Exploring the association of dental care utilization with oral impacts on daily performances (OIDP) - a prospective study of ageing people in Norway and Sweden.

OBJECTIVES: To explore the association of dental health care utilization with oral impacts on daily performances (OIDP) across time focusing ageing Norwegian and Swedish adults adjusting for predisposing, enabling, and need related-factors as defined by Andersen's model. METHODS: Data were based on Norwegian and Swedish 1942 birth-cohorts conducted in 2007 (age 65) and 2012 (age 70). In Norway, the response rates ranged from 54% to 58%. Corresponding figures in Sweden were from 72% to 73%. Self-administered questionnaires assessed OIDP, dental care utilization and predisposing, enabling and need related factors. Logistic regression with robust variance estimation was used to adjust for clustering in repeated data. RESULTS: Significant covariates of OIDP were satisfaction with dental services, dental care avoidance due to financial constraints, frightening experience with dental care during childhood and patient initiated dental visiting. Frequency and regularity of dental attendance were associated with OIDP in the Swedish cohort, only. CONCLUSIONS: In spite of country differences in the public co-financing of dental care, dental care utilization indicators were associated with OIDP across time in both cohorts. Encouraging regular and dentist initiated visiting patterns and strengthening beliefs in keeping own teeth could be useful in attempts to reduce poor oral health related quality of life in ageing people.

Scandinavian systems monitoring the oral health in children and adolescents; an evaluation of their quality and utility in the light of modern perspectives of caries management.

BACKGROUND: Recording reliable oral health data is a challenge. The aims were a) to outline different Scandinavian systems of oral health monitoring, b) to evaluate the quality and utility of the collected data in the light of modern concepts of disease management and to suggest improvements. MATERIAL AND METHODS: The information for in this study was related to (a) children and adolescents, (b) oral health data and (c) routines for monitoring such data. This meant information available in the official web sites of the "KOSTRA-data" (Municipality-State-Report) in Norway, the Swedish National Board of Health and Welfare ("Socialstyrelsen") and Oral Health Register (the SCOR system, National Board of Health) in Denmark. RESULTS: A potential for increasing the reliability and validity of the data existed. Routines for monitoring other oral diseases than caries were limited. Compared with the other Scandinavian countries, the data collection system in Denmark appeared more functional and had adopted more modern concepts of disease management than other systems. In the light of modern concepts of caries management, data collected elsewhere had limited utility. CONCLUSIONS: The Scandinavian systems of health reporting had much in common, but some essential differences existed. If the quality of epidemiological data were enhanced, it would be possible to use the data for planning oral health care. Routines and procedures should be improved and updated in accordance with the modern ideas about caries prevention and therapy. For appropriate oral health planning in an organised dental service, reporting of enamel caries is essential.

Satisfaction with teeth and life-course predictors: a prospective study of a Swedish 1942 birth cohort.

This study aimed to assess the stability or change in satisfaction with teeth among Swedish adults between the ages of 50 and 65 yr, and to identify the impact of socio-demographics and of clinical and subjective oral health indicators on participants' satisfaction with teeth during that period. Self-administered standardized questionnaires were used as part of a longitudinal study. In 1992, 1997, 2002, and 2007 all residents (born in 1942) of two Swedish counties were invited to participate in the study. A total of 63% women and 66% men reported being satisfied with their teeth between 50 and 65 yr of age. The corresponding figures, with respect to dissatisfaction, were 7% and 6% respectively. Generalized estimated equation models revealed a decline in the odds of being satisfied with advancing age, which was particularly important in subjects with lower education, tooth loss, and smokers. Consolidation in oral health perceptions starts before age 50, suggesting early intervention before that age. Promotion of a healthy adult lifestyle and improved access to quality oral healthcare might increase the likelihood of people being satisfied with their teeth throughout the third age-period in both genders.

Variation in subjective oral health indicators of 65-year-olds in Norway and Sweden.

OBJECTIVE: Guided by the conceptual framework of Gilbert and co-workers, this study assesses satisfaction with oral health as reported by 65-year-olds in Sweden and Norway, the relationship of socio-demographic factors, clinical and subjective oral health indicators with satisfaction of oral health, and the consistency of those relationships across countries. MATERIAL AND METHODS: In 2007, standardized questionnaires were mailed to all the residents in two counties in Sweden and three in Norway who were born in 1942. Response rates were 73.1% (n=6078) in Sweden and 56.0% (n=4062) in Norway. RESULTS: Totals of 76.8% of the Swedish and 76.5% of the Norwegian participants reported satisfaction with oral health. Corresponding figures for toothache were 48.1% (Sweden) versus 51.5% (Norway), and for temporomandibular joint symptoms, 10.9% (Sweden) versus 15.1% (Norway). Multiple logistic regression analysis revealed that subjects who perceived they had bad health, smoked daily, had missing teeth, experienced toothache, had problems with chewing, bad breath, and oral impacts were less likely than their counterparts in the opposite groups to be satisfied with their oral health status. The corresponding odds ratios (ORs) ranged from 0.08 (problems chewing) to 0.2 (oral impact). No statistically significant two-way interactions occurred and the model explained 46% of the variance in satisfaction with oral health across the two countries (45% in Sweden and 47% in Norway). CONCLUSIONS: The oral condition of 65-year-olds in Norway and Sweden produced impacts in oral symptoms, functional limitations, and problems with daily activities that varied to some extent. Satisfaction with oral health varied by socio-demographic factors and subjective oral health indicators. A full understanding of the oral health and treatment needs of 65-year-olds cannot be captured by clinical measures alone.

Socio-economic inequality in the self-reported number of natural teeth among Norwegian adults--an analytical study.

OBJECTIVE: To assess inequality in dental status associated with educational level, gross personal and family income among Norwegian adults. METHODS: Data were collected by Norway's Central Bureau of Statistics in November-December 2003. A two-stage, proportional random sample comprising 2000 persons aged 16-79 years was drawn from the national population register. Information became available for 1309 subjects by interview. The present analyses pertain to 1092 subjects aged 25-79 years (response rate 66%, mean age 47.9 years). RESULTS: Of the respondents, 3% were edentulous and 9% had fewer than 20 teeth. The mean number of teeth was 27.1 (SD 7.0). In multiple logistic regression analysis, low gross personal and adjusted family income were associated with increased likelihood of having fewer than 20 natural teeth (OR = 2.84, 95% CI 1.58, 5.10; OR = 3.63, 95% CI 1.99, 6.62, respectively). Educational level was significantly associated with dental status in bivariate but not in multivariate analyses, except once among males. The predictors of socio-economic inequality in dental status accounted for a limited proportion of explained variance (Nagelkerke's R(2)) when controlling for age, place of residence, perceived oral health compared with others, perceived importance of oral health, dental attendance and smoking. CONCLUSION: Socio-economic inequality in dental status persists among Norwegians aged 25-79 years but absolute differences have decreased during the last 30 years. The findings are encouraging but challenging as far as choice of strategy for further reduction of differences in tooth loss.

Predictors of Norwegian dentists' decisions to recommend replacement of teeth at the time of extraction.

OBJECTIVE: To study predictors of dentists' recommendations to replace the teeth which they extracted for adult patients in Norway in 1998. DESIGN: Cross-sectional postal questionnaire survey. PARTICIPANTS: A systematic random sample of 1,500 Norwegian general dental practitioners and response rate of 67% after two reminders. After exclusions, 302 dentists who had extracted 822 permanent teeth for 587 patients (16-92 years old) over a period of two weeks, were accepted for the study. RESULTS: According to the dentists, 30% of the patients were in definite need of a replacement for the extracted tooth or teeth, 29% were cases open to question and 41% had no need for a replacement. Model I: Tooth type extracted and the number of teeth extracted per patient were the most important predictors of the dentists definitely recommending a replacement after tooth extraction. Model II: When including the group of patients for whom a replacement was open to question, the odds of the dentists recommending a replacement for having an extracted anterior tooth or premolar increased from 13 (95% CI 6.16, 26.07) to 21 (95% CI 10.51, 40.69). Demographic characteristics had no significant effect on the dentists' decision. CONCLUSIONS: The two most important predictors for recommending a replacement after extraction were the position of the tooth or teeth and the number of teeth extracted. The reason why the number of remaining teeth had no significant independent effect was possibly because this group of patients had a relatively high number of natural teeth.