Inequalities by sex on remaining teeth in adults: A decomposition analysis.

OBJECTIVE: To identify which social determinants of health explain the gap in the remaining teeth between men and women. METHODS: A secondary analysis of data from the Chilean National Health Survey (CNHS) 2016-2017 was performed on the number of remaining teeth in adults. The explanatory variables were organized into structural and intermediate social determinants of health according to the WHO framework. The contribution of both groups and the contribution of each individual explanatory variable to the remaining teeth gap was estimated using the Blinder-Oaxaca decomposition analysis. RESULTS: The predicted average number of remaining teeth for men was 23.4 and 21.0 for women, thus a mean difference of 2.4 teeth. 49.8% of the inequality between men and women was due to the different distribution (endowments) of the predictors in the model. Among them, structural determinants of health, namely education level (15.8%) and employment status (17.8%), contributed the most. Intermediate determinants had no relevant contribution to explain the gap. CONCLUSIONS: Results revealed that the difference in the mean number of remaining teeth between men and women was mainly explained by two structural determinants: education level and employment status. The lack of explanatory power of intermediate determinants and the large explanatory power of structural determinants means that tackling oral health inequity in Chile requires strong political commitment. The role of intersectoral and intersectional public policies to address gender inequalities in oral health in Chile is discussed.

Changes in oral health inequalities in adults in Chile.

The adult population in Chile has a high prevalence of dental caries and non-functional dentition. Fifteen years after the Health Reform, aimed to reduce health inequalities, it is necessary to analyse changes in social inequalities in oral health in Chilean adults. METHODS: A secondary analysis of data from 2003 and 2016-2017 National Health Surveys (NHS) in Chile was performed on seven oral health outcomes in adults: prevalence of untreated caries, prevalence of severe untreated caries, number of teeth with untreated caries, prevalence of functional dentition, prevalence of edentulism, number of remaining natural teeth and utilization of dental services. Inequalities were measured with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) by education level. RESULTS: A decrease of caries inequalities measured with SII was observed from 2003 to 2016-17 NHS but an increase of remaining teeth inequalities was measured. The SII of the remaining teeth increased from 6.6 [95% CI = 5.0, 8.2] in 2003 to 8.8 [95% CI = 7.3, 10.3] in 2016-17. The SII of functional dentition by education increased from 29.0 [95% CI = 22.0, 36.0] in 2003 to 38.8 [95% CI = 32.6, 45.0]) in 2016-17. The utilization of dental services ≤1 year was the only outcome that showed a decrease in absolute and relative inequality, the SII was 33.9 [95% CI = 23.3, 45.6] in 2003 and 26.2 [95% CI = 16.6, 35.8] in 2016-17 and the RII decreased from 2.5 [95% CI = 1.7, 3.3] in 2003 to RII = 1.8 [95% CI = 1.4, 2.3] in 2016-17. CONCLUSION: The increase of tooth loss inequalities in contrast to the decrease of inequalities in dental services utilization show the need to re-evaluate the current dental programmes for adults in Chile. This may include establishing a stronger oral health promotion strategy and greater dental treatment coverage focusing on avoiding tooth extractions in vulnerable social groups.

Periodontal disease and its impact on general health in Latin America: LAOHA Consensus Meeting Report.

Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.

Periodontal disease and its impact on general health in Latin America: LAOHA Consensus Meeting Report

Abstract: Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.

Development of a self-report questionnaire designed for population-based surveillance of gingivitis in adolescents: assessment of content validity and reliability.

OBJECTIVE: This study aimed to develop and assess the content validity and reliability of a cognitively adapted self-report questionnaire designed for surveillance of gingivitis in adolescents. MATERIAL AND METHODS: Ten predetermined self-report questions evaluating early signs and symptoms of gingivitis were preliminary assessed by a panel of clinical experts. Eight questions were selected and cognitively tested in 20 adolescents aged 12 to 18 years from Santiago de Chile. The questionnaire was then conducted and answered by 178 Chilean adolescents. Internal consistency was measured using the Cronbach's alpha and temporal stability was calculated using the Kappa-index. RESULTS: A reliable final self-report questionnaire consisting of 5 questions was obtained, with a total Cronbach's alpha of 0.73 and a Kappa-index ranging from 0.41 to 0.77 between the different questions. CONCLUSIONS: The proposed questionnaire is reliable, with an acceptable internal consistency and a temporal stability from moderate to substantial, and it is promising for estimating the prevalence of gingivitis in adolescents.

Development of a self-report questionnaire designed for population-based surveillance of gingivitis in adolescents: assessment of content validity and reliability

Abstract The major infectious diseases in Chile encompass the periodontal diseases, with a combined prevalence that rises up to 90% of the population. Thus, the population-based surveillance of periodontal diseases plays a central role for assessing their prevalence and for planning, implementing, and evaluating preventive and control programs. Self-report questionnaires have been proposed for the surveillance of periodontal diseases in adult populations world-wide. Objective This study aimed to develop and assess the content validity and reliability of a cognitively adapted self-report questionnaire designed for surveillance of gingivitis in adolescents. Material and Methods Ten predetermined self-report questions evaluating early signs and symptoms of gingivitis were preliminary assessed by a panel of clinical experts. Eight questions were selected and cognitively tested in 20 adolescents aged 12 to 18 years from Santiago de Chile. The questionnaire was then conducted and answered by 178 Chilean adolescents. Internal consistency was measured using the Cronbach's alpha and temporal stability was calculated using the Kappa-index. Results A reliable final self-report questionnaire consisting of 5 questions was obtained, with a total Cronbach's alpha of 0.73 and a Kappa-index ranging from 0.41 to 0.77 between the different questions. Conclusions The proposed questionnaire is reliable, with an acceptable internal consistency and a temporal stability from moderate to substantial, and it is promising for estimating the prevalence of gingivitis in adolescents.

Prevalence, severity, and risk indicators of gingival inflammation in a multi-center study on South American adults: a cross sectional study.

OBJECTIVES:: The aim of this study is to investigate the prevalence and severity of gingival inflammation and associated risk indicators in South American adults. MATERIAL AND METHODS:: Multi-stage samples totaling 1,650 adults from Porto Alegre (Brazil), Tucumán (Argentina), and Santiago (Chile) were assessed. The sampling procedure consisted of a 4-stage process. Examinations were performed in mobile dental units by calibrated examiners. A multivariable logistic regression model was utilized for associating variables as indicators of gingival inflammation (GI) (Gingival Index ≥0.5). Statistical significance was set at 0.05. RESULTS:: A total of 96.5% of the adults have GI. Regarding the severity of GI, 22.5% of participants examined have mild GI, 74.0% have moderate GI, and 3.6% have severe GI. The multivariate analyses identify the main risk indicators for GI as adults with higher mean of Calculus Index (OR=18.59); with a Visible Plaque Index ≥30% (OR=14.56); living in Santiago (OR=7.17); having ≤12 years of schooling (OR=2.18), and females (OR=1.93). CONCLUSIONS:: This study shows a high prevalence and severity of gingival inflammation, being the first one performed in adult populations in three cities of South America.

Prevalence, severity, and risk indicators of gingival inflammation in a multi-center study on South American adults: a cross sectional study

ABSTRACT Objectives: The aim of this study is to investigate the prevalence and severity of gingival inflammation and associated risk indicators in South American adults. Material and Methods: Multi-stage samples totaling 1,650 adults from Porto Alegre (Brazil), Tucumán (Argentina), and Santiago (Chile) were assessed. The sampling procedure consisted of a 4-stage process. Examinations were performed in mobile dental units by calibrated examiners. A multivariable logistic regression model was utilized for associating variables as indicators of gingival inflammation (GI) (Gingival Index ≥0.5). Statistical significance was set at 0.05. Results: A total of 96.5% of the adults have GI. Regarding the severity of GI, 22.5% of participants examined have mild GI, 74.0% have moderate GI, and 3.6% have severe GI. The multivariate analyses identify the main risk indicators for GI as adults with higher mean of Calculus Index (OR=18.59); with a Visible Plaque Index ≥30% (OR=14.56); living in Santiago (OR=7.17); having ≤12 years of schooling (OR=2.18), and females (OR=1.93). Conclusions: This study shows a high prevalence and severity of gingival inflammation, being the first one performed in adult populations in three cities of South America.