Is grandparents' social class associated with adult grandchildren's oral health? Analysis of two British cohorts.

OBJECTIVES: No studies have taken a multigenerational approach to the study of oral health inequalities. This study investigated whether grandparents' social class was associated with adult grandchildren's oral health. METHODS: Data from the 1958 National Child and Development Study (NCDS) and the 1970 British Cohort Study (BCS) were analysed. Cohort members' occupational social class and persistent trouble with mouth, teeth or gums in the past 12 months were reported at ages 33 years in the NCDS and 26 years in the BCS. Information on grandparents' and parents' social class was reported by the cohort members' mothers during childhood. The association between grandparents' social class and cohort members' report of persistent trouble with mouth, teeth or gums was tested in marginal structural models (MSMs). RESULTS: Data from 9853 NCDS and 6487 BCS participants were analysed. Grandparents' social class was not associated with cohort members' report of persistent trouble with teeth, gums or mouth in the NCDS sample (odds ratios of 1.25 [95% Confidence Interval: 0.95-1.65] for social class IV/V and 1.12 [95% CI: 0.76-1.64] for social class IIINM-M relative to social class I/II) or the BCS sample (odds ratios of 0.98 [95% CI: 0.68-1.43] for social class IV/V and 0.88 [95% CI: 0.67-1.16] for social class IIINM-M relative to social class I/II). CONCLUSION: This study provided no support for an independent association between grandparents' social class and adult grandchildren's oral health.

Socioeconomic inequalities in adult oral health across different ethnic groups in England.

BACKGROUND: Ethnic inequalities in oral health among British adults remain largely unexplored. This study explored the role of socioeconomic position (SEP) in explaining ethnic inequalities in oral health; and the consistency of socioeconomic inequalities in oral health across ethnic groups. METHODS: Data from 45,599 adults, aged 16 years and over, who participated in the Health Survey for England were pooled across 5 years. The seven ethnic groups included were White British, Irish, Black Caribbean, Indian, Pakistani, Bangladeshi and Chinese. Edentulousness and toothache were the outcome measures. A composite measure of SEP was developed based on education, social class, income and economic activity using confirmatory factor analysis. Ethnic inequalities in oral health were assessed in logistic regression adjusting for sex, age, survey year and SEP. RESULTS: Indian (OR: 0.55, 95%CI: 0.40-0.76), Pakistani (0.56, 0.38-0.83), Bangladeshi (0.35, 0.23-0.52) and Chinese (0.41, 0.25-0.66) were less likely to be edentulous than White British after controlling for SEP. Irish (1.22, 1.06-1.39) and Caribbean (1.37, 1.19-1.58) were more likely and Bangladeshi (0.83, 0.69-0.99) were less likely to have toothache than White British after controlling for SEP. Socioeconomic inequalities in edentulousness were consistently found across almost all ethnic groups while socioeconomic inequalities in toothache were found among White British and Irish only. CONCLUSION: This study shows that the role of SEP in explaining ethnic inequalities in oral health depended on the outcome being investigated. Socioeconomic inequalities in oral health among minority ethnic groups did not consistently reflect the patterns found in White British.

Racial Discrimination and Uptake of Dental Services among American Adults.

This study examined the relationship between racial discrimination and use of dental services among American adults. We used data from the 2014 Behavioral Risk Factor Surveillance System, a health-related telephone cross-sectional survey of a nationally representative sample of adults in the United States. Racial discrimination was indicated by two items, namely perception of discrimination while seeking healthcare within the past 12 months and emotional impact of discrimination within the past 30 days. Their association with dental visits in the past year was tested in logistic regression models adjusting for predisposing (age, gender, race/ethnicity, income, education, smoking status), enabling (health insurance), and need (missing teeth) factors. Approximately 3% of participants reported being discriminated when seeking healthcare in the past year, whereas 5% of participants reported the emotional impact of discrimination in the past month. Participants who experienced emotional impact of discrimination were less likely to have visited the dentist during the past year (Odds Ratios (OR): 0.57; 95% CI 0.44-0.73) than those who reported no emotional impact in a crude model. The association was attenuated but remained significant after adjustments for confounders (OR: 0.76, 95% CI 0.58-0.99). There was no association between healthcare discrimination and last year dental visit in the fully adjusted model. Emotional impact of racial discrimination was an important predictor of use of dental services. The provision of dental health services should be carefully assessed after taking account of racial discrimination and its emotional impacts within the larger context of social inequalities.

Ethnicity, migration status and dental caries experience among adults in East London.

OBJECTIVE: To assess the interrelationship between ethnicity, migration status and dental caries experience among adults in East London. METHODS: We analysed data from 1910 adults (16-65 years) representing 9 ethnic groups, who took part in a community-based health survey in East London. Participants completed a supervised questionnaire and were clinically examined by trained dentists. Dental caries was assessed with the number of decayed, missing and filled teeth (DMFT). The association of ethnicity, nativity status and migration history with DMFT was assessed in negative binomial regression models controlling for demographic, socioeconomic and behavioural factors. RESULTS: White migrants had greater DMFT than UK-born adults, whereas every Asian and Black migrant group had lower DMFT than adults of the same ethnic group born in the UK (albeit significant only for Black Caribbean and Asian Others). Among foreign-born adults, age at arrival (Rate Ratio: 1.03; 95% Confidence Interval: 1.01-1.05) and length of residence (1.04; 95% CI: 1.02-1.06) were positively associated with DMFT. A significant interaction between both factors was also found, with more pronounced differences between older and younger migrants at longer stay in the UK for White Others, Black Caribbean and Asian Others. CONCLUSION: Large inequalities in caries experience were found between foreign- and UK-born adults, with considerable variation across ethnic groups. Looking beyond cultural explanations, in favour of social and environmental factors, may help to explain those inequalities.

Oral impacts on quality of life and problem-oriented attendance among South East London adults.

BACKGROUND: Dental care seeking behaviour is often driven by symptoms. The value of oral health related quality of life (OHRQoL) measures to predict utilisation of dental services is unknown. This study aims to explore the association between OHRQoL and problem-oriented dental attendance among adults. METHODS: We analysed cross-sectional data for 705 adults, aged 16 years and above, living in three boroughs of Inner South East London. Data were collected during structured interviews at home. The short form of the Oral Health Impact Profile (OHIP-14) was used to assess the frequency of oral impacts on daily life in the last year. Problem-oriented attendance was defined based on time elapsed since last visit (last 6 months) and reason for that visit (trouble with teeth). The association between OHIP-14 (total and domain) scores and problem-oriented attendance was tested in logistic regression models adjusting for participants' sociodemographic characteristics. RESULTS: Problem-oriented attenders had a higher OHIP-14 total score than regular attenders (6.73 and 3.73, respectively). In regression models, there was a positive association between OHIP-14 total score and problem-oriented attendance. The odds of visiting the dentist for trouble with teeth were 1.07 greater (95% Confidence Interval: 1.04-1.10) per unit increase in the OHIP-14 total score, after adjustment for participants' sociodemographic characteristics. In subsequent analysis by OHIP-14 domains, greater scores in all domains but handicap were significantly associated with problem-oriented attendance. CONCLUSION: This study shows that oral impacts on quality of life are associated with recent problem-oriented dental attendance among London adults. Six of the seven domains in the OHIP-14 questionnaire were also associated with dental visits for trouble with teeth.

Ethnic inequalities in periodontal disease among British adults.

AIM: To explore ethnic inequalities in periodontal disease among British adults, and the role of socioeconomic position (SEP) in those inequalities. METHODS: We analysed data on 1925 adults aged 16-65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults living in an ethnically diverse and socially deprived area. Participants completed a questionnaire and were clinically examined for the number of teeth with periodontal pocket depth (PPD)≥4 mm and loss of attachment (LOA)≥4 mm. Ethnic inequalities in periodontal measures were assessed in negative binomial regression models before and after adjustment for demographic (gender and age groups) and SEP indicators (education and socioeconomic classification). RESULTS: Compared to White British, Pakistani, Indian, Bangladeshi and Asian Others had more teeth with PPD≥4 mm whereas White East European, Black African and Bangladeshi had more teeth with LOA≥4 mm, after adjustments for demographic and SEP measures. The association of ethnicity with periodontal disease was moderated by education, but not by socioeconomic classification. Stratified analysis showed that ethnic disparities in the two periodontal measures were limited to more educated groups. CONCLUSION: This study showed considerable ethnic disparities in periodontal disease between and within the major ethnic categories.

Ethnic inequalities in dental caries among adults in East London.

BACKGROUND: This study explored ethnic inequalities in dental caries among adults and assessed the role of socioeconomic position (SEP) in explaining those inequalities. METHODS: We analysed data on 2013 adults aged 16-65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults and children living in East London in 2009-10. Participants completed a questionnaire and were clinically examined for dental caries at home. Dental caries was measured using the number of decayed, missing and filled teeth or DMFT index. Ethnic inequalities in dental caries were assessed in negative binomial regression models before and after adjustment for demographic (sex and age groups) and SEP measures (education and socioeconomic classification). RESULTS: White Eastern European and White Other had higher DMFT, whereas all Asian (Pakistani, Indian, Bangladeshi and Other) and all Black (African, Caribbean and Other) ethnic groups had lower DMFT than White British. Similar inequalities were found for the number of filled and missing teeth, but there were no differences in the number of decayed teeth between ethnic groups. CONCLUSIONS: This study showed considerable disparities in dental caries between and within the major ethnic categories, which were independent of demographics and SEP.

The association of depression and anxiety with dental caries and periodontal disease among Finnish adults.

OBJECTIVE: To explore the association of depression and anxiety with two oral health outcomes, dental caries and periodontal disease and assess possible mediators for any of the associations. METHODS: Secondary analysis of the Finnish Health 2000 Survey. Depression was assessed with Beck's Depression Inventory and anxiety with Composite International Diagnostic Interview. Number of decayed teeth included carious lesions reaching dentine; periodontal disease was number of teeth with periodontal pockets of 4 mm or deeper. Third molars were excluded. The association of mental disorders and oral health was tested in regression models adjusted for confounders and potential mediators. RESULTS: Depression was associated with number of decayed teeth only among 35- to 54-year-olds. The association between anxiety and the number of decayed teeth was not statistically significant. Depression and periodontal pocketing were not significantly associated. CONCLUSION: Depression was significantly associated with number of decayed teeth only among participants aged 35-54 old and not with other age groups. Neither depression nor anxiety was significantly related to periodontal disease.

Income gradients in oral health according to child age.

This study aimed to confirm whether the well-known income disparities in oral health seen over the life course are indeed absent in 9- to 11-yr-old children, and to explore the role of access to dental care in explaining the age-profile of the income gradient in child oral health. We used data from the 2007 United States National Survey of Children's Health. Income gradients in parental reports of children's decayed teeth or cavities, toothache, broken teeth, bleeding gums, and fair/poor condition of teeth were assessed in stratified analyses according to age of child (1-5, 6-8, 9-11, 12-14, and 15-17 yr), using survey logistic regression to control for family-, parental-, and child-level covariates. Health insurance status and use of preventive dental care were the indicators for children's access to dental care. The adjusted ORs for the effect of family income on having decayed teeth or cavities, toothache, and fair/poor condition of teeth were not significant in 9- to 11-yr-old children. Different age-patterns were found for broken teeth and bleeding gums. The attenuation of the income gradients in having decayed teeth or cavities, toothache, and fair/poor condition of teeth, previously seen in 9- to 11-yr-old children, was also seen in 15- to 17-, 12- to 14-, and 6- to 8-yr-old children, respectively, after controlling for children's access to dental care. This study supports the attenuation of income inequalities in oral health in 9- to 11-yr-old children. Access to dental care could attenuate income gradients in oral health in other age groups.

Intergenerational mobility and adult oral health in a British cohort.

OBJECTIVES: This study aimed to characterize trajectories of intergeneration mobility from birth to age 33 years and to assess the influence of these trajectories on adult oral health. METHODS: Repeated data on occupational social class (birth and 7, 11, 16, 23 and 33 years) and two subjective oral health indicators (lifetime and past-year prevalence of persistent trouble with gums or mouth) measured at age 33 years, from the 1958 National Child Development Study, were used for this analysis. Latent class growth analysis (LCGA) was used to identify different trajectories of exposure to manual social class over time. Binary logistic regression was then used to explore the association between these trajectories and each oral health indicator, adjusting for participants' sex. RESULTS: Latent class growth analysis showed that a four trajectory model provided the best fit to the data. The four trajectories that emerged were identified as stable manual, stable nonmanual, late steep increase (those who were likely to be in the manual social class until age 16 years but ended up in the nonmanual social class afterwards) and steady increase (those whose likelihood of leaving the manual social class increased gradually over time). Lifetime and past-year prevalence of persistent trouble with gums or mouth was significantly higher in the stable manual trajectory than in all other trajectories. No differences were found between the stable nonmanual, late steep increase and steady increase trajectories. CONCLUSION: Although four distinctive trajectories were identified in the 1958 NCDS, only those who remained in the manual social class over time reported worse oral health by age 33 years. Proximal socioeconomic experiences may be more relevant to adult oral health than early life experiences.

Daily smoking and 4-year caries increment in Finnish adults.

OBJECTIVES: Although the harmful effects of smoking on periodontal disease and oral cancer are now indisputable, its effect on dental caries is less well known. This study assessed whether daily smoking predicts caries increment in adults over 4 years. METHODS: Data from 955 adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education and dental behaviours. The 4-year net increment in the numbers of decayed (DT), filled (FT) and missing (MT) teeth and the DMFT index were calculated using the data from baseline and follow-up clinical oral examinations. RESULTS: Daily smoking was not associated with net DMFT increment. In subsequent analysis by components, daily smoking was associated with net DT increment, but not with net FT or MT increments. When daily smokers were split into two groups by consumption level (1-19 and 20+ cigarettes/day) and compared to nondaily smokers, a significant dose-response relationship was additionally found between levels of tobacco consumption and net DT increment. Although daily smokers reported less favourable behaviours than nonsmokers, these associations only explained partially the effect of daily smoking on net DT increment. CONCLUSIONS: Daily smoking was independently related to caries development (net DT increment) in adults over 4 years, but not to caries treatment (net FT and MT increments) or caries experience (net DMFT increment).

Impact of malocclusion on the quality of life of Saudi children.

OBJECTIVE: To assess the relationship between malocclusion severity and quality of life in children. MATERIALS AND METHOD: Two hundred and seventy-eight children aged 11 to 14 years were recruited voluntarily from the Dental and Maxillofacial Centre of the Almana General Hospital in Alkhobar, Saudi Arabia. The children were asked to fill out the Arabic version of the Child Perception Questionnaire for 11- to 14-year-old children (CPQ11-14) and were then clinically examined to determine the severity of their malocclusion using the Dental Aesthetic Index (DAI). Multivariate analysis of variance was used to compare the four domains and the total CPQ11-14 scores between the four DAI severity groups. RESULTS: Significant differences were found between DAI severity groups for the four domains and the total CPQ11-14 scores. Although children with very severe (handicapping) malocclusion had significantly higher domain and total CPQ11-14 scores than all the other groups (differences of up to 6 and 22 units, respectively, compared to children with no/minor malocclusion), there were no differences between those with no/minor, definite, and severe malocclusion. CONCLUSION: These findings suggest that only very severe malocclusion had an impact on the quality of life of the participants. Orthodontists should focus not only on clinical measures of malocclusion but should also consider the impact of severe malocclusion on patients' quality of life.

Childhood stunting and caries increment in permanent teeth: a three and a half year longitudinal study in Peru.

BACKGROUND: Malnutrition has been consistently associated with caries in primary teeth, although an effect on permanent teeth has not been established because of the few longitudinal studies. AIM: To explore the association between stunting and caries increment in permanent teeth over 3.5 years. DESIGN: In 2003, 121 children aged 7-9 years were randomly selected from nine underserved communities in Lima (Peru). Parents provided demographic information and a food diary for their children. Clinical examinations included assessments of height, weight, oral hygiene, and dental caries. Stunting was defined using the 2000 CDC and 2007 WHO standards. In 2006, 83 children were re-examined, and the 3.5-year net DMFS increment was calculated. The association between stunting and net DMFS increment was assessed using negative binomial regression. RESULTS: Stunting was related to net DMFS increment after adjustment for sex and age, oral hygiene, sugary snacks between meals, and caries experience in primary and permanent teeth. Consistent results were found when using either the 2000 CDC (incidence rate ratio: 1.61; 95%CI: 1.07, 2.44) or 2007 WHO standards (IRR: 1.79; 95%CI: 1.28, 2.51). CONCLUSION: Stunting was a significant risk factor for caries increment in permanent teeth over a 3.5-year period, independent of other well-known risk factors for caries development.

Poverty, social exclusion and dental caries of 12-year-old children: a cross-sectional study in Lima, Peru.

BACKGROUND: Socioeconomic differences in oral health have been reported in many countries. Poverty and social exclusion are two commonly used indicators of socioeconomic position in Latin America. The aim of this study was to explore the associations of poverty and social exclusion with dental caries experience in 12-year-old children. METHODS: Ninety families, with a child aged 12 years, were selected from 11 underserved communities in Lima (Peru), using a two-stage cluster sampling. Head of households were interviewed with regard to indicators of poverty and social exclusion and their children were clinically examined for dental caries. The associations of poverty and social exclusion with dental caries prevalence were tested in binary logistic regression models. RESULTS: Among children in the sample, 84.5% lived in poor households and 30.0% in socially excluded families. Out of all the children, 83.3% had dental caries. Poverty and social exclusion were significantly associated with dental caries in the unadjusted models (p = 0.013 and 0.047 respectively). In the adjusted model, poverty remained significantly related to dental caries (p = 0.008), but the association between social exclusion and dental caries was no longer significant (p = 0.077). Children living in poor households were 2.25 times more likely to have dental caries (95% confidence interval: 1.24; 4.09), compared to those living in non-poor households. CONCLUSION: There was support for an association between poverty and dental caries, but not for an association between social exclusion and dental caries in these children. Some potential explanations for these findings are discussed.

First molar eruption related to plaque acidogenicity in children of different socio-economic status.

OBJECTIVE: The aim of this study was to evaluate the association between the eruption stage of the lower first permanent molar and dental plaque acidogenicity. Socio-economic status (SES), gender, and oral hygiene condition were also variables considered. MATERIAL AND METHODS: 230 children between 6 and 8 years of age were recruited from one public and one private primary school with different SES in Lima, Peru. Clinical examinations were performed to assess lower first permanent molar eruption stage, plaque acidogenicity, and oral hygiene condition. Bivariate associations were analyzed through chi-square tests and the variable interactions were analyzed through a hierarchical log-linear analysis with backward elimination. RESULTS: 21.8% of the population had highly acidogenic plaque, 34.3% acidogenic plaque, and 43.9% non-acidogenic plaque. Of the lower first permanent molars, 46.1% were fully erupted, whereas 53.9% were partially erupted. According to the final log-linear model, children with fully erupted molars and non-acidogenic plaque are less frequent in low than in high SES. Also, the frequency of children with partially erupted molars and acidogenic to highly acidogenic plaque is higher in males than in females. Finally, fully erupted molars and non-acidogenic plaque are more frequent in children with good hygiene than in children with moderate to poor hygiene. CONCLUSIONS: Association between eruption stage of the lower first permanent molar and plaque acidogenicity was not significant in a bivariate context. However, in a multivariate context, socio-economic status, oral hygiene condition, and gender had an impact on the association between the two main variables.

Influence of host-related risk indicators on dental caries in permanent dentition.

The aim of this study was to assess the individual and grouped influence of host-related factors on dental caries experience in permanent dentition of 7-9 year-old children. One hundred and twenty one children were recruited applying a stratified cluster sampling without replacement. Clinical examinations, Colorimetric Test and non-stimulated and stimulated saliva collection were performed; the samples obtained were later incubated using Snyder culture medium. Simple and multiple binary logistic regression analyses were performed to assess the individual and grouped influence of the host-related factors and establish a modelfor predicting dental caries in permanent dentition. 78.5% of the evaluated children presented dental caries in permanent dentition. Binary logistic regression analyses revealMd that only dental caries in deciduous dentition and stimulated salivary flow were significantly associated to dental caries in permanent dentition. The final multivariate model showed that the adjusted OR was 1.76 for an increase of 1 tooth in dmft and 2.29 for a decrease of 1 ml in stimulated salivary flow. Dental caries in deciduous dentition is a risk indicator for dental caries in permanent dentition, and stimulated salivary flow is a protective factor Variables like enamel resistance to acid dissolution and buffer capacity are not related to dental caries in permanent dentition, making them inappropriate for risk studies.

Influence of host-related risk indicators on dental caries in permanent dentition

El propósito de este estudio fue establecer la influencia individualy agrupada de los factores relacionados al hospedador sobre la experiencia de caries dental en dentición permanente de niños de 7 a 9 años de edad. Se reclutaron 121 niños aplicando un muestreo estratificado simple. Se realizaron exámenes clínicos, la PruebaColorimétrica y la recolección de saliva estimulada y no estimulada;las muestras obtenidas fueron incubadas posteriormente empleando el medio de Snyder. Para establecer la influencia individual y agrupada se llevaron a cabo análisis de regresión logística simple y múltiple, a fin de establecer un modelo de predicción de riesgo de caries dental en dentición permanente.78.5 por ciento de los niños evaluados presentaron caries dental en dentición permanente. Elanálisis de regresión logística sólo encontró asociación significativa entre caries dental en dentición permanente con la experiencia de caries dental en dentición decidua y el flujo salival estimulado. El modelo multivariado final mostró que el OR ajustado para elincremento del ceod en 1 pieza era de 1.76, y para la disminución de 1 ml del flujo salival estimulado fue de 2.29.Se encontró que la experiencia de caries dental en dentición decidua es un indicador de riesgo para caries dental en dentición permanente, y el flujo salival estimulado un factor de protección. Las variables como resistencia del esmalte a la desmineralización y la capacidad buffer de la saliva no mostraronrelación con la caries dental en dentición permanente, lo que los hace inapropiados para estudios de riesgo.

Influence of host-related risk indicators on dental caries in permanent dentition

El propósito de este estudio fue establecer la influencia individualy agrupada de los factores relacionados al hospedador sobre la experiencia de caries dental en dentición permanente de niños de 7 a 9 años de edad. Se reclutaron 121 niños aplicando un muestreo estratificado simple. Se realizaron exámenes clínicos, la PruebaColorimétrica y la recolección de saliva estimulada y no estimulada;las muestras obtenidas fueron incubadas posteriormente empleando el medio de Snyder. Para establecer la influencia individual y agrupada se llevaron a cabo análisis de regresión logística simple y múltiple, a fin de establecer un modelo de predicción de riesgo de caries dental en dentición permanente.78.5 por ciento de los niños evaluados presentaron caries dental en dentición permanente. Elanálisis de regresión logística sólo encontró asociación significativa entre caries dental en dentición permanente con la experiencia de caries dental en dentición decidua y el flujo salival estimulado. El modelo multivariado final mostró que el OR ajustado para elincremento del ceod en 1 pieza era de 1.76, y para la disminución de 1 ml del flujo salival estimulado fue de 2.29.Se encontró que la experiencia de caries dental en dentición decidua es un indicador de riesgo para caries dental en dentición permanente, y el flujo salival estimulado un factor de protección. Las variables como resistencia del esmalte a la desmineralización y la capacidad buffer de la saliva no mostraronrelación con la caries dental en dentición permanente, lo que los hace inapropiados para estudios de riesgo.(AU)