Disparities of Delayed Dental Visits and Severe Tooth Loss Among Older Native Hawaiians and Other Pacific Islanders in Hawai'i: A Cross-Sectional Study of Behavioral Risk Factor Surveillance System Data from 2012 to 2020.

Oral health is a major health concern in the US and globally, particularly among communities of color and low-income/low-education groups. General health disparities have been reported among Native Hawaiians (NHs) and Other Pacific Islanders (OPIs), although less is known about the specific racial/ethnic and socioeconomic trends that are relevant to oral health disparities for NHOPIs. We examined delayed dental visits and severe tooth loss among older NHOPI adults in relation to sociodemographic factors and community level disparities using five waves of data from the Hawai'i Behavioral Risk Factor Surveillance System collected between 2012 and 2020. Weighted Poisson regression was used to estimate the unadjusted and adjusted prevalence ratio of delayed dental service utilization and severe tooth loss. Relative to other racial/ethnic groups, older NHs had higher rates of delayed dental service utilization and severe tooth loss after adjusting for sociodemographic factors, and disparities were also found in rural communities.Awareness of the unique challenges and inequities faced by older Indigenous and racially/ethnically marginalized populations is critical for policymakers to develop strategies to achieve health equity.

Evaluation of oral health among people with multimorbidity in the marginalized population of Karachi, Pakistan: A multicenter cross-sectional study.

Background: Oral health is linked to physical and mental well-being. Oral disease is common among poor and socioeconomically disadvantaged people in developing and industrialized countries. Objectives: This study assessed the oral health disease burden among people with multimorbidity in marginalized populations. Methods: This cross-sectional study was conducted across 16 locations in the slums of Karachi, Pakistan, to assess oral health disease problems among adults aged 18 to 70 with comorbidity or multimorbidity. The questionnaire covered the socioethnic, demographic, and disease status of people with oral health status. Data analyses were performed using SAS version 9.4. Results: Of the 16 designated slum locations, 870 individuals were considered for oral health screening. Gingivitis was highly prevalent, 29% among slum dwellers with multimorbidity of diabetes, hepatitis, and hypertension. Dandasa was widely used as a tooth-cleansing agent in 35% of the study population. By contrast, 45.4% of people showed unsatisfactory oral hygiene conditions. Pathan ethnicity showed the highest prevalence (i.e., 29.8% of dental problems with disease multimorbidity in 26.8% of Baldia Town residents of Karachi). Of the 870 individuals, the highest frequency of dental problems was found in the age group of 18-38 years (28-42.9%) and among female participants (53.8%). Conclusion: There is an urgent need for the global enhancement of public health programs, specifically focusing on implementing effective strategies to prevent oral illnesses, promote oral health, and address other chronic diseases in basic healthcare settings. Enhancing oral health poses significant difficulties, especially in less developed nations.

Utilization of dental care and dentate status in diabetic and nondiabetic patients across US states: An analysis using the 2020 Behavioral Risk Factor Surveillance System.

OBJECTIVE: This study examines the differences, by state, in dental care utilization and tooth retention between adults with and without diabetes mellitus (DM). METHODS: We conducted a secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System, an annual, state-based, random telephone survey of noninstitutionalized US civilian adults. The predictor variable was DM status. The outcome variables were time since the last dental appointment and tooth loss. We utilized multiple multinomial logistic regression models followed by postestimation procedures to determine state-level adjusted proportions for dental visits within the last year and complete teeth retention among DM and non-DM adults. RESULTS: Among adults with DM, 60.0% reported dentist visits within a year of survey participation, while 53.6% had complete tooth retention. As education and income levels increased, dental attendance and tooth retention increased among adults with DM. Most Southern states had a higher prevalence of DM, a lower proportion of dentist visits, and worse tooth retention among DM adults. Nationally, DM individuals were 4.3 percentage points less likely to visit a dentist and were 7 percent less likely to have complete teeth retention than non-DM adults. Compared with the national average, 25/50 states had greater disparities in dental visits between DM and non-DM adults, and 27/50 states had greater disparities in tooth loss between DM and non-DM adults. CONCLUSION: State-level variations indicate geographical and dental coverage influences on DM and dental outcomes. There is a need for state-specific interventions to improve dental access and outcomes for adults with DM.

Dental Loss in the Lower Socioeconomic Stratum of a Sample of the Chilean Population Born in the 19TH and 20TH Centuries / Pérdida Dental en el Estrato Socioeconómico Bajo de una Muestra de la Población Chilena Nacida en los Siglos XIX y XX

SUMMARY: Partial or total dental loss (edentulism) is associated with decreased quality of life. Chile has large socioeconomic gaps, which are also recognized in oral health, but it is not known how Edentulism has evolved throughout the country. The aim of this study was to determine the edentulism in people born during the 19th and 20th centuries in Chile, who died in the 20th century, and to compare it with current data from the Chilean Ministry of Health (MINSAL) to observe its evolution in the country. For this purpose, 60 3D models of skulls from the Subactual Osteological Collection of Santiago were analyzed (30 individuals per sex), in which the presence and absence of teeth in antemortem in the maxilla were analyzed. A high percentage of tooth loss was observed, with 65 % partial edentulism, a 30 % total edentulism, and only 5 % had complete dentition in this osteological collection. In addition, a significant decrease over time was found; in 2017, the percentage of complete dentition at the national level was 32.8 %. A higher frequency of edentulism was also found in females from the osteological collection, with a significant probability of twice as much edentulism as in males. However, this sex difference was smaller than those found in the current study. Our study is the first to compare edentulism in Chile in two different time periods, since, in addition to studying it in the 19th and 20th century, it is carried out with data from the present day and in line with previous research, reveals the importance of socioeconomic and sex variables for dental loss.

La pérdida parcial o total de dientes (edentulismo) se asocia a una disminución de la calidad de vida. Chile tiene grandes brechas socioeconómicas, que también se reconocen en la salud oral, pero se desconoce cómo ha evolucionado el edentulismo en el país. El objetivo de este estudio fue determinar el edentulismo en personas nacidas durante los siglos XIX y XX en Chile y fallecidas en el siglo XX, y compararlo con datos actuales del Ministerio de Salud de Chile (MINSAL) para observar su evolución en el país. Para ello, se analizaron 60 modelos 3D de cráneos de la Colección Osteológica Subactual de Santiago (30 individuos por sexo), en los que se analizó la presencia y ausencia de dientes en dentición antemortem en el maxilar. Se observó un alto porcentaje de pérdida dentaria, con un 65 % de edentulismo parcial y un 30 % de edentulismo total, y sólo un 5 % presentaba dentición completa en esta colección osteológica. Además, se encontró una disminución significativa a lo largo del tiempo; en 2017, la dentición completa a nivel país fue del 32,8 %. También se encontró una mayor frecuencia de edentulismo en las mujeres de la colección osteológica, con una probabilidad significativa del doble de edentulismo que en los hombres. Sin embargo, esta diferencia de sexo fue menor que la hallada en datos actuales. Este estudio es el primero que compara el edentulismo en Chile en dos épocas diferentes, ya que además de estudiarlo en los siglos XIX y XX, se realizó con datos de la actualidad y, en línea con investigaciones previas, revela la importancia de las variables socioeconómicas y de sexo en la pérdida dental.

Estimation of Oral Disease Burden among Older Adults in LTC: A Scoping Review.

Oral health is an essential part of healthy aging and very little data exists around the disease burden for older adults in a long-term care setting. The aim of this scoping review was to estimate the disease burden of dental caries, periodontal disease, and tooth loss among older adults in Long-Term Care (LTC). This scoping review was conducted in accordance with the Joanna Briggs Institute methodology. A detailed strategy was used to conduct a comprehensive search of electronic databases: PubMed, Embase, and Dentistry and Oral Sciences Source (DOSS). The Rayyan AI platform was used to screen abstracts for assessment by one of five co-investigators. Results indicate that only one in three might have a functional dentition upon entry into LTC, and among those who are dentate, most might expect to develop at least one new coronal and one new root caries lesion each year. There is a need to better document the disease experiences of this group to tailor approaches to care that might reduce the avoidable suffering as a result of dental caries and periodontal disease.

Oral Health Considerations for Adults Aged 18 Years or More Seeking Dental Care in the Past Year: A CDC Oral Health Data Analysis.

BACKGROUND:  Oral health is an essential aspect of overall well-being, with regular dental care being fundamental to its maintenance. This study focuses on understanding dental care utilization among adults aged 18 and above who have visited a dentist or dental clinic in the past year, aiming to uncover patterns, disparities, and determinants of oral health practices within this demographic. METHODS:  Data from the U.S. Centers for Disease Control and Prevention (CDC) Oral Health dataset were utilized to conduct this analysis. The dataset encompasses a diverse and nationally representative sample of adults aged 18 and above. The study explored the proportion of adults who sought dental care between 2008 and 2020, further stratified by demographic variables including age, gender, income, education, and race. The analysis provides insights into the prevalence of dental care utilization and the role of demographic factors in shaping oral health behaviors. RESULTS:  The study found that 64.8% (n =397,291; 95% CI: 64.4 - 65.2) of adults aged 18 and above visited a dentist or dental clinic in 2020. Subgroup analysis revealed variations in dental care use by age, gender, income, education, and race. Among genders, 67.4% (n = 150,510; 95% CI: 66.9 - 67.9) of females sought care in 2020, compared to 61.9% (n = 116,535; 95% CI: 61.4 - 62.4) of males. Those earning >$50,000 had the highest proportion, 75.3% (n = 13,363; 95% CI: 74.8 - 75.8), seeking care. Among racial groups, White adults had the highest proportion, 68.4% (n = 204,486; 95% CI: 68.0 - 68.8) in 2020. In education groups, college graduates or professionals had the highest, 77.3% (n = 121,800; 95% CI: 76.8 - 77.8) in 2020. Among ages, adults aged 65+ had the highest proportion, 67.1% (n = 96,012; 95% CI: 66.4 - 67.8) in 2020. However, as age decreased, dental visit proportion generally remained within the same range. CONCLUSION:  This study enhances our understanding of dental care utilization patterns within the studied population, shedding light on disparities in oral health practices. Moreover, it provides insight into how demographic factors shape dental/oral healthcare-seeking behaviors. Ultimately, these insights guide efforts to improve oral health outcomes and well-being within this population.

The role of differential exposure and susceptibility to heavy drinking linking income inequalities and tooth loss: An investigation of the alcohol harm paradox using a four-way decomposition analysis.

OBJECTIVES: To examine the extent to which the effect of income inequalities on tooth loss is attributable to differential exposure and susceptibility to heavy drinking in older Brazilian adults. METHODS: We conducted a secondary analysis using data from The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016), a nationally representative sample of community-dwelling people aged 50 years and over. Causal mediation analysis based on the counterfactual outcome framework decomposed the effect of income on tooth loss mediated by heavy drinking into four components (four-way decomposition): controlled direct effect (neither mediation nor interaction), reference interaction (interaction only), mediated interaction (both mediation and interaction) and pure indirect effect (mediation only). Proportions of effect attributable to each component were calculated to estimate the differential exposure (the sum of the third and fourth components) and differential susceptibility (the sum of the second and third components) to heavy drinking. RESULTS: The analytical sample comprised 8114 participants. After adjusting for covariates, 7.3% (95% CI: 3.8%; 10.9%) and -39.5% (95% CI: -75.8%; -3.3%) of the effects of income on tooth loss were attributable to differential exposure and susceptibility to heavy drinking, respectively, consistent with the alcohol harm paradox. When setting non-functional dentition as outcome, only the effect of differential susceptibility remained (-81.7% [95% CI: -128.2%; -35.2%]). CONCLUSION: Our findings suggest that individuals of low-income groups appear to be more susceptible to the effects of heavy drinking on tooth loss.

Socioeconomic Status and Tooth Loss Impact on Oral Health-Related Quality of Life in Chinese Elderly.

OBJECTIVE: We studied the association between the socioeconomic status (SES), tooth loss, and oral health-related quality of life (OHRQoL) in an adult cohort in western China. As socioeconomic inequalities in oral health are often neglected in oral health promotion. we aimed to verify the impact of SES on tooth loss and OHRQoL. METHODS: In all, 348 participants aged 60 years and older were selected for this study. Relationships amongst SES, tooth loss, and OHRQoL were identified by using a structural equation model (SEM). RESULTS: In the final sample, 312 people were included, and the response rate was 89.7%. The bias-corrected 95% confidence intervals of the total, direct, and indirect effects were (-0.267 to 0.475), (-0.489 to 0.185), and (0.088 to 0.450), respectively. The comparative fit index of SEM was 0.943. The model showed that their SES directly affected tooth loss in the elderly population. This indirectly affects their oral health-related quality of life. The numbers of natural teeth and occlusal units (with standardised path coefficients of 0.79 and 0.74, respectively) were found to be the most significant factors relating to tooth loss. CONCLUSION: SES affected the oral health-related quality of life in elderly people through tooth loss in a Chinese study population. Our data suggest that improvements in the social and economic environments are a primary measure that should be implmented to prevent tooth loss and improve the OHRQoL.

Influence of disabilities on state-level disparity in dental care utilization and tooth loss: Findings from the 2020 Behavioral Risk Factor Surveillance System.

INTRODUCTION: The aim of this study is to describe the prevalence of disparity in access to dental care and tooth loss between US adults with and without disabilities at the state level. METHODS: This secondary analysis included data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional state-run annual telephone survey of noninstitutionalized US adults aged 18 years or older. The primary predictor, having any disability, was defined as reported difficulty in hearing, vision, cognition, mobility, self-care, or independent living. The two dental outcomes used were reported time since last dental visit and missing teeth status. We conducted descriptive analysis and multinomial regression models on weighted data to report the prevalence and state-level disparity in dental outcomes between individuals with and without disability. RESULTS: Nationally, one in four adults reported a disability, with a disproportionately higher prevalence among females, Native Americans and lower education and income groups. The highest utilization of dental services within a year among individuals with disabilities was found in the Northwestern and Midwestern states. Western states had the highest proportion of individuals with disability to have had a recent dental visit and a complete dentition, while the Southern states had the lowest proportions. After adjusting for sociodemographic factors, 59.1% of individuals with disabilities had dental visits within a year, which is 8.0% points less than those without disabilities. Similarly, only 50.8% of individuals with a disability had complete tooth retention, which is 10.1% points less than individuals without disability. Regardless of the type of disability, adults with a disability were less likely to have visited the dentist in the past year or to have retained all of their teeth. Those with self-care disabilities had the lowest rates of both. CONCLUSION: There were clear disparities in the utilization of dental care and dentate status among adults with disabilities at the state level. The findings from this study highlighted the necessity of finding local solutions to address the gap in dental care utilization and tooth loss between those with and without disability among the US population.

Using machine learning to study the association of sociodemographic indicators, biomarkers, and oral condition in older adults in Colombia.

BACKGROUND: Chronic health conditions and socioeconomic problems that affect the well-being and life expectancy of older adults are common. The objective of this cross-sectional study was to analyze the association between sociodemographic variables, oral conditions, and general health and the biomarkers of older adults using machine learning (ML). METHODS: A total of 15,068 surveys from the national study of Health, Well-Being and Aging (Salud, Bienestar y Envejecimiento) data set were used for this secondary analysis. Of these, 3,128 people provided blood samples for the analysis of blood biomarkers. Sociodemographic, oral health, and general health variables were analyzed using ML and logistic regression. RESULTS: The results of clustering analysis showed that dyslipidemia was associated with poor oral condition, lower socioeconomic status, being female, and low education. The self-perception of oral health in older adults was not associated with the presence of teeth, blood biomarkers, or socioeconomic variables. However, the necessity of replacing a dental prosthesis was associated with the lowest self-perception of oral health. Edentulism was associated with being female, increased age, and smoking. CONCLUSIONS: Socioeconomic and educational disparities, sex, and smoking are important factors for tooth loss and suboptimal blood biomarkers in older adults. ML is a powerful tool for identifying potential variables that may aid in the prevention of systemic and oral diseases in older adults, which would improve geriatric dentistry. PRACTICAL IMPLICATIONS: These findings can help the academic community identify critical sociodemographic and clinical factors that influence the process of healthy aging and serve as a useful guide to enhance health care policies and geriatric oral health care services.

Assessment and Improvement of Masticatory Performance in Frail Older People: A Narrative Review.

According to the World Health Organization (WHO), the estimated number of older adults is around 962 million and is projected to increase to 2.1 billion by 2050. The oral frailty concept is associated with gradual oral function loss in relation to aging. There is a need to emphasize the improvement of oral function based on an evaluation of masticatory performance in patients with various oral conditions or systemic diseases and especially in the frail elderly. The present narrative review presents an overview of the current state of the assessment and improvement of masticatory performance in frail older people. To fully encompass oral frailty, oro-facial hypofunction, or oro-facial fitness, dental Patient Reported Outcomes (dPROs) should be included; nevertheless, there are limited evidence-based rehabilitation approaches. The concept of oral frailty, oro-facial hypofunction, or oro-facial fitness should involve dental Patient Reported Outcomes (dPROs), and in this sense, there are only a few evidence-based rehabilitation procedures to improve oro-facial hypofunction besides prosthodontics. It must be considered that reduced neuroplastic capacity in old individuals might preclude a positive outcome of these strategies that might need to be accompanied by functional training and nutritional counseling.

Validity of self-reported oral conditions among Brazilian older women: Do socio-economic factors matter?

OBJECTIVE: To validate the level of agreement between self-report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self-report among women aged 60 and older. METHODS: A cross-sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF-T index) and the use of dental prostheses. The self-reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin's concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information. RESULTS: Ninety-nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self-reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self-reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels. CONCLUSIONS: Our findings suggest that the participants' socio-economic position might influence their self-reported number of teeth.

Underlying pathways of social inequality in tooth loss: the mediating role of sugary beverages and diabetes.

BACKGROUND: Previous studies show social inequality in tooth loss, but the underlying pathways are not well understood. The aim was to investigate the mediated proportion of sugary beverages (SBs) and diabetes and the association between educational level and tooth loss, and to investigate whether the indirect effect of SBs and diabetes varied between educational groups in relation to tooth loss. METHODS: Data from 47,109 Danish men and women aged 50 years or older included in the Danish Diet, Cancer and Health Study was combined with data from Danish registers. Using natural effect models, SBs and diabetes were considered as mediators, and tooth loss was defined as having <15 teeth present. RESULTS: In total, 10,648 participants had tooth loss. The analyses showed that 3% (95% confidence interval 2-4%) of the social inequality in tooth loss was mediated through SBs and diabetes. The mediated proportion was mainly due to differential exposure to SBs and diabetes among lower educational groups. CONCLUSIONS: The findings show that SBs and diabetes to a minor degree contribute to tooth-loss inequalities. The explanation indicates that individuals in lower educational groups have higher consumption of SBs and more often suffer from diabetes than higher educational groups.

Oral Health Disparities and Inequities in Older Adults.

The number of individuals 65 and older living in the United States is increasing substantially and becoming more racially and ethnically diverse. This shift will affect the demographics of the patient population seeking dental care. It will also impact the future treatment needs of older adults. In older adults, similar to the general adult population, oral health disparities continue to exist related to race, ethnicity, gender, and socioeconomic level. Dental practitioners must understand these changes in order to meet the challenges of providing oral health care to the increasing numbers of diverse, medically compromised, and cognitively impaired older adults.

Education-related inequalities in oral health among older adults: Comparing Singapore and Japan.

OBJECTIVES: Oral health inequalities exist worldwide, and cross-country comparisons can provide valuable insights into country-level characteristics contributing to such inequalities. However, comparative studies in Asian countries are limited. This study examined the magnitude of education-related oral health inequalities in older adults in Singapore and Japan. METHODS: Longitudinal data for older adults, aged ≥65 years, from the Panel on Health and Ageing of Singaporean Elderly (PHASE; 2009, 2011-2012, and 2015) and Japan Gerontological Evaluation Study (JAGES; 2010, 2013, and 2016) were used. Dependent variables were being edentate and having a minimal functional dentition (MFD; i.e. ≥20 teeth). The absolute and relative inequalities were calculated using the slope index of inequality (SII) and relative index of inequality (RII) for educational level [low (<6 years); middle (6-12 years); high (>12 years)] in each country. RESULTS: A total of 1032 PHASE participants and 35 717 JAGES participants were included. At baseline among PHASE participants, 35.9% were edentate and 24.4% had MFD, while among JAGES participants, 8.5% were edentate and 42.4% had MFD. The prevalence of low, middle and high educational levels for PHASE was 76.5%, 18.0% and 5.5%, and for JAGES were 0.9%, 78.1% and 19.7%, respectively. Older adults in Japan had lower education-related inequalities for being edentate [for both SII (-0.53, 95% CI = -0.55 to -0.50) and RII (0.40, 95% CI = 0.33-0.48)] and for not having MFD for both SII (-0.24, 95% CI = -0.27 to -0.20) and RII (0.83, 95% CI = 0.79-0.87) compared to Singapore. CONCLUSIONS: Education-related inequalities for being edentate and not having MFD were higher among older adults in Singapore compared to Japan.

Ethnicity, Social Support and Oral Health Among English Individuals.

OBJECTIVE: To determine whether social support explains ethnic inequalities in oral health among English individuals. METHODS: Data from 42704 individuals across seven ethnic groups in the Health Survey for England (1999-2002 and 2005) were analysed. Oral health was indicated by self-reports of edentulousness and toothache. Social support was indicated by marital status and a 7-item scale on perceived social support. Confounder-adjusted regression models were fitted to evaluate ethnic inequalities in measures of social support and oral health (before and after adjustment for social support). RESULTS: Overall, 10.4% of individuals were edentulous and 21.7% of dentate individuals had toothache in the past 6 months. Indian (Odd Ratio: 0.50, 95% Confidence Interval: 0.32-0.78), Pakistani (0.50, 95%CI: 0.30-0.84), Bangladeshi (0.29, 95%CI: 0.17-0.47) and Chinese (0.42, 95%CI: 0.25-0.71) individuals were less likely to be edentulous than white British individuals. Among dentate participants, Irish (1.21, 95%CI: 1.06-1.38) and black Caribbean individuals (1.37, 95%CI: 1.18-1.58) were more likely whereas Chinese individuals (0.78, 95%CI: 0.63-0.97) were less likely to experience toothache than white British individuals. These inequalities were marginally attenuated after adjustment for marital status and perceived social support. Lack of social support was associated with being edentulousness and having toothache whereas marital status was associated with edentulousness only. CONCLUSION: The findings did not support the mediating role of social support in the association between ethnicity and oral health. However, perceived lack of social support was inversely associated with worse oral health independent of participants' sociodemographic factors.

A longitudinal assessment of chronic periodontitis in Australian adults.

AIM: The study aimed to estimate the incidence/progression and reversal of chronic periodontitis and to identify factors associated with chronic periodontitis in Australian adults over a 12-year period. MATERIALS AND METHODS: Data were obtained from the longitudinal component of the National Study of Adult Oral Health (NSAOH) in 2004-2006, and repeated data, among the same adults, in 2017-2018. NSAOH 2004-2006 was a population-based study of Australian adults aged 15+ years. The American Academy of Periodontology/European Federation of Periodontology case definitions were used, and then compared with two other case definitions. Multivariable Poisson regression models were used to estimate incidence rate ratios (IRRs) and reversal rate ratio (RRRs) of periodontitis. RESULTS: A total of 775 dentate Australian adults had dental examinations at both times. The proportion of incidence/progression and reversal among Australian adults was 56.4% and 11.0%, respectively. Tobacco smokers presented with more than three times higher incidence (IRR: 3.32, 95% CI: 1.50-7.60) and lower reversals (RRR: 0.94, 95% CI: 0.39-0.98) than those who had never smoked. Cessation of smoking was positively associated with periodontitis reversal. The total incidence/progression was 471.7/10,000 person-years, with reversal being 107.5/10,000 person-years. The average number of teeth lost due to periodontal disease was 1.9 in 2017-2018. Being male and not having periodontal treatment were significant risk markers for the incidence/progression of periodontitis. CONCLUSION: Smoking is a risk factor for periodontitis. Cessation of smoking is an effective means of reducing the incidence and progression of chronic periodontitis, to reduce the risk of tooth loss, and to improve overall periodontal health.

Effects of universal oral healthcare coverage in an adult population: A long-term nationwide natural experiment.

OBJECTIVES: A large and long-term natural experiment occurred in Finland from the late 1980s-2000, when adults' entitlement to subsidized oral healthcare was strongly dependent on the arbitrary classification based on their year of birth: people born in 1956 or later were entitled to subsidized care, while people born before 1956 were not. The aim of this study was to investigate the effect of this expanded universal oral healthcare coverage on service use and oral health outcomes. METHODS: Data from annual nationally representative cross-sectional postal surveys among 15-64-year-olds between 1990 and 2014 were used. For this study, the following outcome variables were formed: experiencing toothache during the past month (yes/no), the number of missing teeth with three different thresholds (over 10, over 5 or at least 1 missing tooth), brushing more than once a day and the number of visits to the dentist. Regression discontinuity plots and bias-corrected local polynomial regression discontinuity estimators measuring the effect of the extended universal coverage on the outcomes at the year-of-birth cut-off of 1956 were generated separately from the data from 1990 to 2000 and from 2002 to 2014. RESULTS: Between 1990 and 2000, the number of visits to the dentist (0.2 visits, 95% CI, confidence intervals: -0.03; 0.43) and the proportion of those who visited the dentist during the past 12 months (4.2%, 95% CI: 0.1%; 8.3%) increased at the year-of-birth cut-off of 1956. There were minor drops (1.5%-1.9%) in the number of missing teeth across all thresholds (over 10, over 5, or at least 1 missing teeth) at the cut-off. Analyses with the data from the surveys from 2002 to 2014 showed that there were no discontinuities in these outcomes at the cut-off of 1956. Regression discontinuity estimates related to toothache experience and toothbrushing frequency were inconclusive due to high variability in the underlying data and the likely small effect of the more universal coverage on these outcomes. CONCLUSIONS: The current study provided evidence of the beneficial effects of universal oral healthcare coverage on the oral healthcare service use and teeth preservation from a large and long-term natural experiment occurred in Finland from the late 1980s to 2000.

Income- and education-based inequalities of edentulism and dental services utilization in Brazil.

OBJECTIVE: Tooth loss is a worldwide public health problem affecting mainly socioeconomically disadvantaged groups. Dental services utilization may increase access to preventive actions and conservative treatment, reducing the prevalence of tooth loss. This study evaluated the income- and education-based inequalities in edentulism according to the utilization of dental services among adults and older adults in Brazil. METHODS: Data from the National Oral Health Survey (SB Brazil, 2010) of adults (ages 35-44 years, n = 9779) and older adults (ages 65-74 years, n = 7619) were analysed. Socioeconomic indicators (SES) included education and income. The magnitude of inequality in edentulism by education and income levels was estimated by the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). The changes in the RII and SII according to the utilization of dental services were estimated. Regression models estimated the association between SES and edentulism and whether dental services utilization modified this association. RESULTS: Higher edentulism prevalence was observed among those with lower education and income levels. The utilization of dental services changed the education-based inequality index in edentulism for adults, with percentage changes of 17.4% (RII) and 56.8% (SII). For adults with low education (0-4 years of study), the odds of edentulism were 80% (OR 0.2; 95% CI 0.1-0.6) and 90% (OR 0.1; 95% CI 0.01-0.2) lower for those who had used dental services within the preceding year and within 1-2 years compared with those who had used such services within the preceding 3 or more years, respectively. CONCLUSION: There was a social gradient in the prevalence of edentulism in adults and older adults, and the education-based inequalities in edentulism were lower among adults reporting utilization of dental services in the preceding year.

Impact of social marginalization on oral health-related quality of life in older adults

Abstract The aim of this study was to determine the association between oral health-related quality of life (OHRQoL) and social marginalization in people aged 60 years and older enrolled in social security in Mexico. A cross-sectional and analytical study was carried out in older adults. To assess the OHRQoL, the OHIP-14 instrument was applied, and the degree of social marginalization and sociodemographic characteristics were analyzed. Measures of central tendency and dispersion, simple frequencies and proportions were estimated. Student's t-test was used for comparison of means, and prevalence ratio (PR) and logistic regression were used to assess associations, all with a significance value of 0.05 and 95% confidence intervals. Perceived OHRQoL in the population measured through the OHIP-14 reached an average value of 9.84 ± 8.91, with the highest value in the dimension of physical pain (2.06 ± 1.91). Perceived treatment need was higher among people with social marginality (p = 0.011). The multivariate analysis shows that marginalized people have a lower OHRQoL. Socially marginalized older adults showed a low a better perception of OHRQoL, independent of demographic and clinical factors.