Impact of an oral care subsidization reform on intersectional inequities in self-rated oral health in Sweden.

BACKGROUND: Oral health in Sweden is good at the population level, but seemingly with persisting or increasing inequities over the last decades. In 2008, a major Swedish reform introduced universal partial subsidies to promote preventive care and reduce the treatment cost for patients with extensive care needs. This study aimed to apply an intersectional approach to assess the impact of the 2008 subsidization reform on inequities in self-rated oral health among adults in Sweden over the period 2004-2018. METHODS: Data from 14 national surveys conducted over 2004-2018 were divided into three study periods: pre-reform (2004-2007), early post-reform (2008-2012) and late post-reform (2013-2018). The final study population was 118,650 individuals aged 24-84 years. Inequities in self-rated oral health were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy across 48 intersectional strata defined by gender, age, educational level, income, and immigrant status. RESULTS: Overall, the prevalence of poor self-rated oral health decreased gradually after the reform. Gender-, education- and income-related inequities increased after the reform, but no discernible change was seen for age- or immigration-related inequities. The majority of intersectional strata experienced patterns of persistently or delayed increased inequities following the reform. CONCLUSIONS: Increased inequities in self-rated oral health were found in most intersectional strata following the reform, despite the seemingly positive oral health trends at the population level. Applying an intersectional approach might be particularly relevant for welfare states with overall good oral health outcomes but unsuccessful efforts to reduce inequities.

Association of tooth location, occlusal support and chewing ability with cognitive decline and incident dementia.

AIM: Emerging evidence suggests association of tooth loss with impaired cognition. However, the differential effects of anterior versus posterior tooth loss, occlusal support loss and chewing ability are not considered comprehensively. MATERIALS AND METHODS: We conducted cross-sectional (N = 4036) and longitudinal analyses (N = 2787) on data from Health 2000 and 2011 Surveys for associations of posterior occlusal support loss, anterior versus posterior tooth loss, and chewing ability with baseline cognition and 11-year cognitive decline. Additionally, 15-year incident dementia risk was investigated (N = 4073). RESULTS: After considering relevant confounders and potential reverse causality bias, posterior occlusal support loss significantly increased dementia risk across all categories indicative of posterior occlusal support loss (hazard ratios [HRs] between 1.99 and 2.89). Bilateral inadequate posterior occlusal support was associated with 11-year decline in overall cognition (odds ratio [OR] = 1.48:1.00-2.19), and unilateral inadequate posterior occlusal support with total immediate (OR = 1.62:1.14-2.30) and delayed recall decline (OR = 1.45:1.03-2.05). Moreover, posterior tooth loss was associated with dementia (HR = 2.23:1.27-3.91) and chewing ability with total immediate decline (OR = 1.80:1.04-3.13). CONCLUSIONS: Posterior tooth and occlusal support loss significantly increases dementia risk. The impact of posterior occlusal support loss appears to be dose-dependent, and this effect is distinct from that of dentures. Dental healthcare services should be particularly attentive to the state of posterior dentition. Further studies exploring possible mechanisms are warranted.

Dietary inflammatory index in relation to salivary cytokine concentrations and periodontitis: A cross-sectional analysis.

AIM: To examine the associations of dietary inflammatory index (DII) with salivary cytokine concentrations and periodontitis after controlling for body mass index (BMI), socio-demographic factors and lifestyle. MATERIALS AND METHODS: Subgroups from two Finnish surveys, DILGOM 2007 and Health 2000, were included (total n = 727). The DII scores were calculated based on a food frequency questionnaire. Periodontal status was assessed with a cumulative risk score in DILGOM 2007 and by pocket depth measurement in Health 2000. From saliva, interleukin (IL)-1ß, IL-1 receptor antagonist, IL-6, IL-8, IL-10 and tumour necrosis factor (TNF)-α concentrations were measured. RESULTS: The DII scores did not differ between non-periodontitis and periodontitis participants in pairwise comparison. After adjusting for energy intake, periodontal status, BMI, age, education level, smoking habit and physical activity, DII was not associated with salivary cytokine concentrations. After adjusting for salivary cytokine levels and other confounding factors, DII was associated with periodontitis in the Health 2000 subgroup but not in the DILGOM 2007 subgroup. CONCLUSIONS: The current data support the evidence that diet is not associated with salivary cytokine levels but may be associated with periodontitis. The association observed between diet and periodontitis is related to factors other than diet-dependent inflammatory tendency in the oral cavity.

The use of dental anxiety management techniques during one-session treatment: a study on five video-recorded patient cases.

OBJECTIVE: The aim was to examine what kinds of dental anxiety management techniques dentists use in the context of one-session treatment. MATERIAL AND METHODS: The data consisted of videotaped treatment sessions for five dentally anxious adults. The treatment was conducted by two experienced dentists without formal training in the treatment of dentally anxious patients or behavioral management techniques. Theory-driven qualitative content analysis, based on the anxiety management classification of Milgrom et al. was used to identify and classify the techniques used during the treatments. RESULTS: Altogether, diverse categories of dental anxiety management techniques were identified under the main themes of enhancing trust and control and psychological management. Techniques that fell into enhancing trust and control included the categories of 'building a trustful relationship', 'informational control', and 'behavioral control'. These techniques were used consistently throughout the sessions. Additionally, psychological management techniques were identified and classified as 'behavioral strategies: relaxing the body' and 'cognitive strategies: relaxing the mind', which were regularly used in specific situations. CONCLUSION: The results indicate that a variety of dental anxiety management techniques were used during one-session treatments. The findings provide valuable insights for dentists in managing their patients with dental anxiety and improving their overall treatment experience.

Use of oral health care services by family caregivers and care recipients: the LENTO intervention.

OBJECTIVE: We aimed to evaluate the impact of an individually tailored preventive oral health intervention on the use of oral health care services by older family caregivers (FCs) and their care recipients (CRs). MATERIAL AND METHODS: A randomized controlled six and 12-month oral health intervention study included FCs and CRs aged ≥65 years living in Eastern Finland. The participants were randomly assigned to an intervention (FCs n = 53, CRs n = 47) and a control (FCs n = 39, CRs n = 35) group. Individually tailored oral health interventions for the FCs provided by a dental hygienist focused on oral hygiene and self-care. Generalized estimating equations were used to analyze the impact of intervention on the change in the use of oral health care services. RESULTS: The intervention had no significant effect on the use of oral health care services by the FCs or their CRs. Traditional factors such as female gender, a higher number of teeth, toothache, no dental fear, and higher morbidity were significantly (p < 0.05) associated with an increased use of oral health care services in the FCs, but not among the CRs. CONCLUSIONS: Individually tailored preventive oral health intervention showed no effect on the use of oral health care services. To promote oral health among the elderly, specific interventions focusing on use of oral health care services are needed. TRIAL REGISTRATION: clinicaltrials.gov/study/NCT04003493.

Prevalence and risk factors of frailty among older family caregivers.

AIM: The aim of this study was to investigate the prevalence of frailty and identify the demographical and clinical factors associated with frailty among older family caregivers. METHOD: The participants of this cross-sectional study were older family caregivers (n = 125) living in Eastern Finland. Data on functional and cognitive status, depressive symptoms, nutritional status, medication, chronic diseases, stroke, and oral health were obtained. The Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. Frailty status was evaluated using the abbreviated comprehensive geriatric assessment (aCGA) scale. RESULTS: Seventy-three percent of caregivers were identified as frail. According to multivariable logistic regression, cataract, glaucoma, or macular degeneration and the MNA score were predictors of frailty. After adjusting for age, gender, and number of own teeth, the MNA score remained a significant predictor of frailty (adjusted OR = 1.22, 95% CI = 1.06, 1.41). As the MNA scores decreased (meaning poorer nutritional status), the risk of frailty increased. CONCLUSIONS: The present study showed that frailty is prevalent among older family caregivers. Recognising older family caregivers with frailty or at risk of frailty is vital. It is essential to acknowledge vision problems' role in frailty and to monitor and support the nutritional status of family caregivers regularly to prevent frailty development.

Use of oral health care services among older home care clients in the context of an intervention study.

BACKGROUND: An increasing number of care-dependent older people living at home need external support to receive regular dental care. OBJECTIVES: To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition. MATERIALS AND METHODS: This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up. RESULTS: At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use. CONCLUSIONS: In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

Association of tooth count with cognitive decline and dementia in the Finnish adult population.

AIM: To evaluate whether tooth loss is associated with cognitive decline and incident dementia. MATERIALS AND METHODS: We analysed data from the Finnish population-based Health 2000 and follow-up Health 2011 surveys (participants aged ≥30 years and without dementia at baseline; N = 5506 at baseline and 3426 at 11-year follow-up). Dementia diagnoses until 2015 were ascertained from national registers (N = 5542). Tooth count was dichotomized as adequate (≥20) versus tooth loss (<20). Tooth loss was further stratified into 10-19 teeth, 1-9 teeth and edentulism. Upper and lower jaws were also considered separately. Baseline cognitive test scores were dichotomized by median as high versus low, and 11-year change as decline versus no decline. RESULTS: Tooth loss (<20) was associated with lower baseline overall cognition (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.03-1.43), 11-year cognitive decline (OR = 1.30, 95% CI = 1.05-1.70) and higher 15-year dementia risk (hazard ratio = 1.52, 95% CI = 1.15-2.02) after adjusting for multiple confounders. After adjustment for dentures, associations became non-significant, except for 10-19 teeth remaining and dementia. Results were similar after considering reverse causality bias; however, 10-19 teeth remaining was significantly associated with 11-year cognitive decline even after adjustment for dentures. No jaw-specific differences were observed. CONCLUSIONS: Tooth loss adversely impacts the risk of cognitive decline and dementia. The role of dentures should be further explored.

Gender differences in the association between malocclusion traits and oral health-related quality of life in Finnish adults.

We aimed to evaluate the gender-specific associations of malocclusion traits with oral health-related quality of life (OHRQoL) among Finnish adults. Data were obtained from the Health 2000 Survey, Finland. Included participants (n = 3993) were ≥30 years old with OHRQoL and occlusion data. OHRQoL was measured using the 14-item Oral Health Impact Profile (OHIP-14). OHIP-14 severity mean score, prevalence of impacts, and means of seven dimensions were outcomes. Explanatory variables were any malocclusion trait, increased overjet, negative overjet, open bite, deep bite, and crossbite/scissor bite. Logistic (prevalence) and cumulative (severity) regression models were adjusted for age, decayed teeth, deep periodontal pocket, occluding pairs, orthodontic treatment, and self-perceived health. Gender modified the association between any malocclusion trait and OHRQoL, with the association being stronger in females. Females without any malocclusion trait (OR = 1.62, 95% CI = 1.14-2.28) or without crossbite/scissor bite (OR = 1.68, 95% CI = 1.16-2.43) had better OHRQoL (lower prevalence) than those with malocclusions. Males without increased overjet (OR 1.50, 95% CI = 1.04-2.17) had lower mean OHIP-14 severity score than males with increased overjet, after adjustments. The association between psychological and physical disability and malocclusion traits was different between males and females. Gender differences in the impact of malocclusion traits should be considered when assessing orthodontic treatment need.

Unlike severe periodontitis, caries does not associate with intracranial aneurysms or aneurysmal subarachnoid hemorrhage.

PURPOSE: Periodontal diseases and caries are common oral diseases that predispose to tooth loss if untreated. In this study, we investigated whether loss of teeth or caries associate with intracranial aneurysm (IA) pathology similar to periodontal diseases. METHODS: A total of 166 patients with either IA or aneurysmal subarachnoid hemorrhage (aSAH) underwent oral examination in Kuopio University Hospital and Tampere University Hospital. Findings were compared to geographically matched controls acquired from cross-sectional Health2000 survey. This study consisted of three sequential steps. First, we compared the number of missing teeth and prevalence of caries in IA and aSAH patients and geographically matched control population, second step was a multivariate analysis including other risk factors, and third step was a 13-year follow-up of the Health2000 survey participants with missing teeth or caries at baseline. RESULTS: Loss of teeth did not significantly differ between IA patients and controls. In logistic regression model adjusted for known risk factors and demographic data, 1-4 caries lesions (OR: 0.40 95%Cl 0.2-0.9, p = 0.031) was associated with lack of IAs, while age (OR: 1.03 95%Cl 1.01.1 p = 0.024), current smoking (OR: 2.7 95%Cl 1.4-5.1, p = 0.003), and severe periodontitis (OR: 5.99 95%Cl 2.6-13.8, p < 0.001) associated to IA formation. In the cox-regression, severe periodontitis at baseline increased the risk of aSAH (HR: 14.3, 95%Cl 1.5-135.9, p = 0.020) during a 13-year follow-up, while caries or missing teeth did not. CONCLUSION: Unlike severe periodontitis, caries does not increase the risk of IAs and aSAHs. However, cariogenic bacteria may participate to IA pathology by disseminating to circulation via inflamed gingival tissue.

Association between cynical hostility and temporomandibular pain mediated through somatization and depression: an 11-year follow-up study on Finnish adults.

BACKGROUND: Hostility is believed to have an adverse effect on physical health through mediating psychosocial factors. OBJECTIVES: This study aimed to investigate the association of hostility with temporomandibular (TMD) pain. Another aim was to investigate if the association is mediated through increases in depressiveness and somatization in an 11-year follow-up on Finnish adults, based on the Health 2000 and 2011 Surveys (BRIF8901). MATERIAL AND METHODS: The sample comprised subjects who underwent clinical TMD pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TMD pain symptoms in 2011. Hostility was measured using the Cynical Distrust Scale, somatization was measured using the Symptom Checklist-90, and depressiveness using Beck's Depression Inventory-21. Four subgroups were formed based on the presence of TMD pain: no pain, pain in 2000 only, pain in 2011 only, and pain in 2000 and 2011. Analyses included chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hostility in 2000 as the predictor. Mediation analysis was performed using Hayes' Process v3.5. RESULTS: Those with higher hostility showed a higher prevalence of TMD pain. Longitudinally, the association of hostility with TMD pain in 2000 only, and with TMD pain in both years, was mediated either by somatization only or by depressiveness that was mediated by somatization. In those with TMD pain in 2011 only, the association was mediated by depressiveness that was mediated by somatization. CONCLUSION: Hostility increased the risk of TMD pain through increases in depressiveness and somatization.

Associations of inflammatory polyarthritis with clinical and radiological findings of temporomandibular disorders.

OBJECTIVE: To evaluate the association of different forms of inflammatory polyarthritis with clinical signs of temporomandibular disorders (TMD) and radiological findings in temporomandibular joint (TMJ), based on a nationwide health survey in Finland. The aim was also to assess the presence of clinical and radiological TMD findings in subjects with increased risk for developing rheumatoid arthritis (RA). MATERIAL AND METHODS: A nationally representative sample included 6331 Finnish adults who participated in the Health 2000 Survey (BRIF8901). Subjects were examined for signs of TMD, findings in panoramic radiograph of TMJ, musculoskeletal health and serology (rheumatoid factor, RF, and anti-cyclic citrullinated peptide, aCCP). RESULTS: Sixty-four percent of seronegative RA and 60% of seropositive RA subjects had at least one sign of TMD. While adjusting for confounding factors (gender, age, dentures and smoking history), RA was significantly associated with crepitation and abnormal radiological findings in TMJ. Seronegative RA was also associated with restricted mouth opening. Systemic autoimmunity associated with RA ("at risk of RA") was not associated with clinical or radiological TMD findings. CONCLUSIONS: Clinical and radiological findings of TMD are more prevalent among subjects with inflammatory polyarthritis than among the population in general in the Finnish adult population.

Oral health-related quality of life among home-dwelling older people with and without domiciliary care.

OBJECTIVES: The aim was to compare oral health-related quality of life (OHRQoL) between home-dwelling older people with and without domiciliary care when adjusted for gender, education, use of dental services and removable dental prostheses. BACKGROUND: OHRQoL of home-dwelling older people with and without domiciliary care is a neglected area of research, with few studies having been conducted. MATERIALS AND METHODS: A secondary analysis was conducted on the Finnish Health 2011 interview data. Home-dwelling participants (age ≥ 70) with or without domiciliary care were included (n = 758). OHRQoL was measured with the Oral Health Impact Profile questionnaire (OHIP-14) calculating three outcomes: prevalence of at least one impact reported: "occasionally," "fairly often" or "very often" (OFoVo), severity as mean sum score and mean of the seven OHIP-14 dimensions. These were evaluated by use of domiciliary care using logistic and negative binomial regression analyses. RESULTS: Domiciliary care clients tended to have poorer OHRQoL than non-clients (severity mean 4.33 vs 4.11, P = .057), especially men (6.71 vs 4.15, P = .027), and reported more psychological discomfort than non-clients (mean 1.10 vs 0.82, P = .039). The use of removable dental prostheses was the strongest predictor (OR 2.84, P < .001) of poor OHRQoL. CONCLUSION: Domiciliary care clients tended to report poorer OHRQoL, especially with regard to psychological discomfort dimension than non-clients. Thus, support of oral hygiene and regular utilisation of oral health services should be part of domiciliary care among older people to enhance OHRQoL.

Associations of diet quality, food consumption, eating frequency and eating behaviour with dental caries experience in Finnish children: a 2-year longitudinal study.

We examined cross-sectional and longitudinal associations of dietary factors with caries experience in a population sample of 487 children aged 6-9 years at baseline examinations of the Physical Activity and Nutrition in Children (PANIC) Study. Altogether, 406 of these children attended 2-year follow-up examinations. Food consumption and eating frequency were assessed using 4-day food records, diet quality using the Baltic Sea Diet Score (BSDS) and eating behaviour using the Children's Eating Behavior Questionnaire. Caries experience was examined clinically. The cross-sectional associations of dietary factors with caries experience at baseline were analysed using linear regression and the longitudinal associations of dietary factors with a change in caries experience over follow-up using generalised mixed-effects regression adjusted for other risk factors. A higher consumption of high-fibre grain products (standardised regression coefficient ß = -0·16, P = 0·003) and milk (ß = -0·11, P = 0·025) and higher BSDS (ß = -0·15, P = 0·007) were associated with lower caries experience, whereas a higher consumption of potatoes (ß = 0·11, P = 0·048) and emotional overeating (ß = 0·12, P = 0·025) were associated with higher caries experience. Higher snacking frequency (fixed coefficient ß = 0·07, P = 0·033), desire to drink (ß = 0·10, P = 0·046), slowness in eating (ß = 0·12, P = 0·027) and food fussiness (ß = 0·12, P = 0·018) were associated with higher caries experience, whereas enjoyment of food (ß = -0·12, P = 0·034) and higher BSDS (ß = -0·02, P = 0·051) were associated with lower caries experience.

Individually tailored nutritional guidance improved dietary intake of older family caregivers: a randomized controlled trial.

PURPOSE: Older family caregivers (FCs) are vulnerable to insufficient dietary intake and risk of malnutrition. The aim of this study was to assess the impact of individually tailored nutritional guidance on the dietary intake and nutritional status of older FCs and their care recipients' (CRs') nutritional status. METHODS: This study was a randomized controlled 6-month nutrition intervention in Eastern Finland. The inclusion criteria for FCs were having a home-living CR aged 65 or above and a valid care allowance. The exclusion criterion was CR receiving end-of-life care at baseline. Participants were randomly assigned to an intervention (FCs n = 63, CRs n = 59) and a control (FCs n = 50, CRs n = 48) group. Individually tailored nutritional guidance targeted to FCs was given to an intervention group by a clinical nutritionist. The main outcomes were dietary intake (3-day food record). RESULTS: After the 6-month intervention, 63 FCs and 59 CRs in the intervention group and 50 FCs and 48 CRs in the control group were analyzed. In the intervention group of FCs, the intakes of protein, riboflavin, calcium, potassium, phosphorus, and iodine differed significantly (p < 0.05) compared to the control group. In addition, the intake of vitamin D supplementation improved in the intervention group of the FCs and CRs (p < 0.001). CONCLUSION: Individually tailored nutrition guidance improves the intake levels of crucial nutrients, such as the intake levels of protein, vitamin D, and calcium of the FCs. Further studies are warranted to optimize the methods to improve the nutrition of FCs. Registration number of Clinical Trials: ClinicalTrials.gov NCT04003493 (1 July 2019).

Association of temporomandibular disorder-related pain with severe headaches-a Bayesian view.

OBJECTIVES: Association of temporomandibular disorders (TMD)-related pain with severe headaches (migraine and tension-type headaches [TTH]) was studied over a follow-up period of 11 years. MATERIALS AND METHODS: The data used was from two nationally representative health surveys in Finland-the Health 2000 Survey (baseline) and the Health 2011 Survey (follow-up) (Bioresource Research Impact Factor [BRIF] 8901)-conducted by the Finnish Institute for Health and Welfare (THL). The primary dataset of the current study included a subset of the population undergoing a clinical oral examination, including TMD examination, at baseline, and answering the questions related to severe headaches, both at baseline and at follow-up (n = 530). From the primary dataset, two datasets were created to study the onset of migraine (dataset 1) and TTH (dataset 2) separately. Dataset 1 included participants healthy of migraine, but not other headaches, at baseline (n = 345), and dataset 2 participants healthy of TTH and other headaches, except migraine, at baseline (n = 464). Bayesian logistic regression models with weakly informative priors were utilized to assess the association of muscle-related TMD pain (mTMD) at baseline and temporomandibular joint-related TMD pain (jTMD) at baseline with the presence of migraine and TTH at follow-up. RESULTS: Neither of the baseline TMD-related pain variables were associated with the presence of migraine at follow-up (posterior effect estimates-0.12, 95% credible interval [CI] -0.49-0.24, and 0.11, 95% CI -0.38-0.59, for mTMD and jTMD, respectively), whereas mTMD at baseline (posterior effect estimate 0.36, 95% CI 0.02-0.69), but not jTMD at baseline (posterior effect estimate -0.32, 95% CI -0.94-0.25), was associated with the presence of TTH at follow-up. Bayesian sensitivity analyses revealed that the estimates of the regression models were stable, demonstrating sufficient validity and consistency of the estimates. CONCLUSION: These results indicate that diverse mechanisms may exist behind the associations of TMD-related painful conditions with different types of severe headaches. CLINICAL RELEVANCE: TMD-related pain is a frequent comorbidity of severe primary headaches. Therapy of severe primary headaches may thus benefit significantly with the incorporation of a multi-disciplinary clinical team.

Oral health care quality as viewed by leading dentists and their superiors - a qualitative study.

OBJECTIVE: The aim was to investigate how leading dentists and their superiors view oral health care quality, as they are in key positions to pursue high-quality care. MATERIALS AND METHODS: We interviewed five leading dentists and three of their superiors from Southern Finland via semi-structured telephone interviews including themes based on the Institute of Medicine's six quality dimensions. The material was analysed using theory-driven content analysis. RESULTS: Participants divided safety into occupational, instrumental and patient safety and considered timeliness as timing treatment clinically correctly. They also linked timeliness to patient-centeredness with wider opening-hours and quick access to care. Effective care was considered as a prerequisite for efficiency. Participants saw effectiveness as treating the illness, not the number of treatment measures. Leading dentists took survival time of fillings and cost per operation as a measurement of efficiency, and the superiors measured efficiency by the number of treated patients or visits. The leading dentists considered the equal treatment of patients, whereas the superiors took the amount of care provided with public resources and co-workers into consideration. CONCLUSIONS: The participants shared similar views of oral health care quality which should enable cooperation. Observed minor differences relate to professional background and leading positions.

Association between periodontal condition and blood pressure is confounded by smoking.

OBJECTIVE: To investigate the role of smoking as a confounding factor in the association between periodontal pocketing and blood pressure. MATERIAL AND METHODS: After restriction to 45-64-year-old subjects without hypertension, diabetes, rheumatic diseases, obesity and with no history of cardiovascular diseases or ongoing lipid-lowering medications, the study population consisted of 307 subjects of the Health 2000 Survey in Finland. Systolic and diastolic blood pressure and pulse pressure (mmHg) were used as outcome variables. Periodontal condition was measured by the number of teeth with ≥4 mm periodontal pockets. ß-estimates and 95% confidence intervals (CI) were obtained from linear regression models. Analyses were made in the whole study population and stratified according to smoking habits/history. RESULTS: The number of teeth with ≥4 mm periodontal pockets associated statistically significantly with systolic blood pressure and pulse pressure in the whole study population. Among never-smokers or daily smokers, there were no consistent nor statistically significant associations between the number of teeth with ≥4 mm periodontal pockets and systolic/diastolic blood pressure or pulse pressure. CONCLUSIONS: Smoking appeared to confound the association between periodontal condition and blood pressure. Thorough control for the effect of smoking was not obtained using multivariate models.

Perceived oral health and oral health behaviours among home-dwelling older people with and without domiciliary care.

OBJECTIVES: The aim was to compare the perceived oral health and oral health behaviours of home-dwelling older people with and without domiciliary care. BACKGROUND: Oral health is poor in long-term care, but less is known about perceived oral health of home-dwelling older people receiving domiciliary care. MATERIALS AND METHODS: Data from the Health 2000 and Health 2011 surveys (BRIF8901) were used. Interview participants were at least 70 years old and living at home with or without domiciliary care (n = 1298 in 2000 and n = 1027 in 2011). Differences in perceived oral health (subjective oral health, pain, eating difficulties) and oral health behaviours (hygiene, use of services) were compared based on the use of domiciliary care and stratified by gender. Differences between groups were compared with the chi-square test. RESULTS: In 2011, compared to non-clients, domiciliary care clients more often had poor subjective oral health (40.3% vs. 28.9%, P = .045). In both surveys, they also used oral health services less recently (2000, 76.4% vs. 60.9%; and 2011, 61.1% vs. 46.6%) and more often had difficulties chewing hard food (2000, 50.6% vs. 34%, P < .001; and 2011, 38.4% vs. 20.7%, P < .001) than non-clients. In 2000, clients had more difficulty eating dry food without drinking (39.5% vs. 21.6%, P < .001) and cleaning their teeth and mouth (14.3% vs. 1.1%, P < .001) than non-clients. Women clients in 2011 brushed their teeth less often than non-clients (43.5% vs. 23.7%, respectively, P = .001). CONCLUSION: Domiciliary care clients have poorer perceived oral health, and greater difficulties with eating and oral hygiene maintenance than non-clients.

Periodontal condition and ultrasound-based measures of arterial stiffness: results of the Health 2000 Survey.

BACKGROUND: Periodontitis has been associated with inflammatory processes in arterial walls such as impairment in endothelial function and thickening of intima media. As inflammation plays a role also in arterial stiffening, an association between periodontal inflammation and arterial stiffness can be expected. So far, conflicting results of the association between periodontal disease and arterial stiffness have been reported. Many of the earlier studies were conducted in specific populations and heterogeneous measures of both arterial stiffness and periodontal status were used. In this population-based study we aimed to investigate whether periodontal pocketing and gingival bleeding are associated with ultrasound-based measures of arterial stiffness. METHODS: In this cross-sectional study, two sets of data based on the national Health 2000 Survey in Finland were formed. Data set I comprised never-smoking 45-64-year-old dentate (≥ 10 natural teeth), non-diabetic, non-rheumatic, non-obese (BMI ≤ 30 kg/m2), non-hypertensive subjects with no coronary artery disease or ongoing lipid-lowering medications (n = 157). Data set II was formed of an unrestricted 45-74-year-old dentate population (n = 536). Four arterial stiffness measures (carotid artery compliance, Peterson's elastic modulus, Young's elastic modulus and beta stiffness index) based on an ultrasound examination of the common carotid artery were used. Periodontal parameters included the number of teeth with ≥ 4 mm deep periodontal pockets and the number of sextants with gingival bleeding. ß-estimates, confidence intervals, and p-values were obtained from linear regression models. RESULTS: In Data set I, the adjusted ß-estimates for the association between the number of teeth with ≥ 4 mm deep periodontal pockets and Peterson's elastic modulus and Young's elastic modulus were 15.80 (p = 0.12) and 61.02 (p = 0.22), respectively. The respective ß-estimates were 31.06 (p = 0.17) and 121.16 (p = 0.28) for the association between the number of bleeding sextants and these two stiffness measures. The results in Data set II were in line with the results in Data set I, with the exception that the adjusted ß-estimates for the associations between Peterson's elastic modulus and Young's elastic modulus and periodontal parameters were closer to null. CONCLUSIONS: This population-based study did not provide evidence of an association between periodontal condition and arterial stiffness.