Racial inequities in tooth loss among older Brazilian adults: A decomposition analysis.

OBJECTIVE: To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services. METHODS: Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities. RESULTS: The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years. CONCLUSIONS: Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.

Social Capital and Oral Health Among Adults 50 Years and Older: Results From the English Longitudinal Study of Ageing.

OBJECTIVES: This study examines the differential associations of structural and functional social capital with objective and subjective measures of oral health, and the interactions between social capital and other sociodemographic and health factors. METHODS: Secondary analysis of data on 8552 adults 50 years and older from the third wave (2006-2007) of the English Longitudinal Study of Ageing was conducted. Oral health outcomes were self-rated oral health, edentulousness (having no natural teeth), and Oral Impacts on Daily Performances. Structural social capital was measured by membership of social organizations and volunteering. Functional social capital was measured by the number of close ties and perceived emotional social support. Logistic regression models were sequentially adjusted for demographic, socioeconomic, health-related factors, and smoking status. RESULTS: Structural social capital was primarily associated with edentulousness. Not being a member of any organization was associated with higher odds of being edentate (odds ratio [OR] = 1.77, 95% confidence interval [CI] = 1.43-2.16). Functional social capital was associated with self-rated oral health and oral impacts. Low social support was associated with poor self-rated oral health (OR = 1.41, 95% CI = 1.16-1.72) and Oral Impacts on Daily Performances (OR = 1.69, 95% CI = 1.27-2.24). CONCLUSIONS: The association of structural social capital with edentulousness may reflect health selection effects. The availability of a supportive social network seems to be the aspect of social capital most strongly associated with oral health.

Is Social Capital a Determinant of Oral Health among Older Adults? Findings from the English Longitudinal Study of Ageing.

There are a number of studies linking social capital to oral health among older adults, although the evidence base mainly relies on cross-sectional study designs. The possibility of reverse causality is seldom discussed, even though oral health problems could potentially lead to lower social participation. Furthermore, few studies clearly distinguish between the effects of different dimensions of social capital on oral health. The objective of the study was to examine the longitudinal associations between individual social capital and oral health among older adults. We analyzed longitudinal data from the 3rd and 5th waves of the English Longitudinal Study of Ageing (ELSA). Structural social capital was operationalized using measures of social participation, and volunteering. Number of close ties and perceived emotional support comprised the functional dimension of social capital. Oral health measures were having no natural teeth (edentate vs. dentate), self-rated oral health and oral health-related quality of life. Time-lag and autoregressive models were used to explore the longitudinal associations between social capital and oral health. We imputed all missing data, using multivariate imputation by chained equations. We found evidence of bi-directional longitudinal associations between self-rated oral health, volunteering and functional social capital. Functional social capital was a strong predictor of change in oral health-related quality of life - the adjusted odds ratio of reporting poor oral health-related quality of life was 1.75 (1.33-2.30) for older adults with low vs. high social support. However in the reverse direction, poor oral health-related quality of life was not associated with changes in social capital. This suggests that oral health may not be a determinant of social capital. In conclusion, social capital may be a determinant of subjective oral health among older adults rather than edentulousness, despite many cross-sectional studies on the latter.

Methodological development of an exploratory randomised controlled trial of an early years' nutrition intervention: the CHERRY programme (Choosing Healthy Eating when Really Young).

Good nutrition in the early years of life is vitally important for a child's development, growth and health. Children's diets in the United Kingdom are known to be poor, particularly among socially disadvantaged groups, and there is a need for timely and appropriate interventions that support parents to improve the diets of young children. The Medical Research Council has highlighted the importance of conducting developmental and exploratory research prior to undertaking full-scale trials to evaluate complex interventions, but have provided very limited detailed guidance on the conduct of these initial phases of research. This paper describes the initial developmental stage and the conduct of an exploratory randomised controlled trial undertaken to determine the feasibility and acceptability of a family-centred early years' nutrition intervention. Choosing Healthy Eating when Really Young (CHERRY) is a programme for families with children aged 18 months to 5 years, delivered in children's centres in one urban (Islington) and one rural (Cornwall) location in the United Kingdom. In the development stage, a mixed-methods approach was used to investigate the nature of the problem and options for support. A detailed review of the evidence informed the theoretical basis of the study and the creation of a logic model. In the feasibility and pilot testing stage of the exploratory trial, 16 children's centres, with a sample of 394 families were recruited onto the study. We hope that the methodology, which we present in this paper, will inform and assist other researchers in conducting community-based, exploratory nutrition research in early years settings.

From victim blaming to upstream action: tackling the social determinants of oral health inequalities.

The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.

Prevalence and factors associated with traumatic dental injuries (TDI) to anterior teeth of 11-13 year old Thai children.

OBJECTIVE: The objective was to assess the prevalence and factors associated with Traumatic Dental Injuries (TDI) to anterior teeth of 11-13 year old Thai children. METHODS: A cross sectional survey was carried out in a sample of 2,725 children from 52 primary school classes in the Chiang Mai urban area of Thailand. The children were clinically examined for TDI and interviewed. RESULTS: 35.0% of children experienced TDI. Males (45.3%) had TDI levels approximately twice as high as females (25.2%), and the prevalence of TDI increased with age. TDI were more common amongst children living in more disadvantaged households and whose parents were less educated. Children with an overjet greater than 5mm were also more likely to have TDI. Most of the affected children (20.6%) had trauma to I tooth, 10.3% to 2, 2.6% had 3 teeth affected. The proportion of damaged teeth was 4.6 per 100 anterior teeth. Central incisors were the most common teeth with TDI, both in the upper and lower jaws. Enamel fracture was the major type of TDI. Most of the TDI occurred at home and school. Running was the major activity leading to TDI. 'Falls' was the most common manner causing TDI (24.8%). Ground surfaces (22.4% of all cases), particularly concrete surfaces (14.6% of all cases), were the most common vectors which directly contacted or injured children. Biting hard material was the most common activity leading to TDI. CONCLUSION: Traumatic dental injuries are common and are an important dental public health problem in Thailand.

Associations between school environments and childhood traumatic dental injuries.

PURPOSE: To assess the associations between social and physical school environments and the prevalence of traumatic dental injuries (TDI) in 12-year-old children in Thailand. MATERIALS AND METHODS: A cross-sectional study in 52 urban schools in Thailand was carried out from a sample of 2,725 12-year-old children that were clinically examined for TDI and interviewed. Cluster analyses were performed to classify the schools into supportive and non-supportive schools by social and physical environmental characteristics. Analyses of the associations were performed using multilevel analyses, accounting for school variations and controlling for confounding factors at the child level. RESULTS: 35.0% of children had TDI. Prevalence was twice as high amongst boys than girls. The prevalence of TDI was significantly lower in the schools with a supportive social environment (Crude OR = 0.6 (95% CI = 0.4 to 0.8, p = 0.004)). The adjusted OR was 0.7 (95% CI = 0.5 to 0.9, p = 0.02). This statistically significant association existed in boys but there was only an insignificant tendency of association in girls. There was no statistically significant association between TDI and the physical environment of the schools. But there was an insignificant tendency of association with the physical environment in girls. CONCLUSION: TDI were much more common in boys than girls. TDI were significantly less prevalent in male children in schools with supportive, compared to less supportive social environments. In boys, there was a tendency for the more socially supportive environment to be more protective rather than the effect of any type of physical environment. In girls, this protective tendency was only apparent when school environments were both more socially supportive, and physically favourable.

Emerging theories into the social determinants of health: implications for oral health promotion.

In recent years public health research has increasingly focused upon exploring the social determinants of health. This interest has partly arisen through an acknowledgement of the limitations of educational preventive approaches in improving population health and reducing health inequalities. Many health education interventions have been influenced by health behaviour research based upon psychological theories and models. These theories focus at an individual level and seek to explore cognitive and affective processes determining behaviour and lifestyle. Current psychological theories have only a limited value in the development of public health action on altering the underlying social determinants of health. New theoretical approaches have however, emerged which explore the relationship between the social environment and health. This paper aims to review and highlight the potential value to oral health promotion of three important public health theoretical approaches: life course analysis, salutogenic model and social capital. It is important that an informed debate takes place over the theoretical basis of oral health promotion. As the field of oral health promotion develops it is essential that it is guided by contemporary and appropriate theoretical frameworks to ensure that more effective action is implemented in the future.