Is Racial Discrimination Associated with Number of Missing Teeth Among American Adults?

OBJECTIVE: The objectives of this study are to assess the association of racial discrimination with tooth loss among American adults and whether this relationship, if existed, explains ethnic differences in tooth loss. METHODS: Data is from the Behavioural Risk Factor Surveillance System (BRFSS) 2014, a cross-sectional survey of a nationally representative sample of American adults. The survey included data on sociodemographic characteristics, behaviour, health insurance and number of missing teeth. The survey also included questions on whether a person was treated differently because of his/her race. Logistic regression analysis was conducted to assess the relationship between tooth loss and indicators of discrimination. We also examined the relation between ethnicity and indicators of discrimination. RESULTS: The analysis included 4858 participants aged 18 to 44 years. Tooth loss (> one tooth) was reported by 26% of participants. Among those reporting discrimination at healthcare facility, there was 141% increase in tooth loss compared to those not reporting discrimination. Discrimination at work and emotional impact of discrimination were both significantly associated with tooth loss in the partially adjusted models. Accounting for discrimination slightly attenuated ethnic differences in too loss. Black Americans had significantly higher odds for reporting all types of discrimination used here. CONCLUSION: This study demonstrated a potential role for discrimination in tooth loss among American adults. Discrimination could also explain part of ethnic inequalities in oral health.

Prevalence of Tooth Loss Among Older Adults: United States, 2015-2018.

Complete tooth loss can diminish quality of life, limiting food choices and impeding social interaction (1). Reducing complete tooth loss is a national health goal monitored by Healthy People; although prevalence has decreased since the 1960s, disparities persist (2-4). Factors leading to complete tooth loss-untreated dental caries, periodontitis, and smoking-are preventable and differ by socioeconomic status and between men and women (5,6). This report examines disparities in complete tooth loss among U.S. adults aged 65 and over by sex, age, race and Hispanic origin, and education in 2015-2018 and trends from 1999-2000 through 2017-2018.

Association between tooth loss and hypertension among older Chinese adults: a community-based study.

BACKGROUND: The purpose of the study is to examine the association between tooth loss and hypertension among older community residents in urban China. METHODS: This study included 3677 participants aged ≥50 years from the Shanghai Aging Study. We determined the number of teeth missing from questionnaires. Hypertension was defined as the mean of two measurements of systolic blood pressure (SBP) (140 mmHg or higher), diastolic blood pressure (DBP) (90 mmHg or higher) or physician-diagnosed hypertension confirmed from medical records. A multivariable logistic regression model was used to investigate the association between tooth loss and hypertension. RESULTS: The average number of missing teeth among study participants was 9.67. Among them, participants with hypertension had lost an average of 10.88 teeth, significantly higher than those without hypertension (8.95) (p < 0.0001). After adjusting for covariates (socio-demographic characteristics, health behaviors and other chronic conditions), teeth lost (15 or more) was significantly associated with grade III hypertension, with OR = 1.55(95% CI 1.09-2.20). CONCLUSIONS: Significant tooth loss maybe associated with severe hypertension among older Chinese adults. Prevention of tooth loss is important to the overall health of this population.

Do Socioeconomic Conditions Explain Ethnic Inequalities in Tooth Loss among US Adults?

Objective: To assess whether there are ethnic differences in tooth loss among adult Americans aged <40 years and whether socioeconomic position attenuates these differences if they exist. Methods: Data were from the 2014 Behavioral Risk Factor Surveillance System, a health-related telephone cross-sectional survey of a nationally representative sample of US adults. Tooth loss (one tooth or more) was used as the outcome variable. Ethnicity was the main explanatory variable. Family income, education and health insurance were also used in the analysis. Logistic regression models for tooth loss were constructed adjusting for demographic (age, sex, and ethnicity), socioeconomic indicators (income and education), health insurance, dental visits, smoking and diabetes. Results: A total of 76,273 participants were included in the analysis. The prevalence of tooth loss was highest among Blacks (33.7%). Hispanics and other ethnic groups had a higher prevalence of tooth loss than Whites, 29.1% (95%CI: 27.7-30.6), 22.0% (95%CI: 20.3-23.8), and 20.8% (95%CI: 20.2-21.4), respectively. Blacks had odds ratios (OR) 1.98 (95%CI: 1.81-2.16) for tooth loss compared with Whites. After adjusting for socioeconomic positions (SEP), the relationship attenuated but remained significant with OR 1.71 (95%CI: 1.55-1.90). Conclusions: Despite recent changes in the health care system in the United States, ethnic inequalities in tooth loss still exist. Income and education partially explained ethnic differences in tooth loss among Americans aged <40 years.

Racial differences in periodontal disease and 10-year self-reported tooth loss among late middle-aged and older adults: the dental ARIC study.

OBJECTIVE: To investigate racial differences in the associations between periodontitis and 10-year self-reported incident tooth loss in a biracial, community-based cohort of US late middle-aged and older adults. METHODS: Subjects were 3,466 dentate men and women aged 53-74 who underwent dental examinations from 1996 to1998. In 2012-2013, telephone interviewers asked participants about tooth loss in the preceding 10 years. Separate multivariable ordinal logistic regression models were used to calculate proportional odds ratios (OR) and 95% confidence intervals (CI) as estimates of association between periodontitis and tooth loss for Whites and African-Americans (AAs). RESULTS: The majority of participants were White (85 percent) and female (57 percent) with 23 teeth on average at enrollment. Approximately half the Whites (56 percent) and AAs (49 percent) had periodontitis. At follow-up, approximately 44 percent of AAs and 38 percent of Whites reported having lost ≥1 tooth. In multivariable models, severe periodontitis (OR = 3.03; 95% CI = 2.42-3.80) and moderate periodontitis (OR = 1.64; 95% CI= 1.39-1.94) were significant risk factors of incident tooth loss among Whites. For AAs, severe but not moderate periodontitis increased the odds of incident tooth loss (OR = 2.22; 95% CI = 1.37-3.59). In the final model, education was inversely associated with incident tooth loss among AAs, while lower income was associated with greater odds of tooth loss among Whites. CONCLUSIONS: In this population-based cohort, there is racial heterogeneity in the association between periodontitis and tooth loss. Interventions to reduce the impact of periodontitis on tooth loss need to consider these differences.

Periodontal disease in a remote Asian population: association between clinical and microbiological parameters.

OBJECTIVE: The aim was to clinically and microbiologically describe the periodontal conditions in a remote adult Asian population with poor oral hygiene. METHODS: The subjects were 30-60-year-old adults of Karen Hill tribes with no access to dental care. Eighty-six subjects were selected randomly. Clinical registrations included number of remaining teeth, plaque index (PlI), bleeding on probing (BoP), clinical attachment loss (CAL), and probing pocket depth (PPD). Subgingival plaque samples were collected and analyzed with the checkerboard method. RESULTS: Subjects of the study group had mean number of remaining teeth of 26.5 despite the abundant plaque and a high bleeding score. Severe periodontitis (CAL ≥ 7 mm) was recorded in 12.9% of the youngest age group (30-39 years) while it was significantly higher (52%) in the middle group (40-49 years) and (60%) in the eldest age group (50-60 years). Pathological pocketing (PPD ≥ 7 mm) was significantly lower in all age groups. Age, betel chewing, and a microbiological cluster including at least one of Prevotella tannerae, Filifactor alocis and Porphyromonas endodontalis significantly correlated with the severity of periodontal disease. CONCLUSION: Age, betel chewing, and a new bacterial complex other than the "red complex" correlated to periodontal breakdown in this remote adult Asian population.

Forty-Year Trends in Tooth Loss Among American Adults With and Without Diabetes Mellitus: An Age-Period-Cohort Analysis.

INTRODUCTION: This study aimed to assess the trends in tooth loss among adults with and without diabetes mellitus in the United States and racial/ethnic disparities in tooth loss patterns, and to evaluate trends in tooth loss by age, birth cohorts, and survey periods. METHODS: Data came from 9 waves of the National Health and Nutrition Examination Survey (NHANES) from 1971 through 2012. The trends in the estimated tooth loss in people with and without diabetes were assessed by age groups, survey periods, and birth cohorts. The analytical sample was 37,609 dentate (ie, with at least 1 permanent tooth) adults aged 25 years or older. We applied hierarchical age-period-cohort cross-classified random-effects models for the trend analysis. RESULTS: The estimated number of teeth lost among non-Hispanic blacks with diabetes increased more with age than that among non-Hispanic whites with diabetes (z = 4.05, P < .001) or Mexican Americans with diabetes (z = 4.38, P < .001). During 1971-2012, there was a significant decreasing trend in the number of teeth lost among non-Hispanic whites with diabetes (slope = -0.20, P < .001) and non-Hispanic blacks with diabetes (slope = -0.37, P < .001). However, adults with diabetes had about twice the tooth loss as did those without diabetes. CONCLUSION: Substantial differences in tooth loss between adults with and without diabetes and across racial/ethnic groups persisted over time. Appropriate dental care and tooth retention need to be further promoted among adults with diabetes.

The Relationship between Methamphetamine Use and Dental Caries and Missing Teeth.

PURPOSE: This study examined the relationship between methamphetamine use and oral health status. METHODS: Using a cross-sectional design, data were collected in 1998 from 174 newly admitted prisoners in Iowa. Oral examinations identified dental caries and missing teeth, and personal interviews identified methamphetamine use and covariates. Descriptive statistics were used to summarize the data, and bivariate and multivariate linear regression analyses, including testing for interaction effects, were used to examine the effects of methamphetamine use on oral health status. RESULTS: Multivariate regression analyses for carious teeth and surfaces showed significant interaction effects: methamphetamine*race/ethnicity (carious teeth: p=0.039; surfaces: p=0.023) and methamphetamine*tooth brushing when on drugs (carious teeth: p=0.044; surfaces: p=0.035). Methamphetamine use had a significant effect on dental caries among Non-Whites and among those who brushed their teeth less than once a day when on drugs. Soda consumption (carious teeth: p=0.026; surfaces: p=0.030) and reason for last dental visit (carious teeth: p=0.025; surfaces: p=0.011) were also associated with caries. For missing teeth there was a significant methamphetamine*race/ethnicity interaction (p=0.028) among Whites who used methamphetamine compared to Whites who did not use methamphetamine. Age (p=0.0001) and reason for last dental visit (p=0.0001) were also associated with missing teeth. CONCLUSION: The effect of methamphetamine use on missing teeth was moderated by race/ethnicity,; while its effect on dental caries was moderated by race/ethnicity and tooth brushing when on drugs.

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.

Predicting geographically distributed adult dental decay in the greater Auckland region of New Zealand.

OBJECTIVE: To model the geographic distribution of current (and treated) dental decay on a high-resolution geographic basis for the Auckland region of New Zealand. BASIC RESEARCH DESIGN: The application of matrix-based mathematics to modelling adult dental disease-based on known population risk profiles to provide a detailed map of the dental caries distribution for the greater Auckland region. RESULTS: Of the 29 million teeth in adults in the region some 1.2 million (4%) are suffering decay whilst 7.2 million (25%) have previously suffered decay and are now restored. CONCLUSIONS: The model provides a high-resolution picture of where the disease burden lies geographically and presents to health planners a method for developing future service plans.

Dental health and treatment needs among children in a tribal community.

OBJECTIVE: To assess the dental health status and treatment needs among children of 'Pardhi' tribal community. METHODS: A total of 185 children were examined over a period of 2 months using WHO proforma. The statistical software namely SPSS version 15.0 and data was analyzed using Student's t-test and ANOVA test at p < 0.05. RESULTS: The mean score for dft and DMFT was 1.87 ± 1.073 and 2.04 ± 1.564 respectively with males subjects were having comparatively more scores. It was also found significant differences between age groups. Most of the children needed one surface filling, i.e. 29.40%, followed by pulp care and restoration (19.30%), two or more surface fillings (15.60%) and extraction (11.70%). CLINICAL SIGNIFICANCE: The study subjects were characterized by a lack of dental care services, high prevalence of dental caries and treatment needs. Therefore, implementation of a basic oral health care program for this tribal population is a high priority.

Predictors of multiple tooth loss among socioculturally diverse elderly subjects.

PURPOSE: This study identifies clinical factors that predict multiple tooth loss in a socioculturally diverse population of older adults. MATERIALS AND METHODS: A total of 193 participants from English-, Chinese-, or Punjabi-speaking communities in Vancouver, British Columbia, with low incomes and irregular use of dental services were followed for 5 years as part of a clinical trial of a 0.12% chlorhexidine mouthrinse. The participants were interviewed and examined clinically, including panoramic radiographs, at baseline and annually for 5 years. Binary logistic regression was used to test the hypothesis that there was no difference between incidence of multiple (≥ 3) tooth loss in older people with various biologic, behavioral, prosthodontic, and cultural variables over 5 years. RESULTS: Multiple tooth loss, which was distributed similarly among the groups in the trial, occurred in 39 (20%) participants over 5 years. The use of removable prostheses was the best predictor of loss, followed by the number of carious surfaces and number of sites with gingival attachment loss > 6 mm. The pattern of prediction was consistent across the three linguocultural groups. CONCLUSION: The use of removable dentures was the dominant predictor of multiple tooth loss in the three communities, but that tooth loss was not significantly associated with the cultural heritage of the participants.

Dento-alveolar features and diet in an Etruscan population (6th-3rd c. B.C.) from northeast Italy.

OBJECTIVES: The purpose of this study was to assess the prevalence of some dento-alveolar features (caries, dental calculus, tooth wear, enamel hypoplasia, abscesses, retraction of the alveolar bone, chipping, and ante mortem tooth loss) on an Iron Age sample from the Etruscan necropolis of Spina (North-Eastern Italy) and to make a relation with dietary evidence found in the archaeological records. These dental features were used to evaluate the oral health status and dietary habits with the aim of shedding light on the lifestyle and living conditions of this population. MATERIALS AND METHODS: The sample analysed consisted of 680 permanent teeth from 80 burials. RESULTS: Overall, individuals at Spina exhibited a low incidence of caries, abscesses and ante mortem tooth loss, high calculus rates and severe attrition, suggesting a subsistence pattern based on a mixture of fishing, pastoralism and agriculture. The low incidence of hypoplasia was probably related to their good nutritional conditions and weak metabolic stresses during early childhood. CONCLUSIONS: These findings, quite similar to those of Etruscans from other parts of Italy, are very different from those of other populations living in the same territory during the same time. This pattern is indicative of a general good health status in this Iron Age population and may be related, at least in part, to the Etruscan diet.

Socio-cultural factors in dental diseases in the Medieval and early Modern Age of northern Spain.

The aim of this study is to present, discuss and compare the results of pathological conditions in teeth from skeletal remains found in the northern part of the Iberian Peninsula (Spain) in four Medieval cemeteries (late 15th century) and three cemeteries from the Modern Age (late 18th century). The final objective was to evaluate the impact of socioeconomic and cultural changes that took place during the early Modern Age in Spain, on oral health. Dental caries and antemortem tooth loss were considered as indicators of dental disease. A significant increase of both dental caries and antemortem tooth loss occurred in Modern Age individuals when compared to Medieval values, as reported for other regions. Increased trade with other continents may explain this deterioration of dental health, as food exchanges (mainly with America) contributed to diet changes for the overall population, including higher carbohydrate consumption (introduction of potatoes) at the expense of other vegetables. A sex-specific increase of dental disease with age, and a significantly higher prevalence of carious lesions in Modern Age females than in males, were also found. These changes can be explained by women having had limited access to dental care after the Middle-Modern Age transition, as a consequence of socio-cultural and political changes. In these changes, an increasing influence of the Catholic Church in Spanish society has to be noted, as it can contribute to the explanation of the unequal dental health of men and women. Women were socially excluded from dental care by regulations inspired by religious precepts.

Oral Health-Related Quality of Life among a large national cohort of 87,134 Thai adults.

BACKGROUND: Oral health has been of interest in many low and middle income countries due to its impact on general health and quality of life. But there are very few population-based reports of adult Oral Health Related Quality of Life (OHRQoL) in developing countries. To address this knowledge gap for Thailand, we report oral health findings from a national cohort of 87,134 Thai adults aged between 15 and 87 years and residing all over the country. METHODS: In 2005, a comprehensive health questionnaire was returned by distance learning cohort members recruited through Sukhothai Thammathirat Open University. OHRQoL dimensions included were discomfort speaking, swallowing, chewing, social interaction and pain. We calculated multivariate (adjusted) associations between OHRQoL outcomes, and sociodemographic, health behaviour and dental status. RESULTS: Overall, discomfort chewing (15.8%), social interaction (12.5%), and pain (10.6%) were the most commonly reported problems. Females were worse off for chewing, social interaction and pain. Smokers had worse OHRQoL in all dimensions with Odds Ratios (OR) ranging from 1.32 to 1.51. Having less than 20 teeth was strongly associated with difficulty speaking (OR = 6.43), difficulty swallowing (OR = 6.27), and difficulty chewing (OR = 3.26). CONCLUSIONS: Self-reported adverse oral health correlates with individual function and quality of life. Outcomes are generally worse among females, the poor, smokers, drinkers and those who have less than 20 teeth. Further longitudinal study of the cohort analysed here will permit assessment of causal determinants of poor oral health and the efficacy of preventive programs in Thailand.

Gender differences in oral health in South Asia: metadata imply multifactorial biological and cultural causes.

OBJECTS: This study was designed to examine the magnitude and etiology of gender differences in oral health. South Asia was selected for study because sex differences in caries rates exist in prehistory here, great cultural diversity provides context, and clinical reports document caries by gender. METHODS: A literature survey yielded extensive data on caries rates in India, Nepal, Bangladesh, and Sri Lanka. The percentage of individuals with caries (prevalence) and the mean number of decayed, missing, and filled teeth (experience) comprise the data. Statistical tests for gender differences come from published sources or were independently computed. RESULTS: Higher caries rates were found more often among females than males. The data show that: (a) in male children caries rates are greater than, or equal to, female rates, (b) the gender bias reverses (F > M caries rates) from adolescence through the reproductive years, (c) mature adults typically exhibit significant differences, with higher caries rates in females, (d) a male gender bias in adults is rare, and (e) though some studies find no significant gender difference in caries, a female bias dominates. Tooth loss is also greater in women than men and often results from caries (vs. periodontal disease). CONCLUSIONS: The gender gap in oral health exists in South Asia and results from genetic, hormonal, and cultural influences. Three cultural factors contribute to this gender gap South Asia: (a) the relative value of sons and daughters, (b) frequent fasting among Hindu women, and (c) the belief that dietary restrictions result in easier childbirth.

Dental restorations for dinka and nuer refugees: a confluence of culture and healing.

The Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and the Self-reporting Questionnaire-24 were used to evaluate distress among 22 Dinka and Nuer refugees to the US before and after complete restoration of four to six lower front teeth that had been extracted during childhood in Sudan. Participants reported significant improvement in levels of distress following full restoration of missing teeth, including symptoms of PTSD. These results illustrate the value of incorporating community perspectives into the selection of health treatment options for newly arriving populations. But they also emphasize the unique situation faced by each refugee population as they embark on a wholly new cultural learning process.

Adult oral health status in California, 1995-2006: demographic factors associated with tooth loss due to disease.

The most recent 2006 estimates indicate that 60 percent of California adults did not experience tooth loss due to disease. However, about 39 percent were missing one or more teeth due to disease, and another 1 percent were edentulous. In an 11-year (1995-2006) pooled multivariate analysis, California adults who were older, less educated, racial/ethnic minorities, current or former smokers, or had lower annual incomes were more likely to be missing teeth.

The effects of income and education on ethnic differences in oral health: a study in US adults.

BACKGROUND: Ethnic differences exist in oral health. However, the causes of the differences have not been adequately addressed. The objective of this study is to examine the effect of socioeconomic position on ethnic differences in oral health. METHODS: Data were from the Third National Health and Nutrition Examination Survey conducted in the USA (1988-94). The effects of income and education on ethnic differences in perceived oral health, gingival bleeding, periodontitis and tooth loss were analysed using a series of regression models. RESULTS: The probabilities of poorer oral health were higher among African-American, Mexican-Americans and other ethnic groups than in White Americans. Adjusting for income and education resulted in a reduction in the ORs for having poorer perceived oral health (44%), tooth loss (29%), gingival bleeding (61%) and periodontitis (30%) among African-Americans than White Americans. Similar reductions in risk were observed among Mexican-Americans and other ethnic groups. CONCLUSION: The results indicate that education and income play an important role in ethnic differences in oral health. Despite the major impact of socioeconomic position, the results imply that there are causes additional to socioeconomic position for ethnic differences in oral health.

Racial/ethnic variations in associations between socioeconomic factors and tooth loss.

OBJECTIVES: To compare the associations between socioeconomic factors and tooth loss among White, Black, and Mexican-American people. METHODS: Analyses were conducted on 16,821 adults, using data from the National Health and Nutrition Examination Survey-III. Age- and multivariate-adjusted negative binomial regressions were used to explore the relation of socioeconomic factors, region of residence, gender, and foreign birth with the number of missing teeth. Effect modification by race/ethnicity was assessed by the inclusion of interaction terms. RESULTS: In multivariate-adjusted analyses, non-Hispanic White people with 9-12 years of education exhibited 71% higher mean number of missing teeth than those with >12 years of education [incidence rate ratio (IRR) = 1.71, 95% confidence interval (CI): 1.52-1.92]. Education was unrelated to the number of teeth among non-Hispanic Black people (IRR = 1.16; 95% CI: 1.00-1.35) or Mexican-Americans (IRR = 1.10, 95% CI: 0.93-1.31). The poorest White people exhibited 39% more missing teeth, on average, than the most affluent White people, but no association between poverty and number of teeth was observed among Black or Mexican-American people. CONCLUSIONS: The associations between socioeconomic factors and tooth loss vary across race/ethnicity. This suggests that the health benefits associated with high socioeconomic status are not equally shared across racial/ethnic groups.