaining oral health (Locker, 2001), but the lower rate of regular utilization in Japan versus that in the USA and Europe has been a long-standing issue (Ikebe et al., 2002;McGrath et al., 1999). Within this context, the Healthy Japan 21 launched in 2000 to promote national health in the 21st century is attempting to promote regular dental service utilization as a national policy by targeting "a regular utilization of dental services rate of 30% or more" (Japan health promotion and fitness foundation, 2000). ...
There are numerous reports on the relationship between regular utilization of dental care services and oral health, but most are based on questionnaires and subjective evaluation. Few have objectively evaluated masticatory performance and its relationship to utilization of dental care services. The purpose of this study was to identify the effect of regular utilization of dental services on masticatory performance. The subjects consisted of 1804 general residents of Suita City, Osaka Prefecture (760 men and 1044 women, mean age 66.5 ± 7.9 years). Regular utilization of dental services and oral hygiene habits (frequency of toothbrushing and use of interdental aids) was surveyed, and periodontal status, occlusal support, and masticatory performance were measured. Masticatory performance was evaluated by a chewing test using gummy jelly. The correlation between age, sex, regular dental utilization, oral hygiene habits, periodontal status or occlusal support, and masticatory performance was analyzed using Spearman's correlation test and t-test. In addition, multiple linear regression analysis was carried out to investigate the relationship of regular dental utilization with masticatory performance after controlling for other factors. Masticatory performance was significantly correlated to age when using Spearman's correlation test, and to regular dental utilization, periodontal status, or occlusal support with t-test. Multiple linear regression analysis showed that regular utilization of dental services was significantly related to masticatory performance even after adjusting for age, sex, oral hygiene habits, periodontal status, and occlusal support (standardized partial regression coefficient β = 0.055). These findings suggested that the regular utilization of dental care services is an important factor influencing masticatory performance in a Japanese urban population.
... Elderly patients with uncontrolled diabetes or rheumatoid arthritis are at higher risk for periodontitis (5)(6)(7)(8)(9). It is beyond all doubts that oral health is essential for general health and contributes positively to quality of life (10)(11)(12)(13)(14)(15) and that the importance of oral health increases with age (16)(17)(18)(19). ...
Aim: This study explored possible disabling and enabling factors in order to develop and implement a structured oral hygiene protocol in nursing homes. Methods: Data were collected from a representative sample of residents (n=359) and health care workers (n=225) in 16 Belgian nursing homes selected by a technique of stratified random sampling based on number of residents and management. Oral hygiene and specific characteristics on individual patient level were assessed during a clinical examination and, on institutional level, in addition to the stratification variables, oral hygiene facilities, behaviour of the director, personnel behaviour and knowledge were assessed by a self-administered validated questionnaire. Main findings: The mean dental plaque index and the mean denture plaque index were 2.17 (maximum=3) and 2.13 (maximum=4) respectively. Significant positive correlations were found between the availability of oral hygiene facilities in an institution and personnel knowledge, supportive and directive behaviour of the directors, number of residents, mean age and degree of dependency of residents. Multiple regression analysis revealed personnel knowledge as the most predictive variable for the availability of oral hygiene facilities on institutional level. On an individual level, degree of dependency was the only significant determinant for the presence of dental plaque (adjusted OR: 3.09). The only significant explanatory variable for denture plaque was the management of the institution with better denture cleanliness for residents in commercial institutions (adjusted OR: 0.43). Principal conclusions: After controlling for potential confounders, primary enabling factors affecting the implementation of an oral hygiene protocol were good personnel knowledge, the type of management of the institution and the supportive and directive behaviour of the board of directors. Potentially disabling factors were high degree of dependency of the residents, high mean age of the residents and a high proportion of dentate residents.
... Ouderen met functionele beperkingen die hulp krijgen bij hun mondhygiëne ervaren dat ze nog steeds 'zorgwaardig' zijn. Dit verhoogt -door zich verzorgd te voelen en er verzorgd uit te zien -het gevoel van eigenwaarde en waardigheid en komt direct ten goede aan de levenskwaliteit, terwijl de ervaren gezondheidsvoordelen van preventieve of zelfs restauratieve tandheelkundige behandelingen niet altijd duidelijk zijn (Locker, 2001). ...
In order to explore how the level of frailty and various frailty factors affect the dental service use and oral self-care behaviour of frail elderly people, 51 frail elderly people were interviewed. Additional information on age, gender, living situation, prosthetic status, self-reported health and oral health, chronic diseases and an index for frailty was collected. A thematic qualitative analysis of the collected data reveals that frail elders maintain long-established oral hygiene routines as long as possible to sustain a sense of self-worth. When burdened by severe health complaints they discontinue visits to the dentist first and oral hygiene routines subsequently. A loss of confidence in the results of dental service use, the trivializing of complaints and a diminishing sense of the importance of oral health play a role in these developments. Frail elderly people also experience psychological and social barriers to oral healthcare and dental service use when they are institutionalized.
... Ouderen met functionele beperkingen die hulp krijgen bij hun mondhygiëne ervaren dat ze nog steeds 'zorgwaardig' zijn. Dit verhoogt -door zich verzorgd te voelen en er verzorgd uit te zien -het gevoel van eigenwaarde en waardigheid en komt direct ten goede aan de levenskwaliteit, terwijl de ervaren gezondheidsvoordelen van preventieve of zelfs restauratieve tandheelkundige behandelingen niet altijd duidelijk zijn (Locker, 2001). Vanuit het perspectief van de patiënt kunnen financiële middelen effectiever worden gebruikt voor ondersteuning bij preventieve behandelingen, waaronder dagelijkse mondhygiëne, dan voor tandheelkundige restauratieve behandelingen, tenzij deze worden aangewend ter verlichting van ervaren pijn of ongemak of het behoud/herstel van functie. ...
In order to explore how the level of frailty and various frailty factors affect the dental service use and oral self-care behaviour of frail elderly people, 51 frail elderly people were interviewed. Additional information on age, gender, living situation, prosthetic status, self-reported health and oral health, chronic diseases and an index for frailty was collected. A thematic qualitative analysis of the collected data reveals that frail elders maintain long-established oral hygiene routines as long as possible to sustain a sense of self-worth. When burdened by severe health complaints they discontinue visits to the dentist first and oral hygiene routines subsequently. A loss of confidence in the results of dental service use, the trivializing of complaints and a diminishing sense of the importance of oral health play a role in these developments. Frail elderly people also experience psychological and social barriers to oral healthcare and dental service use when they are institutionalized. Publisher: Abstract available from the publisher. dut
... The aims of this study were to assess dental attendance of this patient group and attempt to identify associated clinical characteristics. Routine dental attendance has been associated with better oral health 18 and various studies have demonstrated that oral health-related quality of life (OHRQOL) improves with routine dental attendance although these have focused mainly on the elderly population [19][20][21] . A more recent study suggests that improvement of OHRQOL due to regular dental attendance is mainly influenced by residential location rather than patient factors possibly reflecting the local dental services as well as local patient concepts of dental care 22 . ...
Head and neck cancer (HNC) patients face complex oral health issues following treatment. The aims of this study were to determine the proportion of HNC patients attending their dentist regularly and investigate clinicodemographic characteristics associated with attendance. Two surveys asked about patient attendance patterns and dentition. Pre-treatment orthopantomographs were evaluated for those treated between 2007-2009. The response rate was 66% (444/672). 69% (305/444) saw a high street dentist regularly. 28% of edentulous patients attended regularly compared with 84% with natural teeth, p < 0.001. Associations at p < 0.001 with regular attendance were the leaving of formal education (> 16 years) and earlier clinical staging. HNC patients should be encouraged to see a dentist regularly for routine dental care and cancer surveillance in partnership with the cancer service.
... A importância dos indicadores subjetivos tem sido demonstrada em várias pesquisas, fornecendo informação para a formulação de políticas de saúde e avaliação de serviços, considerando a percepção das pessoas sobre os impactos provocados por condições bucais. A oferta de tratamento odontológico abrangente é capaz de eliminar tais impactos, gerando melhoria na QV dos usuários 19 . A efetividade do tratamento odontológico para a melhora da QV foi demonstrada em Viana (ES), utilizando-se o OHIP 14, onde usuários declararam redução de impactos quando tiveram seus tratamentos odontológicos concluídos 13 . ...
... These findings support results from longitudinal research demonstrating that routine dental attendance results in better oral health outcomes, including fewer missing teeth [12,13], fewer decayed teeth [12,13], lower overall DMFS (decayed, missing, and filled surfaces) scores [12,13], better oral health-related quality of life [13-17] and better self-reported oral health [13,16]. Within the limitations of a cross-sectional study, and based on previous longitudinal findings, we can infer that once financial barriers are removed, the oral health of Canadians reporting cost barriers to care have the potential to improve. ...
Background
Prior to the 2007/09 Canadian Health Measures Survey, there was no nationally representative clinical data on the oral health of Canadians experiencing cost barriers to dental care. The aim of this study was to determine the oral health status and dental treatment needs of Canadians reporting cost barriers to dental care.
Methods
A secondary data analysis of the 2007/09 Canadian Health Measures Survey was undertaken using a sample of 5,586 Canadians aged 6 to 79. Chi square tests were conducted to test the association between reporting cost barriers to care and oral health outcomes. Logistic regressions were conducted to identify predictors of reporting cost barriers.
Results
Individuals who reported cost barriers to dental care had poorer oral health and more treatment needs compared to their counterparts.
Conclusions
Avoiding dental care and/or foregoing recommended treatment because of cost may contribute to poor oral health. This study substantiates the potential likelihood of progressive dental problems caused by an inability to treat existing conditions due to financial barriers.
... [3][4][5][6][7] Improved oral health has been known to be correlated with better access to dental care. 8,9 Different reports indicated that the incidence of gingival inflammation among pregnant women is significantly higher than non-pregnant women. [10][11][12] These gingival changes are, however, limited and reversible if adequate oral hygiene is maintained. ...
Objectives
To determine the access of dental care among a sample of pregnant women in Riyadh, Saudi Arabia and identify possible barriers for dental care during pregnancy.
Methods
The target population in this cross-sectional study was female patients attending one private and two governmental hospitals in Riyadh, Saudi Arabia. The age range for these patients was limited to child bearing age (18–48 years old). The pregnant women were identified in obstetric and gynecology clinics. The control group of non-pregnant women was identified in dermatology clinics. A self-administered questionnaire was developed to assess the pattern of dental service utilization and attitude toward dental treatment during pregnancy. Personal information such as age, education, employment and number of live births were also collected.
Results
A total of 959 properly filled questionnaires out of 1176 (71% response rate) were used in the analysis. The mean age of the sampled subjects was 29.6 (±7.0) years. Only 22% of the sampled pregnant women indicated that they visited their dentists during their current pregnancy. Seventy-two percent of the sampled pregnant women indicated that they have experienced at least one dental problem that might need a dental intervention during their current pregnancy. The likelihood of visiting a dentist during pregnancy for pregnant women who visited the dentist before pregnancy was 20.4 times more compared to pregnant women who did not visit the dentist before pregnancy (N = 510, OR = 20.4, 95% CI [11.9, 34.5]). A lack of knowledge of the importance and safety of dental treatment during pregnancy was reported by the majority of sampled women to be significant barriers for dental care during pregnancy.
Conclusions
The majority of the sampled pregnant women did not visit the dentist during pregnancy and had major misconceptions about the need for and/or the safety of dental treatment during pregnancy.
... This directly improves their quality of life, whereas the perceived health benefits of preventive or even restorative dental visits are not always obvious. Such benefits could not be established in a longitudinal study by Locker [63]. ...
Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people.
We conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers.
Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports.
The level and type of frailty influences people's perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures aimed at recognizing indicators for poor oral care behavior, and providing appropriate information and support, are discussed.
... • Among older adults in Ontario high-income individuals made more visits and received an average of 26% more services than low-income individuals 33 . ...
... A solução para a alta prevalência de impactos dos problemas associados à saúde bucal relacionada com a qualidade de vida está certamente ligada ao acesso a tratamento odontológico abrangente, incluindo tratamento especializado, para pessoas com alta prevalência de necessidades clínicas e percebidas, especialmente para grupos com contexto socioeconômico desfavorável, para os quais o custo do tratamento configura-se como a principal barreira 10 . ...
... Slechts weinigen twijfelen er nog aan dat een goede mondgezondheid invloed heeft op de algemene gezondheid en positief bijdraagt aan de levenskwaliteit. [1][2][3][4] Een goede mondgezondheid is ook voor ouderen van eminent belang. [5][6][7] Door een betere zelfzorg van de jongere generaties van de bevolking en een toename van de kwaliteit van de mondzorg in de afgelopen decennia is het percentage ouderen met natuurlijke gebitselementen gestegen en dit percentage zal in de komende jaren verder stijgen. ...
The oral health status of residents in Dutch nursing homes is rather poor, especially of those depending on caregivers for their oral health care. Moreover, when care dependency is rising, the provision of good oral health care becomes more difficult. With more elderly people still having (parts of) their natural teeth, the need for good oral health care is increasing even more.Therefore a specific guideline was developed. The ultimate aim of the guideline “Oral health care for dependent residents in long term care facilities” is to improve the oral health of nursing home residents. Oral health care needs to be incorporated in daily nursing home care routine and in the integral care plan of every resident. Attention is given to the importance of an adequate implementation of this guideline as well as to the necessity of research evaluating the effects of it’s implementation.
... However, if not carefully organized and implemented, these policies might be at risk of benefiting those in a high SEP and thus further increasing health inequality in the society concerned (3). The health of populations improves in an equitable way only when there is a fair distribution of oral health services and these are equally utilized by all individuals with similar health needs from different strata of society (4,5). However, central to this equation is the need for evidence of reasons for accessing available services by different strata of the society, especially in low and middle income countries where the expansion of health-care systems and provision of universal health coverage are key to the current international policy agenda (6). ...
Objective:
To test the relationship between socioeconomic position (SEP), family composition, number of siblings, and birth position in the family, and the utilization of oral health services by senior secondary school pupils in Ile-Ife, Nigeria.
Methods:
A cross-sectional study design included senior secondary school pupils in the Central Local Government Area of Ile-Ife during 2007/2008. Sample size calculation was performed and 1,200 pupils were invited to participate. A multistage, stratified sampling technique was used. Data collection included a self-administered questionnaire. Data were analyzed using logistic regression.
Results:
The response rate was 76 percent (n=1043). The mean age was 15.8 (standard deviation=1.9) and 49 percent were males. Only 22.5 percent of pupils had ever visited a dentist in their lives. Results from multivariate analyses showed that pupils attending free schools, those paying 1 to 10,000 naira (equivalent to US 120.29) were respectively 1.93, 1.87, and 2.74 times less likely to have attended a dentist in the past than pupils in more expensive schools. Pupils living with single mothers or without a parent were unlikely to have visited the dentist. Number of siblings and birth position in the family were not associated with utilization of oral health services.
Conclusions:
Adolescents from families with a low SEP growing up without their parents may need extra incentives to visit dentist.
... Both type and number of reported oral symptoms discriminated between patients with and without oral impacts (OIDP > 0). Dental attendance was one of the strongest predictors of oral impact in this study.The association between dental attendance and improved oral health has been widely documented [42]. However, in this study, dental attendance was associated with deteriorated OHRQoL.That pattern might reflect perceived treatment need among the study population [43]. ...
There are only few studies considering the impact of oral mucosal lesions (OML) on the oral quality of life of patients with different dermatological conditions. This study aimed to assess the relationship between oral health-related quality of life (OHRQoL) and OML and reported oral symptoms, perceived general and oral health condition and caries experience in adult skin diseased patients attending an outpatient dermatologic clinic in Sudan.
A cross-sectional survey was carried out with 544 diagnosed skin diseased patients (mean age 37.1 years, 50 % females), during the period October 2008 to January 2009. The patients were orally examined and OML and caries experience was recorded. The patients were interviewed using the Sudanese Arabic version of the OIDP. OHRQoL was evaluated by socio-demographic and clinical correlates according to number of types of OML diagnosed (no OML, one type of OML, > one type of OML) and number and types of oral symptoms.
An oral impact (OIDP > 0) was reported by 190 patients (35.6 %) (mean OIDP total score 11.6, sd = 6.7). The prevalence of any oral impact was 30.5 %, 36.7 % and 44.1 %, in patients with no OML, one type of OML and more than one type of OML, respectively. Number of types of OML and number and types of oral symptoms were consistently associated with the OIDP scores. Patients who reported bad oral health, patients with ≥ 1 dental attendance, patients with > 1 type of OML, and patients with ≥ 1 type of oral symptoms were more likely than their counterparts in the opposite groups to report any OIDP. The odds ratios (OR) were respectively; 2.9 (95 % CI 1.9-4.5), 2.3 (95 % CI 1.5-3.5), 1.8 (95 % CI 1.1-3.2) and 6.7 (95 % CI 2.6-17.5). Vesiculobullous and ulcerative lesions of OML disease groups associated statistically significantly with OIDP.
OIDP was more frequently affected among skin diseased patients with than without OML. The frequency of the impacts differed according to the number of type of OML, oral symptoms, and OML disease groups. Dentists and dermatologists should pay special attention to skin diseased patients because they are likely to experience oral impacts on daily performances.
Objective
To investigate the association of demographic and socio‐economic characteristics with self‐reported oral health (SROH) among older adults who participated in the Health and Retirement Study (HRS) in 2008, 2018, or both, and to describe temporal changes.
Methods
Data were from the University of Michigan's Health and Retirement Study (HRS), a nationally representative longitudinal survey of Americans aged 51 and older. Responses from participants who completed the Core HRS survey and Dental Module (DM) in 2008 (n = 1310), 2018 (n = 1330), and the “common group” at both timepoints (n = 559) were analysed. Using the common group, the outcome measure was 2018 self‐rated oral health (Favourable vs Unfavourable). Potential explanatory variables included 2008 self‐rated oral health (SROH), sociodemographic, and dental utilisation‐related factors. Survey logistic regression analysis was used to identify factors that were associated with unfavourable 2018 SROH in 2018.
Results
Unfavourable SROH prevalence was 28.5% and 31.6% in 2008 and 2018, respectively. Among the common, longitudinal group, the unfavourable prevalence remained the same, 26.1% at both timepoints. A positive association was seen between 2018 unfavourable SROH and baseline variables of 2008 unfavourable SROH, male gender, less education, and lower levels of wealth.
Conclusions
Over a quarter of participants reported unfavourable SROH. There was little change in SROH during this period. Sociodemographic factors influence the SROH of the older population. Policies and programs to promote and protect the oral health of older adults should be designed and implemented to reduce social inequalities and improve the SROH of disadvantaged older adults.
The study aimed to investigate the relationship between smoking, Sugar-Sweetened Beverage (SSB) consumption and tooth brushing among adolescents in China. A valid sample of 6084 middle school students from the Zhejiang province was included. Participants were questioned about smoking status, SSB consumption, tooth brushing, and oral health-related quality of life (OHRQoL). Among the participants, smoking prevalence was 1.9% and nearly half of the students consumed SSBs. The demographic factors associated with smoking were gender, place of residence, and parental level of education. There are co-variations between smoking status, SSB consumption, and tooth brushing. Logistic regression showed that smoking adolescents were more likely to brush their teeth less than once per day (OR = 1.74, p < 0.05), consume soft drinks once or more per day (OR = 2.18, p < 0.01) and have a higher score on the Child Oral Health Impact Profile (OR = 1.05, p < 0.05) after adjusting for demographic factors. The findings provide compelling evidence for governments and related stakeholders to intervene in the lifestyle of adolescents. Future studies are needed to understand the interaction effects of such behaviors, and should help to inform appropriate interventions.
Objective: To assess the self-perception of adolescents in conflict with the law about their concern with oral health, in addition to tracing their relationship with other related variables. Methods: A cross-sectional study involving male institutionalized adolescents in a city in southern Brazil who underwent clinical examination and interviews to understand their concern for their oral health and the relationship between this outcome and associated factors. Concern about oral health was obtained through a validated questionnaire. Two fitted models were performed using Poisson regression (α < 0.05). One of them used the decayed, missing, and filled teeth index (DMF-D), and another considered the components of this index as exploratory variables. Results: Sixty-eight adolescents were included, and a high occurrence (75%) of concern about their oral health was observed. In the final multivariate analysis that included DMFT, this index (prevalence ratio [PR]: 1.033; 95% confidence interval [95%CI]: 1.004 – 1.063) and concern about tooth color (PR: 2.208; 95%CI: 1.028 – 4.740) were significantly associated with oral health concerns. When the various index components were included in the multivariate model, only the number of decayed teeth (PR: 1.073; 95%CI: 1.007 – 1.144) and concerns about tooth color (PR: 2.250; 95%CI: 1.057 – 4.793) were associated with the outcome. Conclusion: Institutionalized adolescents are highly concerned about their oral health, being associated with a DMF index, especially the decayed component, and a concern with the color of their teeth.
Introduction:
An increasing percentage of the world's population has had access to orthodontic treatment within the last few decades. Consequently, a larger number of patients seeking for correction of their malocclusions, nowadays, present with a history of previous orthodontic therapy. Orthodontists performing retreatments in their practice may have to face additional difficulties, and one of them is treating individuals that may be even more demanding for excellent results and efficient treatments.
Objectives:
This manuscript discusses the challenges faced when performing orthodontic retreatments. It illustrates a two-phase retreatment of a pre-adolescent and the ortho-surgical retreatment of a young adult with high demands for fast and exceptional results. Finally, this paper elaborates on the positive impacts that these retreatments had on the patients' self-esteem and quality of life.
Yaşam kalitesi kişinin kendini sosyal, psikolojik ve fizyolojik olarak iyi hissetme halidir. Kişinin fiziksel sağlığından, psikolojik durumundan, sosyal ilişkilerinden ve çevrenin sosyal özelliklerinden etkilenir. Sağlık alanında verilen hizmetlerin değerlendirilmesinde yaşam kalitesi üzerine yapılan araştırmalar önem kazanmaktadır. Hastalık durumunun ve hastalık tedavilerinin birey üzerindeki etkileri sağlık protokollerinin düzenlenmesinde rol oynar. Ağız sağlığı da genel sağlığın ayrılmaz bir parçasıdır. Diş çürüğü, travma ve maloklüzyon gibi oral problemlere çocukluk döneminde rastlanırken adölesan ve yetişkinlik döneminde de etkileri devam edebilmektedir. Ağız sağlığının kötü olmasına bağlı olarak çocuklarda ve adölesanlarda estetik kaygı, konuşma bozuklukları ile birlikte yaşanan ağrıya bağlı olarak uyku, yemek yeme problemleri ve konsantrasyonda zorluk görülmektedir. Ağız sağlığının iyi olması, bireyin günlük aktivitelerini rahatlıkla idame ettirebilmesine katkıda bulunur, bununla birlikte topluma yaratıcı bir şekilde katkıda bulunması konusunda motive olmasına yardımcı olur. Ağız sağlığına bağlı yaşam kalitesinin değerlendirilmesinde çok sayıda ölçek kullanılmaktadır. Bu derlemenin amacı çocuk ve adölesanlarda ağız sağlığına bağlı yaşam kalitesini ve ağız sağlığına bağlı yaşam kalitesini değerlendirmede kullanılan ölçekleri değerlendirerek bir araya getirmektir.
Dental health services research builds on the general field of health services research. Health services research has been expressed as an examination of the question ‘so what actually happens?’ This is the examination of the outcomes of dental public health activity and, in particular, oral health. Examples of key issues in dental health services research include the scientific basis for dental recall intervals and questions around the appropriateness of care. Structure, process and outcome have been used as a framework to evaluate the quality of healthcare. Effectiveness, efficiency and equity are intermediate healthcare outcomes linked to the health of individuals and communities. The dental care process model features the notion of an episode of dental care that reflects the delivery of dental services within visits, and potentially multiple visits comprising a course of care that reflects the diagnosis and treatment plan. Much of dental health services research is directed at studies of dental visiting typically focused on access to dental care or on number of dental visits utilised. While much of dental health services research has focused on dental visits in terms of access, studies that look at the types of services provided give a fuller picture of what actually happens during a dental visit or series of visits that make up an episode of dental care. This chapter defines dental health services research, outlines conceptual models of health services and describes applications of dental health services research with a focus on dental visits and service provision.
Valoración de factores biopsicosociales determinantes del riesgo de desnutrición en los adultos mayores en hogares de ancianos* Evaluation of biopsychosocial factors in determining of risk malnutrition in the elderly in nursing homes Riveros Ríos M Cátedra de Medicina Familiar. Facultad de Ciencias Médicas. Facultad de Ciencias Médicas. Universidad Nacional de Asunción. * Tesis presentada en la Facultad de Ciencias Médicas. Universidad Nacional de Asunción, para el escalafón docente de la Cátedra de Medicina Familiar. RESUMEN Introducción: El estado nutricional adecuado, entre otros factores, es un aspecto de importancia para la conservación de la autonomía funcional de los adultos mayores. Objetivos: determinar los factores biopsicosociales asociados en el adulto mayor que conllevan al riesgo de desnutrición (RD). Paciente y Métodos: Estudio observacional descriptivo, corte transversal con componente analítico, incluyo a 124 adultos mayores de ambos sexos que viven en Hogares de la ciudad de Asunción-Paraguay. Muestreo: No probabilístico por conveniencia. Variables analizadas: Riesgo de desnutrición (RD), Comorbilidad, depresión, Salud bucal, Función mental, Capacidad funcional, Medicación con afección nutricional y para el dolor. Resultados: Se encontro RD en un 50% de los varones, y 42% de las mujeres Por orden de prevalencia, patologías asociadas: Cardiopatías 55%, HTA 45%, artrosis 40%, DM tipo 1 32%, EPOC y ACV 12% respectivamente, Parkinson 10% e IRC 2% En un 64% de las mujeres y 75% de los varones una salud bucal no satisfactoria. Presentaron en 42% depresion moderada y en 20% depresion severa,Presencia de deterioro cognitivo severo en 8%, moderado 20% y leve 6%, En un 16% con dependencia para todas las actividades y solo en 15% independencia en todas las ABVD.Farmacos 58% de antiácidos, 37% laxantes, 15% de antidepresivos tricíclicos. Solo el 12% presentaba manejo farmacológico para el dolor. Conclusión: La mitad de los pacientes presentaban RD, estos presentaban mayor prevalencia de salud bucal no satisfactoria, dependencia de las ABVD, uso de fármacos con alteración del gusto y menor uso de fármacos para el dolor. Palabras clave: adulto mayor, RD (riesgo de desnutrición), AVBD (actividades básicas de la vida diaria). ABSTRACT Introduction: adequate nutritional status, among other factors, is an important aspect for preserving the functional autonomy of the elderly. Objectives: To determine biopsychosocial factors associated in the elderly that lead malnutrition risk (MR). Patient and Methods: Observational, cross-cutting analytical component study, included 124 elderly men and women living in households in the city of Asuncion Paraguay. Sampling: No probabilistic for convenience. Variables analyzed: malnutrition risk (MR), comorbidity, depression, oral health, mental function, functional capacity with nutritional condition and medication for pain. Results: MR was found in 50% of men and 42% of women. In order of prevalence, associated diseases: Heart disease 55%, hypertension 45%, arthritis 40%, type 1-DM 32%, COPD and stroke 12% each one, Parkinson 10%, CRI 2%. 64% of women and 75% of men have unsatisfactory oral health. 42% had moderate depression and 20% severe depression, Presence of severe cognitive impairment in 8%, moderate 20% and slight 6%, 16% depend for all activities and only 15% independent. Medication: 58% of antacids, laxatives 37%, tricyclic antidepressants 15%. Only 12% had drug for pain management. Conclusion: Half of the patients had MR these had a higher prevalence of unsatisfactory oral health, BADL dependence, use of drugs with altered taste and less use of pain medications.
This article describes child oral health–related quality of life measures and provides some examples of their use in determining the effect of clinical interventions, such as dental treatment under general anesthesia, orthodontic treatment, and treatment of orofacial clefting.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of interventions aimed at improving adults’ use of primary dental care services in order to improve their oral health and quality of life.
Background: The periodontitis are infections associated with pathogenic microorganisms and host response alterations. The psychosocial stress and inadequate coping behaviours to it may exert immunosuppressive effects, increasing susceptibility to periodontitis. The aim was to research the association between psychosocial stress, coping behaviours and smoking with periodontal condition. Methods: One hundred and sixty six voluntary subjects were recruited of both sexes, with healthy systemic conditions, between 25-65 years of age (41,2±11,3), that go to the Dentistry Branch of National University of Cuyo. For stress and coping behaviors assessment tests were applicated: Social Readjustment Rating Scale (SRRS), Stress Symptom Inventory (SSI), coping behaviours questionnaire COPE. Levels of salivary cortisol were determined and smoking habits were evaluated. The examinations of the periodontal condition were: probing pocket depth, attachment level, gingival and plaque index. The statistical survey included: bivariated and multivariated logistic regression, X 2 test; ANOVA. Results: The obtained results demonstrate significative association by bivariate analysis: age and periodontal condition (p
Introduction: adequate nutritional status, among other factors, is an important aspect for preserving the functional autonomy of the elderly. Objectives: To determine biopsychosocial factors associated in the elderly that lead malnutrition risk (MR). Patient and Methods: Observational, cross-cutting analytical component study, included 124 elderly men and women living in households in the city of Asuncion Paraguay. Sampling: No probabilistic for convenience. Variables analyzed: malnutrition risk (MR), comorbidity, depression, oral health, mental function, functional capacity with nutritional condition and medication for pain. Results: MR was found in 50% of men and 42% of women. In order of prevalence, associated diseases: Heart disease 55%, hypertension 45%, arthritis 40%, type 1-DM 32%, COPD and stroke 12% each one, Parkinson 10%, CRI 2%. 64% of women and 75% of men have unsatisfactory oral health. 42% had moderate depression and 20% severe depression, Presence of severe cognitive impairment in 8%, moderate 20% and slight 6%, 16% depend for all activities and only 15% independent. Medication: 58% of antacids, laxatives 37%, tricyclic antidepressants 15%. Only 12% had drug for pain management. Conclusion: Half of the patients had MR these had a higher prevalence of unsatisfactory oral health, BADL dependence, use of drugs with altered taste and less use of pain medications. Key Words: elderly, MR (malnutrition risk), BADL (basic activities of daily living).
Objective. To assess oral and nutritional condition in nursing home residents and their relationships looking for the potential role of a dental hygienist in the nursing home at least as consultant. Methods. Seventy residents (50 F, 20 M) of a nursing home in Nomi (Prov. Trento) were randomly selected and assessed for malnutrition with Mini Nutritional Assessment; they were divided into three groups as far as their oral conditions were concerned: residents with own teeth (Group A), resident edentules without dentures (Group B), edentules with dentures (Group C). Results. 27.1% were malnourished, 55.7% at nutritional risk and 17.1% well nourished. Group A (natural teeth) consisted of 25 people, Group B (edentules without dentures) of 14, Group C (edentules with dentures) of 21. In group A teeth were 6.04 ± 6.17, of whom just 0.7 ± 3.4 normal with a % of plaque and tartar respectively 72.7 ± 16.7 and 74.3 ± 15.7%. In group B DFMT was obvioulsy 28 ± 0. In group C there was no partial denture, but in 12% there was a superior denture, in 80% there was a complete denture, just in 6% an inferior denture. In 70% of residents denture was not fit and often used just at meals. People wearing dentures showed % of plaque and tartar respectively 71.6 ± 17.4 and 63.3 ± 17.2%. Conclusions. Oral and nutritional conditions in nursing homes residents are not reassuring; even though it is out of doubt that teeth not proper make feeding much difficult, it was not possibile to show a relationship between bad dentition and malnutrition. The importance of a registred dental hygienist is stressed within a nursing home together with its unvaluable role in monitoring oral condition starting from admission in the setting with at least an annual planned revaluation.
Objective:
To determine if an oral health-related quality of life (OHRQoL) social gradient existed when Australian Defence Force (ADF) members have universal and optimal access to dental care.
Methods:
A nominal roll included 4,089 individuals who were deployed to the Solomon Islands (SI) as part of operation ANODE and a comparison group of 4,092 ADF personnel frequency matched to the deployed group on sex, age group, and service type, from which 500 deployed and 500 comparison individuals were randomly selected. The dependent variables were the OHIP-14 summary measures. Rank was used to determine socioeconomic status. The demographic variables selected were: sex and age.
Results:
Response rate was 44%. Of the individual OHIP-14 items, being self-conscious, painful aching and having discomfort when eating were the most common problems. Mean OHIP-14 severity was 2.8. In bivariate analysis, there was not a significant difference in mean OHIP-14 severity (p=0.52) or frequency of OHIP-14 impacts (p=0.57) by military rank. There was a significant increasing OHIP-14 extent score from commissioned officer to non-commissioned officer to other ranks (0.07, 0.19, 0.40, p=0.03).
Conclusion:
Even with optimal access to dental care, there was an OHRQoL social gradient between military ranks in the ADF. This article is protected by copyright. All rights reserved.
The aim of this study was to evaluate the current status of dental geriatric education in Korea.
ObjectivesA cross-sectional study was carried out to investigate the determinants of self-rated oral health among community-dwelling older people in Japan.Methods
The participants were 897 (357 men and 540 women) aged 65 years and over who participated in a comprehensive geriatric health examination, which included an oral examination, a face-to-face interview assessing cognitive function, questionnaires regarding depressive symptoms and functional capacity, and a medical examination. The oral examination measured indices of oral health status: number of present teeth, number of functional teeth, occlusal force and amount of resting saliva. Multiple logistic regression analyses were carried out to determine the factors associated with poor self-rated oral health.ResultsThe mean age of the participants was 73.5 ± 5.0 years. The prevalence of poor and rather poor self-rated oral health was 11.5% and 29.5%, respectively. Multiple logistic regression analyses showed that the number of present teeth (odds ratio [OR] 0.97, 95% confidence intervals [CI] 0.95–0.99), difficulty in mastication (OR 3.20, CI 2.18–4.70), presence of xerostomia (OR 1.43, CI 1.02–2.01), total score on the MoCA-J (OR 1.06, CI 1.01–1.11), and reduction in frequency of leaving the house (OR 1.64, CI 1.12–2.41) were significantly associated with poor self-rated oral health.Conclusions
The present results suggested that self-rated oral health was a significant factor in oral health status as well as overall well-being among community-dwelling older Japanese people. Geriatr Gerontol Int 2014; ●●: ●●–●●.
The aim of this study was to determine if Australian Defence Force (ADF) members had better oral health-related quality of life (OHRQoL) than the general Australian population and whether the difference was due to better access to dental care.
The OHRQoL, as measured by OHIP-14 summary indicators, of participants from the Defence Deployed Solomon Islands (SI) Health Study and the National Survey of Adult Oral Health 2004–06 (NSAOH) were compared. The SI sample was age/gender status-adjusted to match that of the NSAOH sample which was age/gender/regional location weighted to that of the Australian population.
NSAOH respondents with good access to dental care had lower OHIP-14 summary measures [frequency of impacts 8.5% (95% CI = 5.4, 11.6), extent mean = 0.16 (0.11, 0.22), severity mean = 5.0 (4.4, 5.6)] than the total NSAOH sample [frequency 18.6 (16.6, 20.7); extent 0.52 (0.44, 0.59); severity 7.6 (7.1, 8.1)]. The NSAOH respondents with both good access to dental care and self-reported good general health did not have as low OHIP-14 summary scores as in the SI sample [frequency 2.6 (1.2, 5.4), extent 0.05 (0.01, 0.10); severity 2.6 (1.9, 3.4)].
ADF members had better OHRQoL than the general Australian population, even those with good access to dental care and self-reported good general health.
This study investigated the frequency of Iowa dentists' provision of in-office and out-of-office dental care for people who are homebound, as well as comparing the practice and educational characteristics among dentists who did and did not provide care for patients who were homebound. The authors mailed a survey form to all licensed dentists on the Iowa State Health Professional license database (n = 1,168), excluding pediatric dentists and orthodontists. A second mailing was sent to all nonrespondents four months later, resulting in 638 returned forms for a 54.6% response rate. The questionnaire included two outcome responses associated with the treatment in the dentist's office or in the patient's home for patients who are homebound. About 40% of Iowa dentists reported providing care in the office to patients who are homebound, but care outside of the office was provided by fewer dentists (6%) who had more years of practice experience. These results suggest an increased sense of professional or community responsibility among these older Iowa dentists. Education efforts may increase homebound care and more involvement of younger dentists.
To investigate change in oral health in relation to use of dental services, a random sample of 45- to 54-yr-old subjects from Adelaide, South Australia, was surveyed in 2004-2005 (n = 986, response rate = 44.4%). Service use and a global oral-health transition (GOHT) statement were collected over 2 yr. Worsening in oral health was reported from the GOHT statement by 25% of persons, while improvement was reported by 30%. Prevalence ratios (PRs, 95% CI), adjusted for sex, education, health card status, and toothbrushing, showed that worsening oral health was inversely associated with dental visiting (PR = 0.5, 0.4-0.7) and with scaling and cleaning services (PR = 0.6, 0.4-0.9), whereas extractions (PR = 2.3, 1.6-3.4) and dentures (PR = 2.2, 1.3-3.7) were associated with a higher prevalence of worsening. Scaling and cleaning services were associated with improvement in oral health (PR = 1.5, 1.01-2.3), while endodontic services were inversely associated with improvement (PR = 0.3, 0.1-0.9). Worsening in oral health was associated with extractions and dentures and was inversely associated with visiting and preventive care. Improvement in oral health was associated with preventive care and was inversely associated with endodontic treatment.
Objectives:
To find an association between self-reported change in oral health and dental treatment volume.
Methods:
Baseline data were obtained from the Tasmanian component of the National Survey of Adult Oral Health 2004-06 and 12-month follow-up data from service use logbooks and mail self-complete questionnaires. The global oral health transition statement indicated change in oral health. Many putative confounders were analyzed and Poisson regression with robust variance estimation was used to calculate the prevalence ratios and 95 percent confidence intervals for bivariate- and multivariate-adjusted relationships.
Results:
One-eighth (12.4 percent) of the participants reported that their oral health had improved. Over half visited a dentist (n=176, 52.6 percent), of whom 105 received less than six dental services and 71 received six or more dental services. Baseline oral disease (P=0.01), having a treatment need (P<0.01), usually visiting a dentist for a problem (P<0.05), and having a lot of difficulty paying a $100 dental bill (P=0.01) were significantly associated with the same or worsening oral health. The regression model indicated that having six or more dental services (P<0.01) was significantly associated with improvement in oral health, indicating a threshold effect. Usually visiting a dentist for a check-up was significantly associated with improvement in oral health (P<0.01).
Conclusion:
Having six or more dental services was significantly associated with a greater self-reported improvement in oral health than having less than six dental services. The greater prevalence ratios with increasing dental service volume suggested a threshold effect.
To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel-Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as “good,”“very good” or “excellent” by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting “good,”“very good” or “excellent” oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.
We identified factors associated with retention in oral health care for people living with HIV/AIDS (PLWHA) and the impact of care retention on oral health-related outcomes.
We collected interview, laboratory value, clinic visit, and service utilization data from 1,237 HIV-positive patients entering dental care from May 2007 to August 2009, with at least an 18-month observation period. Retention in care was defined as two or more dental visits at least 12 months apart. We conducted multivariate regression using generalized estimating equations to explore factors associated with retention in care.
In multivariate analysis, patients who received oral health education were 5.91 times as likely (95% confidence interval 3.73, 9.39) as those who did not receive this education to be retained in oral health care. Other factors associated with care retention included older age, taking antiretroviral medications, better physical health status, and having had a dental visit in the past two years. Patients retained in care were more likely to complete their treatment plans and attend a recall visit. Those retained in care experienced fewer oral health symptoms and less pain, and better overall health of teeth and gums.
Retention in oral health care was associated with positive oral health outcomes for this sample of PLWHA. The strongest predictor of retention was the receipt of oral health education, suggesting that training in oral health education is an important factor when considering competencies for new dental professionals, and that patient education is central to the development of dental homes, which are designed to engage and retain people in oral health care over the long term.
Knowledge of the effect of dental care and dental visiting behavior on oral health impacts is important for effective resource allocation.
To determine the association between dental care, including the reason for dental attendance and time since last dental visit, with perceived oral health impacts among Australian adults.
Data were obtained from the Australian National Survey of Adult Oral Health 2004/06. Analysis was limited to 4,170 dentate adults who answered the Oral Health Impact Profile (OHIP-14) questions. Prevalence of frequent impacts was defined as the percentage of people reporting 'fairly often' or 'very often' to one or more of the OHIP-14 questions.
Over half the dentate Australians (63.0%) visited a dentist in the past year. Unadjusted analysis showed a statistically significant association between the prevalence of frequent impacts and receipt of: extractions (prevalence ratio = 1.7, 95% CI = 1.2-2.2), scale/clean (0.7, 0.5-0.8), and denture care (1.6, 1.1-2.4). After adjustment for the usual reason for dental attendance there was no effect of any of the three treatments or the time since last visit on the prevalence of frequent impacts.
The usual reason for dental attendance, and not the time since last visit or the type of dental care supplied, accounted for differences in perceived oral health impacts.
Water striders or pond skaters belonging to the subfamily Gerrinae are common inhabitants of various types of fresh water throughout eastern and northern Australia. The present paper deals with the 13 species (in 5 genera) known from Australia. Redescriptions or descriptive notes, illustrations, and keys to adults and nymphs of all species are provided and their distributions recorded and mapped.Tenagogerris pallidusand T. femoratus (both from Northern Territory and Western Australia), Tenagogonus australiensis (Queensland), Limnometra ciliodes (Queensland, Papua New Guinea and Irian Jaya), and Limnogonus fossarum gilguy (Northern Territory, Queensland, South Australia, Western Australia, Indo-Malayan Archipelago, and West Pacific to Samoa and Tonga) are described as new. Limnometra poliakanthinaNieser & Chen is synonymised with L. cursitans (Fabricius) and Hydrometra australis Skuse (= Limnometra skusei Torre-Bueno) with Limnogonus luctuosus (Montrouzier). The evolution and zoogeography of Australian water striders are discussed. Finally, we discuss the ecology of the gerrine water striders of Australia in relation to our present knowledge about habitats, phenology, wing polymorphism, and association between species.
In times of health reform, fiscal restraint and population aging, it becomes increasingly imperative to understand what must be done to better link research and policy in the health area. In this paper, the major determinants of healthy aging are discussed in terms of current conceptual frameworks of health, measurement, methodologies, and data sources. In order to maximize the benefit for the health of current and future Canadian seniors, policy recommendations are made to Statistics Canada, Health Canada, and the Seniors Independence Research Program (SIRP) which cover a range of issues related to measurement and data sources, health services, health status, economic status, and education.
This article reports the results of a study of factors that differentiate among utilizers and nonutilizers of dental services in old age. Two hundred community-dwelling subjects aged 60–89 were surveyed regarding utilization of dental services, dentate status, current treatment needs, recent symptom experiences, and dental fear and anxiety. Discriminant analysis was used to differentiate among utilizers and nonutilizers. Dentate status, perceived need, and recent symptom experiences were the best predictors of utilization. The contribution to accurate classification made by two measures of dental fear and anxiety was marginal at best. When dentate status was removed as a predictor, the role of fear and anxiety became somewhat more important.
Outcome measures are necessary for assessment of the appropriateness, quality, necessity for, and effectiveness of oral health care. With the growing number of older adults in the United States, it is appropriate to reflect on the unique characteristics of this segment of our society and how these characteristics may influence the identification of appropriate outcome measures. Older people often demonstrate multiple acute or chronic oral diseases with interrelated symptoms and clinical findings. Older persons are more likely to take medications with potentially adverse oral health effects. Patients experience a variety of disease processes over many years and have variable access to and experiences with the dental care system. These characteristics make the selection and interpretation of outcomes complex. Limitations of existing measures and considerations for the development of new outcomes measures specifically for older populations are reviewed.
An important goal of a health care intervention or system is to improve the health of an individual or a population. The challenge for health services research is to measure and explain this change. However, the issue of how changes in health status should be defined and measured has been given relatively little attention. This paper draws on the rather sparse literature to examine some issues involved in measuring changes in oral health status and illustrates these using data from a longitudinal study of the oral health of older adults. The paper draws a distinction between quantitative and qualitative change and the challenges involved with each. Four different ways of assessing change are reviewed and their strengths and weaknesses highlighted. Global transition judgements, although relatively simple measures of change, incorporate patients' values and avoid the statistical problems associated with measures such as change scores. Nevertheless, the measurement of change in oral health status is complex and controversial and no approach is universally accepted. Consequently, the decision as to which strategy to adopt is far from simple.
The different measurement properties necessary for instruments whose goal is to detect differences between subjects at a single point in time (discriminative instruments) and those whose goal is to detect longitudinal change within subjects (evaluative instruments) is becoming increasingly recognized. Up to now, requirements for evaluative instruments have been presented as reproducibility, validity, and responsiveness (i.e. the ability to detect change over time). An alternative conceptualization would characterize any instrument as requiring two crucial measurement properties. One is validity, the other a high ratio of signal to noise. For discriminative instruments, the signal to noise ratio can be summarized in a reliability coefficient; for evaluative instruments, in a responsiveness index or coefficient. This formulation can simplify and clarify the understanding and teaching of issues in health status measurement.
The elderly tend to use dental services less than most younger age groups. While the elderly's utilization rates may be rising, very low utilization by edentulous people depresses the overall rate for the group. We use data from the Ontario Study of the Oral Health of Older Adults to identify the variations in the use of dental services in the four study sites of Toronto, North York, Simcoe County and Sudbury and District. We reached 3,033 subjects by telephone and conducted dental examinations and a multi-item personal interview with 907 of them. The 907 subjects ranged in age from 50 to 87 years, 57 percent were female and two-thirds were born in Canada. Overall, 60.5 percent had seen a dentist or denturist in the previous year, but this was much lower among the edentulous (17 percent) when compared to the dentate (72 percent) (Chi-square test; p less than .0001). Of the 357 who did not visit a dentist or denturist in the previous year, nearly half (48 percent) felt they had nothing wrong and 20 percent reported they could not afford care. A high proportion (94 percent) of the edentulous reported visiting only for pain or trouble compared to 26 percent of the dentate (Chi-square test; p less than .0001). Using logistic regression, we found dental status (edentulous), community of residence (Sudbury), income (up to $20,000) and dental insurance coverage (none) were important factors in not making a dental visit in the last year. These same factors, plus education (elementary) were important where subjects reported visiting a dentist or denturist only when there was pain or trouble.
Our purpose was to identify factors predictive of reported dental care use by elders (65+) over a ten-year period in Massachusetts. The Massachusetts Health Care Panel Study began in 1974-75 (wave 1) as a statewide survey of 1625 noninstitutionalized elders. Wave 2 occurred in 1976, wave 3 in 1980, and wave 4 in 1985. The 540 persons who participated in all four waves are the subject of this report. The remainder either died, entered nursing home, or were lost to follow-up. This longitudinal design permits analysis of cohort, aging, and period effects. The outcome variables were self-reported dental care use within two years, or more than two years, as reported at waves 1, 3, and 4. Wave 2 was excluded because less than two years had elapsed since the previous wave. To identify factors predictive of reported use, we used a generalization of the logistic regression model that included a random effect term, which accounts for repeated measures being made on the same subjects. Covariates in the model were dentate status, education, income, cohort, sex, martial status, and time. The variable "time" served as a measure of aging/period effects. Persons were grouped into four birth cohorts. Before adjusting for other covariates, cohort was significantly associated with dental care use, but was not so in the full multivariate model. Dentate status, education, and income were significant predictors of use. The cohort effect was explained by dentate status, education, and income. Time was not significant, indicating no aging/period effects in this ten-year period, or that their net effect was zero.
This article reports the results of a study of factors that differentiate among utilizers and nonutilizers of dental services in old age. Two hundred community-dwelling subjects aged 60-89 were surveyed regarding utilization of dental services, dentate status, current treatment needs, recent symptom experiences, and dental fear and anxiety. Discriminant analysis was used to differentiate among utilizers and nonutilizers. Dentate status, perceived need, and recent symptom experiences were the best predictors of utilization. The contribution to accurate classification made by two measures of dental fear and anxiety was marginal at best. When dentate status was removed as a predictor, the role of fear and anxiety became somewhat more important.
Because it still is widely believed that one deadly disease after another is being eliminated, or diminished, largely because of medical interventions, there is little commitment to social change and even resistance to a reordering of national priorities. In this article we examine the contribution of medical measures to recent mortality changes in coronary heart disease, cancer, and stroke, which together account for two-thirds of total U.S. mortality and consume the vast majority of available resources. Morbidity changes are also examined and found to be not declining in a manner congruent with mortality and, in fact, increasing for some subgroups. Using a combined measure of mortality and morbidity (the probability of a life free of disability), it is demonstrated that although overall life expectancy has increased over several decades, most of this increase is in years of disability. Our late 20th century approach to the emerging AIDS pandemic (the frantic search for a "magic bullet"--either a treatment or a vaccine) belies any suggestion that the arguments and data presented concerning the modest contribution of medical measures are now passé.
This paper examines the association between dental insurance, dental utilization and oral health outcomes among elderly people living independently in two communities in Ontario. Dental insurance had no independent effect on use of dental services, dissatisfaction with oral health status or clinically defined treatment needs. However, dentate attenders were less likely to be dissatisfied with their oral health and less likely to need dental treatment than those defined as non-attenders. One unexpected finding was that the dentate elderly had higher levels of utilization than is often reported in the literature but still had high levels of treatment need.
With increasing numbers of people keeping their teeth into their later years, regular dental care should be a health behavior practiced by all older persons. National surveys show, however, that older people use dental services at a much lower rate than other age groups. Even when low-cost dental services are provided, a significant number of eligible elderly do not seek dental care. A survey was conducted among 116 elderly utilizers of low-cost dental services and 142 comparable elderly who had not sought care in 3 or more years. Andersen and Newman's (1973) model was expanded in include attitudes as predisposing factors. The revised model explained 32% of variance in dental utilization; perceived need and two components of attitudes were among the eight significant variables. A follow-up of nonutilizers 6 months later revealed that 27.4% had subsequently sought dental care. The best predictors of the decision to seek care were attitudinal variables, accounting for 21% of the variance. Implications for planning dental services for low-income elderly, developing health education programs, and policies are discussed.
Since the mid-1970s a number of investigators have developed measures of the extent to which oral disorders compromise functional, social and psychological well-being. They have also examined the associations between clinical indicators of oral health status and these subjective indicators. In general, these associations have been inconsistent and weak. One reason for this might be that the subjective indicators employed were rudimentary and insensitive to the health outcomes of oral disorders. The development of the Oral Health Impact Profile, a more sophisticated measure of the health outcomes of oral disorders, provided a method to examine this hypothesis. Using data from an oral health survey of older adults, we examined the associations between OHIP scores and a variety of clinical indicators of tooth loss, caries and periodontal disease. Even with this measure the associations were predominantly weak, the strongest of the correlations being 0.53. We also examined the influence of personal and sociodemographic characteristics on the relationship between tooth loss and its psychosocial outcomes. Five variables reflecting expectations and resources explained as much variance in OHIP scores as did the number of missing teeth. This analysis illustrates the essential distinction between disease and health and the way in which measures of oral health can be used to pursue fundamental issues in behavioural science and health services research.
This paper reports the results of a study to evaluate the performance of a battery of subjective oral health status indicators originally developed for use in large scale surveys of older adults. The aim was to assess their generalizability, efficiency, reliability, and validity when used in a study of adults aged 18 years and over and to compare their performance with respect to younger and older adults.
Data were collected by means of a mail survey and self-complete questionnaire of a random sample of the population aged 18 years and older.
The results suggested that the measures were sensitive to the oral health concerns of adults of all ages and that item nonresponse was within acceptable limits. Test-retest and internal consistency reliability statistics were good and all hypotheses designed to assess concurrent and construct validity were confirmed.
The results confirm an earlier, but more limited, evaluation and suggest that these indicators are useful for descriptive oral health surveys of general populations.
Since 1973, Alberta's dental plan for the elderly has made government-sponsored, premium-free comprehensive care by dentists and denturists available to all residents of the province over age 64. Details on the numbers and types of different services provided were previously unavailable from the annual reports. However, an examination of the plan's six-million records, covering nearly 260,000 different patients from 1978 to 1992, has now made it possible, for the first time, to conduct a detailed analysis of these dental services. Many time-related changes have occurred in the types of services provided. The number of removable prosthodontic services declined from 14 per cent of all services offered by dentists in 1978-79 to five per cent of these services in 1991-1992, but the services provided by denturists increased by a factor of four. The relative number of surgical and restorative dentistry services offered by dentists also declined. Preventive services grew modestly, but periodontal services grew dramatically from three per cent of all services provided by dentists to 22 per cent. These shifts in services from prosthodontics, restorative dentistry and oral surgery to preventive and periodontic services have important implications for the planning and administration of dental plans for the elderly.
In this study of an older adult population almost one-fifth reported oral dryness. It was the most common of 22 oral symptoms and complaints. In a logistic regression analysis of predictors of oral dryness three variables had significant independent effects: income, taking prescribed medications and experiencing a stressful life change within the previous 6 months. Subjects with oral dryness had more decayed crown surfaces than those without but there was no association with decayed root surfaces. Nor were there any significant associations between reports of oral dryness and a number of indicators of periodontal health. Those with dryness were more likely to report other oral symptoms such as unpleasant taste, a burning sensation in the tongue and other parts of the mouth and pain from dentures. They were also more likely to report problems chewing food, problems with eating and communication and were more likely to be dissatisfied with their oral health. Given its prevalence and effects, oral dryness constitutes an important health issue among older adults.
A major source of bias in health surveys is non-response on the part of those selected to take part in a study. In a survey of the oral health of older adults in Ontario, Canada, we used an initial telephone survey based on random digit dialing with a personal interview and clinical examination follow-up. The telephone survey was completed by 3033 individuals (78.0%) of those sampled. The follow-up was completed by only 907 (30.0%) of these subjects. Nevertheless, there were no major differences in the characteristics of those completing the telephone survey and those subsequently participating in the follow-up. Non-response bias analysis indicated that differences between crude and adjusted estimates of the prevalence of oral conditions were small and the effect of non-response on estimates of the relationship between socioeconomic status and oral health in this population were also small. These results indicate that response rates lower than those conventionally regarded as acceptable do not necessarily compromise the results of epidemiological studies.
Abstract Longitudinal studies of the oral health of older adults are necessary for the measurement of disease incidence and identification of risk factors for oral disease. Loss of respondents to follow-up may, however, seriously bias longitudinal results. Using data from the 1989 and 1992 waves of the Ontario Study of the Oral Health of Older Adults, this paper examines loss to follow-up by comparing the characteristics of lost and retained respondents in terms of clinically-defined and self-rated oral health, sociodemographic characteristics, general health status, and health behaviours. Of the original 907 respondents who completed an interview and clinical examination, 611 participated in the 3-yr follow-up study. Study attrition rates were higher in the edentulous group. Although some statistically significant differences were found between those retained and lost, the magnitude of the differences was small and unlikely to seriously bias estimates of incidence or risk. These results illustrate the need to consider study attrition, response rates and comparisons of retained and lost to follow-up respondents in reporting the results of longitudinal studies. Without such information, confidence in the population estimates derived from those studies is undermined.
The purpose of this study was to investigate the factors influencing the pattern (amount and types) of dental care provided to dental visitors participating in the baseline stage of the Ontario Study of the Oral Health of Older Adults.
We interviewed and examined older adults from four municipalities in Ontario and obtained dental service records for the previous two years for those reporting a dental visit. Individual services and their corresponding time and values were aggregated into categories. We compared the pattern of care for dentate and edentulous subjects, and by age, municipality of residence, and social, demographic and economic characteristics.
The 473 subjects received 5,031 services, more than four hours of dental care per subject over the two years. The 29 edentulous subjects received about one-third the number of services compared with the dentate; however, there were no differences in relative time units (RTUs) or relative value units (RVUs). Among the dentate the amount of care (RVUs) varied by municipality of residence and by visiting behavior, but not by age, income, or other socioeconomic variables.
Both dentate and edentulous visitors received over two hours of care per person per year. Dental care patterns were influenced by dental status, area of residence, and visiting behaviors.
Although numerous investigators have reported on self-perceived oral health status in adult and older adult populations, few have examined how these perceptions change over time. This paper uses data from a longitudinal oral health survey of community-dwelling Canadians aged 50 years and over to explore this issue. Data were collected at baseline and after 3 years. Change was assessed using a global transition judgement and change scores on four subjective oral health status indicators. These indicators addressed chewing capacity, oral and facial pain symptoms, other oral symptoms, and the psychosocial impact of oral disorders. Overall, 23.0% reported that their oral health had worsened over this period, 66.5% that it had remained the same and 10.5% that it had improved. Change scores on the four indicators showed a similar pattern and were significantly associated with these global judgements. Over the same period, substantial proportions lost one or more teeth, acquired new coronal or root DFS increments or experienced loss of periodontal attachment. An additional 17% complained of dry mouth. However, the only clinical indicator associated with changing perceptions of oral health was tooth loss. Of interest was the fact that rates of tooth loss were equally high among those who reported a worsening of oral health and those who reported an improvement. This suggests that the impact of tooth loss on health status may be positive or negative depending upon the condition of the teeth lost.
To examine the contribution of life circumstances and lifestyles, and the interaction between them, to the oral health status of older Canadians.
Subjects were recruited using a telephone interview survey, based on random digit dialling and subsequently interviewed and clinically examined.
Four hundred and ninety-eight dentate subjects aged 53 years and over living independently in Ontario, Canada.
Subjects were classified as living in deprived, middle or privileged life circumstances based on their social and personal attributes. They were also classified as having relatively poor or relatively favourable lifestyles based on their health behaviours. The oral health status indicators used were: the number of missing teeth, the number of decayed and filled root surfaces, mean periodontal attachment loss, the number of oral symptoms in the previous four weeks, self-rated oral health, and a psycho social impact score.
In bivariate analyses, life circumstances were significantly associated with three of these six indicators and lifestyles with five. Healthy lifestyles had an effect on the oral health status of those living in deprived and middle circumstances but not on the privileged, although no overall interaction effect was observed in multivariate analyses controlling for gender and age.
These data suggest that, among this population, life circumstances and lifestyles are both related to oral health. They also indicate that the role of these factors varies according to the condition and health indicator in question.
Reflecting a limited understanding of the definition and determinants of health-related quality of life (HRQoL), the majority of research in this field has concentrated upon the effect of disease- and treatment-related variables. That work specifically investigating HRQoL among upper aerodigestive tract (UADT) cancer patients is no exception to this observation. Treating subject-related and non-subject-related variables separately, the aim of this study was to investigate predictors of global HRQoL rating in a sample of UADT cancer patients, concentrating upon the relative importance of sociodemographic and clinical variables. A cross-sectional study design was used with a sample of 188 UADT cancer patients. Global HRQoL was assessed using the EORTC QLQ-C30 instrument, global domain (global QoL). Other study variables were collected by subject interview and chart review. Two multivariate regression models were independently developed, containing, respectively, subject-rated and non-subject rated variables. In the model containing subject-rated predictors of global QoL, emotional, breathing, physical, financial, pain and appetite problems were significant predictors (F = 14.6, p < 0.0001 and r2 = 0.54). Among non-subject-rated sociodemographic and clinical variables tested, unemployment, older age, female gender, being dentate and a more advanced disease stage predicted worse global QoL rating, while oral as opposed to pharyngeal or laryngeal cancer predicted a better global QoL rating (F = 5.1, p < 0.0001 and r2 = 0.21). In the latter model, a greater proportion of the variance was explained by sociodemographic variables than by clinical variables.
Although the oral sequelae of treatments for upper aerodigestive tract (UADT) cancers have been well described, very little is known about the relationship between dental status and health-related quality of life (HRQL) in patients with UADT cancer. The aim of this study was to investigate the hypothesis that dental status is a predictor of HRQL in a sample of post-therapeutic UADT cancer patients. A cross-sectional study design was used with a sample of 188 subjects. HRQL was evaluated through the global domain of the EORTC QLQ-C30 instrument and data were collected on sociodemographic, disease, treatment and dental status variables. Linear multiple regression analysis was used to determine those variables with a significant independent association with the HRQL. Two multivariate models were developed each containing age, gender, employment status, cancer site and disease stage, plus either the dental status category "partially dentate with no prosthesis" (P/NP) (F-value for model = 7.31; P < 0.0001; r2 = 0.20) which predicted a significantly worse HRQL, or the dental status category "edentulous with prostheses" (E/WP) (F-value for model = 7.56; P < 0.0001; r2 = 0.20) which predicted a significantly better HRQL. Furthermore, the P/NP group reported significantly more "problems with their teeth" (ANOVA, P = 0.0004), significantly more "trouble eating" (ANOVA, P = 0.024) and significantly more "trouble enjoying their meals" (ANOVA, P = 0.01). Although the cross-sectional nature of the data collection and the somewhat crude nature of the dental status variable limit inferences, the results of this study suggest that dental status has an important effect on HRQL in post-therapeutic UADT cancer patients.