Is the value of oral health related to culture and environment, or function and aesthetics?

OBJECTIVE: To examine the disutility of tooth loss. It compared how people value their teeth in two countries which are culturally similar in order to explore the effect of culture on self-perceptions of oral health. BASIC RESEARCH DESIGN: Cross sectional study. PARTICIPANTS: Participants were recruited from subjects attending two hospitals in Turkey and in Iran. INTERVENTIONS: Nineteen descriptions of mouths with varying degrees and types of tooth loss were presented to the participants. They were shown mouth models of partially edentate dentitions and the teeth missing were explained in relation to the participants own mouth. The participants were specifically asked to consider the role their teeth played in function (chewing), communication (speech) and aesthetics (looks) along with "all the other things that make your mouth important". MAIN OUTCOME MEASURES: The participants were asked to indicate on a visual analogue scale how they would value the health of their mouth if they lost the tooth/teeth described and the resultant space was left unrestored. RESULTS: Overall 152 subjects participated, 78 in Turkey and 74 in Iran with 83 being female and 69 male. Their mean age was 29.5 years (SD 9.3), 62.5% had experienced tooth loss and 37.5% had complete (or completely restored) dentitions. Although there were no differences between the two countries in the degree of utility people attached to anterior teeth, Turkish participants attached significantly more disutility than Iranians to the loss of premolar and molar teeth (p < 0.003). CONCLUSION: Country of origin had an influence on the value placed on certain parts of the dentition and this effect is independent of the number of missing teeth, gender and age. This implies that attitudes to oral health are influenced by prevalent cultural attitudes more than by function.

Oral health disparities as determined by selected healthy people 2020 oral health objectives for the United States, 2009-2010.

The Healthy People 2020 initiative contains over 1,200 objectives that serve as a roadmap for tracking the nation's health (1). Oral health is 1 of 42 Healthy People topic areas comprising 33 objectives ranging from dental caries and periodontal disease, to access to preventive dental services and program infrastructure. One important activity of Healthy People is to monitor health disparities. Influential sociodemographic indicators for oral health disparities in the United States include poverty status and race and ethnicity (2). This report focuses on key Healthy People objectives covering select age groups by race and ethnicity and poverty status from 2009 to 2010.

The emotional effects of tooth loss in partially dentate people attending prosthodontic clinics in dental schools in England, Scotland and Hong Kong: a preliminary investigation.

AIM: To compare the emotional effects of tooth loss in three partially dentate populations. DESIGN: A questionnaire survey. MATERIALS AND METHODS: A questionnaire was completed by 150 partially dentate subjects undergoing routine prosthodontic care at Guy's, King's and St Thomas's Dental Institute, London; the Dental School, Dundee, Scotland; and the Faculty of Dentistry, University of Hong Kong. Data were analysed using the Chi-square test. RESULTS: Forty nine per cent of all participants reported difficulties in accepting the loss of some of their teeth. People from Dundee were less likely to have difficulties accepting tooth loss (P = 0.001). People from London took longer to come to terms with their tooth loss and were more likely to feel less confident (P < 0.001). Fifty five per cent of all participants restricted their choice of foods and 54 per cent had not enjoyed their food as much as before. Fewer people in Dundee restricted their choice of food (P < 0.001) and were more likely to enjoy their food (P = 0.009). People in Hong Kong were most likely to restrict their choice of food (P = 0.006). Thirty five percent of all subjects felt unprepared for the effects that tooth loss had upon them. People in Hong Kong were more prepared for tooth loss than those in Dundee and London (P = 0.003). In addition, they were less concerned about leaving their dentures out overnight (P = 0.024). CONCLUSIONS: The emotional effects of tooth loss were significant in all groups. People from London took longer to come to terms with their tooth loss.

A radiographic analysis of the mandibular canal of the edentulous mandible in different racial and gender groups.

Studies on the mandibular canal in the edentulous mandible have rarely been correlated with mandibular canal position, mandibular body width, mandibular canal width, thickness of bony plates, gender and race. The aim of this investigation was to examine the above parameters by studying the bucco-lingual relationship of the mandibular canal in dry edentulous mandibles of Black and White, males and females (n = 13 in each group), of similar age (mean 58, 17 yrs). The mandibles were radiographed cross-sectionally. The position of the mandibular canal in relation to the buccal and lingual cortical plates, and the widths of the mandibular canal and mandibular body, measured at selected distances, were recorded and the values statistically analysed. Race and gender do not seem to influence the position of the mandibular canal in the bucco-lingual plane. The location of the canal is predominantly closer to the lingual cortex in the bucco-lingual plane. It was found that the widths of the left and right halves of the mandibular body are not statistically significantly different but widths of the left and right mandibular canal are significantly different.

Stimulated parotid gland flow rates in healthy, elderly dentulous and edentulous individuals.

The use of dentures has been associated with increased stimulated parotid salivary flow rates (SPFR). A comparison of SPFRs was made between dentulous subjects having 20+ teeth (n = 190) and edentulous individuals (n = 67). Two different populations were selected, a white group from the Baltimore Longitudinal Study of Aging and an African-American group from the Washington Village Medical Center in Baltimore. Each group was healthy and unmedicated and had a mean age of 70.2 years. SPFR was determined with a Carlson-Crittenden cup and 2% citrate for stimulation. The edentulous subjects did not wear their dentures during salivary collection. The results indicated a significantly lower SPFR in dentate individuals compared with edentulous subjects (p < 0.01). Dentulous men also had a lower SPFR than edentulous men (p < 0.04). In addition, a pre- and postsurgical evaluation of 10 individuals who underwent full mouth tooth extractions revealed no differences in SPFR. These results suggest that edentulism per se does not have a deleterious effect on stimulated parotid salivary flow rates.

Dental health status in two groups of refugees in Sweden.

The aim of this study was to determine dental health status in two separate groups of Chilean and Polish refugees in Sweden. In Scandinavia, Sweden has the largest number of immigrants--1 million out of a population of 8.3 million. Since 1975, most immigrants have been refugees and their families. During 1978-82 Sweden granted residency to 20,000 refugees, the two largest groups being Chileans and Poles. In 1981-83 a sample of 193 Chilean and 92 Polish refugees in the county of Stockholm were selected for this study. The investigation consisted of a questionnaire followed by clinical examination, including roentgenograms. The average age was 34.0 years in the Chilean group and 34.8 years in the Polish group. The Chileans had been in Sweden for 17.3 months on an average and the Poles for 16.0 months. The Chileans had an average of 10.0 carious surfaces, D(s), and the Poles 11.3. Gingivitis was recorded in 87% of the total number of sites examined in the Chilean group. The corresponding figure in the Polish group was 79%. Of the Chileans 36.5% and of the Poles 32.5% had periodontal pockets measuring more than 5 mm. The results indicate that, when compared with Swedish individuals of a corresponding age, the refugee groups have a high prevalence of caries and periodontal disease.

The relationship between periodontal conditions and perceptions of periodontal health among Pakistani immigrants in Norway.

The purpose of the present study was to assess the periodontal status of Pakistani immigrants in Norway, a Third World population in an industrialized country. The findings were related to treatment needs, socio-demographic variables and cultural beliefs about periodontal health. The mean number of remaining teeth ranged from 27.7 in the 20-24-year-old age group to 25.1 in the group of 35-year-olds and older. Very few of the study population had no plaque or no subgingival calculus. Only 7.5% of the participants exhibited no bleeding at any index teeth. Age and residence in Pakistan were the strongest predictors of subgingival calculus and pocket depth. Those from the rural areas of Pakistan had deeper pockets than those from the cities. The data showed a population with high prevalences of teeth with plaque, subgingival calculus and frequent gingival bleeding, but few sites with deep pockets. A periodontal treatment need index would indicate a substantial amount of treatment time. The present study suggests that also the perceived periodontal conditions, should be taken into account when periodontal services and health education strategies are planned. The concept of periodontal illness is introduced, defined as a person's perceptions and interpretations of periodontal symptoms.