Type 1 diabetes mellitus and oral health: assessment of coronal and root caries.

OBJECTIVES: The oral health of a large cohort of adult insulin-dependent diabetic patients (Type 1), diagnosed 24 years previously with juvenile onset, was comprehensively assessed. This paper describes the prevalence of coronal and root caries in this adult Type 1 diabetic population and evaluates demographic, dietary, behavioral, physiologic, salivary and medical variables associated with decayed and filled surfaces in the crown (DFS) or root (RDFS). METHODS: Type 1 diabetes mellitus subjects participating in this oral health evaluation had been monitored for 6-8 years as participants in the University of Pittsburgh, Department of Epidemiology, longitudinal study of medical complications associated with diabetes. Four hundred and six diabetic subjects received a comprehensive oral health examination during one of their regularly scheduled medical visits. Oral assessments included coronal and root caries, missing teeth, edentulism, periodontal status, soft tissue pathologies, salivary function and health behaviors. Sixteen diabetic subjects and one control subject were edentulous. Coronal and root caries data from the remaining 390 dentate diabetic subjects were compared with 202 dentate nondiabetic control subjects. RESULTS: The adult Type 1 diabetic subjects were not found to have significantly higher DFS rates as compared with our control subjects or published age-adjusted NHANES III findings. Both control and diabetic subjects had low decayed to filled tooth surface ratios. A linear regression model evaluated possible associations with coronal decayed and filled tooth surfaces (DFS) within the diabetic population. Significant factors included older age, women, fewer missing teeth, more frequent use of dental floss, more frequent visits to the dentist during the last 12 months, and diabetic nephropathy. The prevalence of RDFS was higher in the diabetic subjects as compared to recruited control subjects. Neither dietary behaviors nor glycemic control were found to contribute to coronal or root caries. CONCLUSIONS: Factors associated with presence of coronal and root caries and fillings are discussed. Possible causes and implications for the association between DFS and diabetic nephropathy are provided.

Type 1 diabetes mellitus and oral health: assessment of periodontal disease.

BACKGROUND: The periodontal disease status of 320 dentate adults, diagnosed 23.7 years previously with Type 1 insulin dependent diabetes mellitus, was evaluated. These patients had been monitored at 2-year intervals as part of a large University of Pittsburgh longitudinal study assessing the medical complications associated with insulin dependent diabetes. METHODS: During one of their regularly scheduled medical examinations, a group of 320 adult dentate subjects (mean age of 32.1 years) received a periodontal examination as part of a comprehensive oral health assessment. The oral health assessment collected data regarding demographics, oral health behaviors, tooth loss, coronal and root caries, salivary functions, and soft tissue pathologies. For the periodontal assessments, 3 facial sites (mesial, midcervical, distal) of the teeth in the right maxillary/left mandibular or left maxillary/right mandibular quadrants were evaluated for calculus, bleeding on probing (BOP) and loss of gingival attachment (LOA). RESULTS: Attachment loss was significantly greater for older patients whereas BOP and calculus levels were relatively constant across age categories. Univariate analyses of factors possibly related to extensive periodontal disease (LOA > or =4 mm for at least 10% of sites examined) indicated an association with older age; lower income and education; past and current cigarette smoking; infrequent visits to the dentist; tooth brushing less than once per day; older age of onset; longer duration of diabetes; and the diabetic complication of neuropathy. A multivariate regression model of all possibly significant factors found current cigarette use (odds ratio [OR] = 9.73), insulin dependent diabetes onset after 8.4 years of age (OR = 3.36), and age greater than 32 years (OR = 3.00) explained the majority of the extensive periodontal disease in this group of diabetic patients. CONCLUSIONS: Management and prevention of extensive periodontal disease for Type 1 diabetic patients should include strong recommendations to discontinue cigarette smoking.

Type 1 diabetes mellitus and oral health: assessment of tooth loss and edentulism.

OBJECTIVE: The oral health of an adult population previously diagnosed with juvenile onset insulin dependent-diabetes was comprehensively assessed. The goal of this exploratory cross-sectional evaluation was to described the characteristics related to partial tooth loss edentulism in subjects with Type 1 diabetes mellitus. METHODS: An adult population of 406 Type 1 diabetes mellitus subjects, who had been monitored for 6-8 years as part of a University of Pittsburgh longitudinal study of medical complications associated with diabetes, received an oral health examination for missing teeth, edentulism, coronal and root caries, periodontal status, and oral health behaviors. RESULTS: Of the 406 subjects evaluated, 204 had no missing teeth, 186 had partial tooth loss (1-27 missing teeth), and 16 were edentulous. Patients who had partial tooth loss or who were edentulous were generally older; had lower incomes and levels of education; and had higher rates of nephropathy, neuropathy, retinopathy, and peripheral vascular disease. A logistic regression model found partial tooth loss to be significantly associated with extensive periodontal disease in remaining teeth (OR = 7.35), a duration of diabetes longer than 24 years (OR = 5.32), not using dental floss (OR = 2.37), diabetic neuropathy (OR = 2.29), household income less than $20,000 (OR = 2.21), multiple coronal caries and fillings (OR = 1.98), and bleeding on probing (OR = 1.82). CONCLUSIONS: Although the majority of these adult Type 1 diabetes patients had serious medical complications associated with their diabetes, the possible impact of diabetes mellitus on oral health should be included in their overall management.

Age at first childbirth and later poverty.

PIP: A linear structural equation model is used in this research study in order to estimate the simultaneous effects of age at first birth on a woman's subsequent socioeconomic conditions and related outcomes after the age of 27 years. Estimation was accomplished with a variant of Amemiya's principle and a feasible generalized least squares estimator. Analysis involved examination of the bivariate relationship between age at first birth and poverty at age 27 years for Blacks, Hispanics, and Whites, followed by structural equation models for each racial group and then analysis of the total and indirect effects of age at first birth on poverty. Poverty is measured as the ratio of family income to the poverty threshold. Findings indicate that the association between early childbearing and poverty at the age of 27 years is very strong. Young women with educated parents and women with reading materials in their home before the age of 14 years achieved more schooling. When these effects were controlled, being raised by both parents and having more siblings were only associated with more schooling among Whites. Rural Blacks and Whites completed more schooling than rural Hispanics. Blacks in poor states had lower educational attainment. Age at first birth was only significant among Hispanics. First birth was delayed by 1.26 years among Blacks, 0.88 years among Whites, and 0.98 years among Hispanics for having an additional year of schooling. Delaying marriage had the strongest effect among Whites. Delayed childbearing among Blacks was predicted by having fewer siblings, being raised by both parents, and later menstruation. Earlier White childbearing was associated with women from larger families and women with larger ideal family sizes. Hispanic women raised by both parents was associated with delayed childbearing. Findings confirm that age at first birth was associated for all racial groups with poverty. Age at first birth affected educational attainment of Hispanics and age at first marriage among Whites. Age at first birth impacted on poverty through the number of children among Blacks and Whites, White and Hispanic women's earnings, and Hispanic earnings among other household members. Delaying first births had minimal impact on later poverty among Blacks and considerable impact among Whites and Hispanics.^ieng

Farm background, socioeconomic status, and fertility: the two-generation hypothesis.

PIP: This paper examines whether the effects of farm background on socioeconomic differentials in fertility are diminished among nonfarm couples. The data are for a sample of white ever-married women belonging to the 1901-1910 birth cohorts. The research provides another test of the 2 generation-urbanite hypothesis 1st advanced by the Goldberg studies of Detroit and Indianapolis. Unlike a number of other studies, the findings do not support the hypothesis. Thus, a number of questions arise concerning the results obtained by previous investigators in support of this hypothesis. Different types of samples measuring farm background and socioeconomic status may be plausible explanations for the differing results. It is also important to note that both the Detroit and Indianapolis samples can hardly be considered representative of US urban populations in the 1940s and 1950s. A further difficulty with the Detroit study was that Goldberg aggregated the data of a relatively large number of cohorts. The Indianapolis sample was constrained by the eligibility requirements of the original study. The difficulties of adequately testing Goldberg's hypothesis may have been compounded by the extension of the hypothesis to nationally representative samples. Moreover, The hypothesis was not supported when education was used as a measure of socioeconomic status in the Detroit study. Until other studies can be carefully replicated, definitive answers to such questions as to whether fertility differentials by socioeconomic status will disappear or have become attenuated must remain an unanswered question.^ieng