High Anticholinergic Burden and Dental Caries: Findings from Northern Finland Birth Cohort 1966.

INTRODUCTION: Anticholinergic drugs propose a threat for oral health by causing dry mouth. The aim of this cross-sectional study was to investigate whether a high anticholinergic burden was associated with the presence of initial caries lesions, manifested caries lesions, dental fillings, or tooth loss among 46-y-old people. METHODS: The study population consisted of 1,906 participants from the Northern Finland Birth Cohort 1966 who underwent an oral health examination in 2012-2013. Socioeconomic and medical data were collected from questionnaires, medical records, and national registers. Nine previously published anticholinergic scales were combined and used to measure the high anticholinergic burden from the participants' medication data. Cariological status was determined according to the International Caries Detection and Assessment System, and the number of missing teeth (excluding third molars) was used as an indicator for tooth loss. The decayed, missing, and filled surfaces index was used to depict caries experience. Negative binominal regression models were used to estimate prevalence rate ratios (PRRs) and confidence intervals (CIs). RESULTS: Fourteen percent of the participants (n = 276) used at least 1 anticholinergic drug and about 3% had a high anticholinergic burden (n = 61). After adjusting for confounding factors, participants with a high anticholinergic burden had a higher likelihood of having manifested carious lesions needing restorative treatment (PRR, 1.60; CI, 1.11-2.29) and more missing teeth (PRR, 1.59; CI, 1.13-2.24) when compared to participants without any or with a lower anticholinergic burden. CONCLUSIONS: High anticholinergic burden was associated with a present caries experience and with tooth loss among the general middle-aged population. KNOWLEDGE TRANSFER STATEMENT: The findings of this study suggest that middle-aged patients with a high anticholinergic burden may have a heightened risk of dental caries. These patients may benefit from targeted caries preventive regimes.

Anticholinergic Burden and Dry Mouth in Middle-Aged People.

INTRODUCTION: Anticholinergic burden refers to the cumulative effect of taking 1 or more drugs with anticholinergic properties. At the moment, little is known about the association between the anticholinergic burden and dry mouth. OBJECTIVES: The objective of this article was to study, whether an anticholinergic burden is associated with dry mouth among middle-aged people. METHODS: The study population included 1,345 people aged 46 y from the Northern Finland Birth Cohort 1966 (NFBC1966) study, who took part in a clinical medical and dental examination during 2012-2013. Medication data comprised both self-reported drug use and information obtained from the national register. Anticholinergic burden was measured using 10 different anticholinergic scales. Dry mouth was defined on the basis of having either a subjective feeling of dry mouth (xerostomia) or objectively measured low unstimulated or stimulated whole salivary flow rates (hyposalivation). Poisson regression models with robust error variance were used to estimate relative risk (RR). Regression models were adjusted for sex, smoking, diabetes, rheumatoid diseases, depressive symptoms, anxiety, total number of drugs, and antihypertensive drugs. RESULTS: Approximately 14% of the participants reported having xerostomia and about 2% had hyposalivation. The RRs of different anticholinergic scales for xerostomia varied from 1.05 to 1.68. The scales' RRs were between 0.89 and 2.03 for low unstimulated whole salivary flow (<0.1 mL/min) and between 0.59 and 1.80 for low stimulated whole salivary flow (<0.7 mL/min). Seven of 10 studied anticholinergic scales associated statistically significantly with dry mouth, either with xerostomia or hyposalivation. CONCLUSION: Most of the anticholinergic scales were associated with dry mouth, either with xerostomia or hyposalivation. There was considerable variation in the strength of the associations between anticholinergic scales and dry mouth. KNOWLEDGE TRANSFER STATEMENT: The findings of this study suggest that dentists should take notice of the use of drugs with anticholinergic properties and their harmful effects among middle-aged people. Dentists should provide these patients with necessary guidance on how to cope with dry mouth and give them prophylactic measures against oral diseases associated with dry mouth.

The association of medications with sedative properties with oral health behaviour in community-dwelling older people.

OBJECTIVES: The objective of this study was to determine whether drugs with sedative properties are related to oral health behaviour-such as frequency of toothbrushing, using toothpaste and dental visits-and oral hygiene, measured by the number of teeth with dental plaque, among community-dwelling older people. METHODS: The study population consisted of 159 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study (Geriatric Multidisciplinary Strategy for the Good Care of Older People study). The data were collected by interviews and clinical examinations during 2004-2005. Sedative properties of drugs were assessed using the sedative load (SL) model. Logistic and Poisson regression models were used to estimate odds ratios/relative risks (OR/RR) and 95% confidence intervals (CI). RESULTS: After adjusting for confounding factors, SL associated with infrequent toothbrushing (OR 1.72, CI: 0.61-4.89), toothpaste use less than twice a day (OR 3.34, CI: 1.39-8.12), non-regular dental visits (OR 2.28 CI: 0.91-5.30) and the number of teeth with dental plaque (RR 1.20 CI: 1.04-1.39) compared to participants without a SL. CONCLUSIONS: The results of this study suggest that use of drugs with sedative properties indicates poor oral health behaviour among older people.

Oral health care-related beliefs among Finnish geriatric home care nurses.

OBJECTIVES: The aim was to investigate beliefs about oral health care tasks among nursing staff caring for home-dwelling older people using the Nursing Dental Coping Beliefs (nursing DCBS) index. METHODS: The study population comprised nursing staff working at the homes and sheltered accommodations of older people in Ylivieska, Finland (N = 141). The data were collected using the nursing DCBS index (five-point Likert scale). RESULTS: On average, the nurses held moderate to high Oral health care beliefs, Internal locus of control beliefs and External locus of control beliefs, but low beliefs about Self-efficacy. The nurses with an earlier adjunct education scored lower for Oral health care beliefs on the factor Knowledge about preventing gum diseases (OR = 0.3, 95% CI: 0.1-0.9) than did the others. Regarding beliefs about External locus of control, the age group 31-49 years scored lower on the factor Retaining teeth as one ages (OR = 0.2, 95% CI: 0.1-0.7), but scored higher on the factor How to prevent dental diseases (OR = 5.6, 95% CI: 1.1-29.3) than did younger nurses (≤30 years). The nurses with only a nursing education showed significantly higher mean scores on the Self-efficacy factor Confidence of the need for dental knowledge than did those with an earlier adjunct education (P = 0.034). CONCLUSIONS: The nursing staff mostly believed that oral diseases are preventable and teeth can be retained in advanced age, but failed to recognize the value of dental knowledge and had little confidence in their ability to manage oral diseases. Improving the oral health-related knowledge and self-efficacy beliefs of nursing staff will require additional oral health education.

Salivary flow rate and periodontal infection - a study among subjects aged 75 years or older.

OBJECTIVE: To analyse the relation of stimulated and unstimulated salivary flow rates to periodontal infection in home-dwelling elderly people aged 75 years or older. SUBJECTS AND METHODS: This study was based on a subpopulation of 157 (111 women, 46 men) home-dwelling, dentate, non-smoking elderly people (mean age 79.8, SD 3.6 years) from the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly Study). The data were collected by interview and oral clinical examination. RESULTS: Persons with very low (< 0.7 ml min⁻¹) and low stimulated salivary flow rates (0.7- < 1.0 ml min⁻¹) had a decreased likelihood of having teeth with deepened (≥ 4 mm) periodontal pockets, RR: 0.7, CI: 0.5-0.9 and RR: 0.7, CI: 0.5-0.9, respectively, when compared with those with normal stimulated salivary flow. Persons with a very low unstimulated salivary flow rate (< 0.1 ml min⁻¹) had a decreased likelihood of having teeth with deepened (≥ 4 mm) periodontal pockets, RR 0.8, CI: 0.6-1.0, when compared with subjects with low/normal unstimulated salivary flow. CONCLUSIONS: In a population of dentate, home-dwelling non-smokers, aged 75 years or older, low stimulated and unstimulated salivary flow rates were weakly associated with a decreased likelihood of having teeth with deep periodontal pockets.

Self-efficacy perceptions in oral health behavior.

The aim of this paper is to describe and understand people's views on dental self-efficacy and its formation. The qualitative data were collected by means of focused interviews with five patients selected on the basis of poor orientation to dental-care matters, measured using test scores from a previous questionnaire. The first stage of the analysis is a description of the background of the subjects from their own accounts; two proved to have internalized preventive dental beliefs and behavior deeply while two others had traumatic experiences as a reason for irregular dental appointments. One subject with poor oral health behavior seemed to have limited preventive action to his yearly dental appointment. The second stage of the analysis focuses on interpretation of the subjects' perception of self-efficacy and related comments. Among sources of self-efficacy that prove important in dental care are the cognitive, experiential, supportive and emotional dimensions, and beliefs and values learned in the family and at school. This qualitative research increases our understanding of the oral health behavior of patients and emphasizes the importance of patient-centered oral health education.

Self-esteem as a characteristic of adherence to diabetes and dental self-care regimens.

BACKGROUND, AIMS: There are biological associations between diabetes control and oral infections. We have also found psychological associations between diabetes self-care and oral health behavior. The aim of this study was to evaluate whether self-esteem can determine diabetes adherence and oral health behavior, both of with require daily, persistent self-care. METHOD: Cross-sectional data on 149 IDDM patients was collected by means of a quantitative self-completed questionnaire. RESULTS: High self-esteem was found to relate to good adherence with exercise regimens (p=0.005) and adjustment of insulin doses (p=0.040). These associations were also found when standardized for socio-demographic variables and HbA1c-level. In the dental sphere, logistic regression analysis showed an association between self-esteem and frequency of tooth brushing. CONCLUSIONS: It can be concluded that self-esteem may be a common psychological factor influencing diabetes and dental self-care. Strengthening patients' self-esteem could help patients to maintain daily self-care.

Attributions to dental and diabetes health outcomes.

Previous studies have proposed common psychological factors between oral health behavior and diabetes self-care. The aim here was to describe and analyse more comprehensively the relationships between dental and diabetes health behavior on the basis of attribution theory. The likeness between subjects' own assessments, similarities of the causes given to success and failure, and the predictive power of own dental assessments concerning the metabolic balance of diabetes were studied. The research population was composed of 149 IDDM patients. Data were collected by means of a quantitative questionnaire, a clinical oral examination and from patient records. It was found that from the patients reporting success with avoiding gingivitis 82% also reported success with metabolic status and they also had lower mean HbA1c levels than patients assessing failure with gingivitis. There were some correlations between causes of failure: not bothering to clean approximal surfaces correlated with non-adherence to diabetes treatment instructions, and laziness as the cause of caries correlated with non-adherence to diabetes treatment instructions and with poor motivation for diabetes care. It can be concluded that there are some common determinants for both dental health behavior and diabetes self-care. This connection should be taken into account in health education by health care professionals.

Locus of control beliefs predicting oral and diabetes health behavior and health status.

Our study evaluates the correlation between dental and diabetes locus of control beliefs and the potentiality of locus of control beliefs in predicting oral health behavior, dental status, diabetes compliance, and HbA1c level by using situation-specific locus of control scales and considering the value dimension. Data were collected by means of a quantitative questionnaire, a clinical oral examination and patient records. The research population comprised 149 insulin-dependent diabetics who had teeth of their own. Variables were the frequencies of tooth brushing and dental visiting, oral indexes, diabetes adherence, and HbA1c level. Dental and diabetes locus of control beliefs correlated with each other. Dental locus of control associated with frequency of dental visiting, plaque index, decayed surfaces, and with root caries, but diabetes locus of control associated only weakly with adherence with diabetes self-care regimens and not at all with HbA1c level. Correlations between dental locus of control and oral indexes were stronger among those having high value for dental care. Although there were correlations between dental and diabetes locus of control beliefs, only dental locus of control beliefs are practicable for determining health behavior and health status. It is therefore concluded that locus of control beliefs are health behavior specific.

Dental self-efficacy as a determinant to oral health behaviour, oral hygiene and HbA1c level among diabetic patients.

Because of a mutual association between severity of periodontitis and poor control of IDDM, regular dental visits and daily oral care are important among diabetics. The aim was to develop a method for analysing dental self-efficacy and to study the relationship between dental self-efficacy and reported oral health behaviour and oral hygiene. The relationship between oral health behaviour and HbA1c level was also studied. Data were collected in relation to 149 IDDM patients by means of a quantitative questionnaire, evaluation of dental plaque and patient records. Results showed that tooth brushing self-efficacy, approximal cleaning self-efficacy and dental visiting self-efficacy related to corresponding reported oral health behaviour (p<0.0005). Visible plaque index (VPI) correlated inversely with tooth brushing self-efficacy (r(s) = -0.208, p = 0.012) and dental visiting self-efficacy (r(s) = -0.240, p = 0.004). Approximal cleaning self-efficacy correlated with age (r(s) = 0.225, p = 0.006) and dental visiting self-efficacy was related to higher professional level of education (p = 0.009). Those having better tooth brushing self-efficacy (p = 0.020), higher frequency of tooth brushing (p = 0.032) and lower VPI (p<0.0005) had better HbA1c level. It was concluded that perception of dental self-efficacy plays a decisive rôle in relation to oral health behaviour in diabetic patients, and that compliance with dental recommendations is also related to HbA1c level.

Self-efficacy as a common variable in oral health behavior and diabetes adherence.

Successful treatment of dental caries, periodontal diseases and diabetes requires persistent daily self-care. The aim of this study was to evaluate the perception of self-efficacy as a common behavioral factor determining oral health behavior, diabetes self-care, and actual health status. Cross-sectional data relating to 149 insulin-dependent diabetes mellitus (IDDM) patients were collected from patient records, and by clinical oral examination and a quantitative questionnaire. The study population was recruited from different locations, and the participation percentage was 80%. Self-efficacy scales associated with corresponding behaviors, and a dental self-efficacy scale also correlated with dental caries. Dental self-efficacy correlated with diabetes self-efficacy, diabetes adherence, and with HbA1c. Also, logistic regression analysis revealed that dental self-efficacy was related to diabetes adherence. Further, those diabetics reporting a high frequency of dental visiting had higher diabetes self-efficacy. As a conclusion, good dental self-efficacy has a positive influence on diabetes adherence. The results suggest that the perception of self-efficacy may be a common behavioral factor determining diabetes self-care and oral health behavior.

Gastroenterological drugs and denture stomatitis.

The aim of this study was to investigate the medical and dental variables related to the presence of denture stomatitis. The study population was comprised of 106 elderly people (82 women, 24 men; mean age, 81.3 years) using a maxillary complete denture and living in a geriatric nursing home in Oulu, Finland. The following variables were used in the analysis: medical diagnoses, which could have a possible biological association with stomatitis; daily use of drugs; ability to cope with everyday life; oral hygiene; and the condition of the denture. The prevalence of stomatitis was 52% among residents wearing complete dentures. Patients receiving gastroenterological drugs had less stomatitis (p = 0.01, chi-square). The results suggest a preliminary finding that older adults using gastroenterological drugs had less stomatitis.

Obstacles to regular dental care related to extrinsic and intrinsic motivation.

The aim of this study was to test factors preventing regular dental care as put forward by persons who are extrinsically or intrinsically motivated in relation to dental care. The series consisted of 390 randomly selected young and middle-aged patients, 207 women and 183 men, visiting two occupational health centers in Oulu, Finland. Logistic regression analysis showed that the probability of being extrinsically motivated was greater among those who mentioned the purposelessness of brushing their teeth, lack of time, lack of interest, expense, laziness and failure to appreciate the seriousness of dental care as factors hindering regular dental care very much or somewhat. Thus extrinsically motivated persons seemed to propose superficial reasons and reasons related to non-appreciation of dental care more often than intrinsically motivated persons.

Intrinsic motivation in dental care.

The aim of this work was to develop a method based on the idea of intrinsic motivation for analyzing motivation problems in dental care. A questionnaire dealing with intrinsic motivation was filled in by 207 women and 183 men. Factor analysis of the scale revealed the following dimensions of internal-external motivation: independence, responsibility, vs. non-independence, interest in preserving one's own teeth as long as possible vs. preference for tooth extraction, satisfaction from brushing teeth vs. brushing for others' sake, and critical evaluation of diet vs. improper diet with carbohydrates. The reliability of the questionnaire was good (standardized item alpha .69). The individual's own sense of independence and responsibility and the idea of preserving one's own teeth for as long as possible were found to be more important for the women than for the men. A longer education was also found to be related to preserving one's own teeth as long as possible. The time of the last dental visit was positively related to independence, responsibility and the far-reaching idea of preserving one's own teeth. It can be concluded that aspects of intrinsic motivation can give additional information when trying to understand dental health behavior.

Reasons preventing regular dental care.

The aim was to determine what reasons restrict people's daily cleaning of their teeth and yearly attendance for a dental check-up, using as a theoretical background the ideas of Eichholz & Rogers on the rejection of innovation. The series consisted of young and middle-aged persons, 207 women and 183 men, who filled in a questionnaire on the above topics. The questions were phrased so as to cover different reasons for rejecting innovations. Factors analysis revealed the following factors: reasons preventing daily brushing, practical reasons, unpleasant experiences of dental care, laziness, and lack of appreciation. The reliability of the questionnaire was found to be good. Sex showed a significant correlation with reasons preventing daily brushing. Those for whom a long time had elapsed since the last visit to a dentist had more barriers relating to daily brushing, unpleasant experiences and laziness. The more educated the participants were, the fewer barriers they had in relation to the factors appreciation, unpleasant experiences, and daily brushing.

Suitability of Krathwohl's affective taxonomy for evaluating patient attitudes to dental care.

The aims were to develop a questionnaire for dental health education based on Krathwohl's taxonomy, which measures the affective domain, and to examine correlations between the attitude determined by this questionnaire and sex, age, education, and dental behavior. The material consisted of young and middle-aged persons, 206 women and 183 men, visiting two occupational health centers in Oulu. The questionnaire comprised four questions under each of three headings: preventive dentistry, gingivitis, and dental check-up. The questions under each heading were formulated to correspond to given levels in Krathwohl's taxonomy. Factor analysis showed the questionnaire to be valid and suitable for studying different levels of the affective domain. Krathwohl's taxonomy includes the notion of cumulative adoption of a value, and Guttman scaling was used to show the cumulativeness of the scales. Groups of persons with the most and least positive attitudes were identified, 83% of the patients with the most positive attitude having visited a dentist within a year, whereas 65% of those with the least positive attitude had last done so more than 2 yr earlier. The women had a more positive attitude than the men, but education was not a decisive factor in determining attitude. All the persons with the most positive attitude were over 25 yr old. It was concluded that it was possible to formulate a questionnaire on the basis of Krathwohl's taxonomy which would measure attitudes towards dental care and that it is possible to use this questionnaire in practical situations in order to help the dentist to instruct his patients.