Inequality in oral health related to early and later life social conditions: a study of elderly in Norway and Sweden

Abstract Background: A life course perspective recognizes influences of socially patterned exposures on oral health across the life span. This study assessed the influence of early and later life social conditions on tooth loss and oral impacts on daily performances (OIDP) of people aged 65 and 70 years. Whether social inequalities in oral health changed after the usual age of retirement was also examined. In accordance with "the latent effect life course model", it was hypothesized that adverse early-life social conditions increase the risk of subsequent tooth loss and impaired OIDP, independent of later-life social conditions. Methods: Data were obtained from two cohorts studies conducted in Sweden and Norway. The 2007 and 2012 waves of the surveys were used for the present study. Early-life social conditions were measured in terms of gender, education and country of birth, and later-life social conditions were assessed by working status, marital status and size of social network. Logistic regression and Generalized Estimating Equations (GEE) were used to analyse the data. Inverse probability weighting (IPW) was used to adjust estimates for missing responses and loss to follow-up. Results: Early-life social conditions contributed to tooth loss and OIDP in each survey year and both countries independent of later-life social conditions. Lower education correlated positively with tooth loss, but did not influence OIDP. Foreign country of birth correlated positively with oral impacts in Sweden only. Later-life social conditions were the strongest predictors of tooth loss and OIDP across survey years and countries. GEE revealed significant interactions between social network and survey year, and between marital status and survey year on tooth loss. Conclusion: The results confirmed the latent effect life course model in that early and later life social conditions had independent effects on tooth loss and OIDP among the elderly in Norway and Sweden. Between age 65 and 70, inequalities in tooth loss related to marital status declined, and inequalities related to social network increased

Satisfaction with oral health and associated factors in Sweden and Norway – cross-sectional and longitudinal perspectives

Background: Oral health is defined as a broader concept than oral disease, concerning individuals’ optimal functioning, social and psychological wellbeing. Thus, oral disease affects oral health by its functional, psychological and social consequences for the individual. There seems to be a need to assess information about self-reported oral health for such measures to be valid supplements for the conventional clinical measures. Aims: The main objective of this thesis was to contribute to the validation of a single global measure of oral health in the context of younger and older age groups in Sweden and Norway. Specifically, this study assessed the level of oral health satisfaction in younger and older Swedish age groups, examined associations of self reported oral satisfaction with socio demographic, clinical and non-clinical variables across 65-year-olds in Norway and Sweden and examined changes and predictors of changes in oral health satisfaction of a cohort of Swedes as they aged from 50 to 65 yr. Method: The papers of the present thesis are based upon three structured questionnaire surveys. Survey I applies to paper I and was conducted in 2006 involving a census of 19-year-olds attending dental clinics in Örebro and Östergötland. Data were collected by questionnaires and an oral clinical examination. The second survey, (Survey II) is a prospective cohort study initiated in 1992 among all 50-year-olds (born 1942) resident in Örebro and Östergötland. Survey II applies to Papers II and III. Data were collected in 1992, 1997, 2002 and 2007 at ages 50, 55, 60 and 65 yrs, respectively. The survey started as a collaborative project and the counties were chosen by convenience and not with the purpose of being representative for Sweden as a whole. Survey III was conducted in 2007 among a census of the 1942 cohort currently residing in three counties of Norway, Hordaland, Sogn & Fjordane and Nordland. The Norwegian counties were chosen purposively to represent not only the rural and urban parts of the country, but also variability in oral conditions and dental service offered. Survey II and III were based on a similar questionnaire. Results: The aim of Paper I (based on Survey I) was to investigate clinical- and self-perceived oral health indicators among 19-year-olds, using a single global question on oral health and one clinical indicator in terms of DSa. Four subscales (function, knowledge, quality of life and social) were used to identify predictors for self perceived oral health. The results revealed that 87,5% of the 19 yr old participants (n=3,658) was satisfied with their teeth. Females reported more serious problems than males in the social and quality of life dimensions and responders from Östergötland showed better knowledge about oral disease than responders from Örebro (94,4% versus 90,1%). The strongest predictors of satisfaction with oral health were social aspects and quality of life. Statistically significant two-way interactions occurred between county and knowledge and between county and quality of life. In Östergötland knowledge varied systematically with satisfaction, whereas function did not and in Örebro the opposite result was found. Thus, some or good knowledge was more strongly associated with satisfaction in Östergötland than in Örebro, whereas good function was more strongly associated with satisfaction in Örebro. The aim of paper II (based on Survey II and III) was to assess the prevalence of self-reported oral health satisfaction and to examine its relationship with sociodemographic-, behavioural and subjective oral health indicators. In addition, this study examined the extent to which the abovementioned relationships were consistent across Sweden and Norway as reported by 65- year-olds. A total of 76.8% of the Swedish and 76.5% of the Norwegian participants were satisfied with their oral health. Multiple logistic regression analysis revealed that subjects who perceived bad general health, smoked daily, had missing teeth, experienced toothache, had problems with chewing, bad breath and oral impacts were less likely than their counterparts in the opposite group to be satisfied with their oral health status. The corresponding odds ratios ranged from 0.08 (problems chewing) to 0.2 (oral impact). No statistically significant two-way interactions occurred and the model explained 46% of the variance in oral health satisfaction across the countries (45% in Sweden and 47% in Norway). The aim of paper III (based on Survey II) was to assess the stability or change of self-reported satisfaction with teeth in subjects as they age from 50 to 65 and to assess the impacts of socio-demographic, clinical and non-clinical oral health-related factors on tooth satisfaction throughout that period. The result showed that altogether, 63% females and 66% males remained satisfied with their teeth between the ages of 50 and 65. The corresponding figures, with respect to dissatisfaction, were 7% and 6%. GEE models revealed a decline in the odds of being satisfied with advancing age, and this was particularly important in subjects with lower education, tooth loss and in smokers. Remaining all teeth and the absence of chewing problems were the strongest predictors of satisfaction with teeth between ages 50 and 65. Conclusions and implications: A single global question on oral health satisfaction was applicable in terms of having acceptable psychometric properties in the context of younger and older age groups across Sweden and Norway. This supports the notion that to ascertain information about patients’ oral health, both self-reported oral health measures and conventional clinical measures are needed. Such self-reports can be administered in different ways. To ask a single global oral health question (and register the answer) at the time when patients undergo their regular examination is inexpensive and straightforward. The implementation of such a question is a technical matter for the care provider where there are different possibilities to introduce it directly into the medical record or in adhering it in medical history or risk group registration

Life events, general health and oral health : a study of divorce, death of spouse, and theirrelation to general and oral health in all 65-year-old citizens in Swedish two counties.

BAKGRUND: De som drabbats av svåra livshändelser (här begränsade till skilsmässa eller make/makas död) betraktas som en riskgrupp när det gäller både allmän hälsa och munhälsa. SYFTE: Att undersöka om och i vilken mån svåra livshändelser (skilsmässa eller make/makas död) påverkar den allmänna hälsan och munhälsan, samt vilka aspekter av munhälsa som en global munhälsofråga kan fånga upp. MATERIAL OCH METOD: Studien utfördes som en kvantitativ studie med en enkät om munhälsa som delades ut till samtliga födda 1942 i Örebro och Östergötlands län under 2007. Svarsfrekvensen var 73,1% av totalt 8313 individer. Både allmän hälsa och munhälsa mättes med hjälp av en global fråga. Munhälsan mättes dessutom med sex ytterligare frågor. Deskriptiv analys gjordes, skillnader mellan grupper testades och kompletterades med logistiska regressionsanalyser. RESULTAT: Det finns en statistiskt signifikant skillnad mellan dem som är frånskilda och/eller änka/änkling jämfört med dem som är gifta/sambo. De som inte drabbats av skilsmässa eller make/makas död hade bättre allmän hälsa och munhälsa. Skillnaden är systematisk och signifikant. Skillnaden mellan grupperna är statistisk signifikant även vid användandet av endast en fråga, den globala munhälsofrågan. Den globala munhälsofrågan förefaller i första hand spegla de delar av munhälsan som anknyter till patientens uppfattning om utseende och tuggförmåga. Studien antyder också att den försämrade hälsan kvarstår lång tid efter händelsen. SLUTSATSER OCH REKOMMENDATIONER: Den här studien påvisar vikten av en adekvat anamnes som även inkluderar frågor om civilstånd. En global fråga om självupplevd munhälsa är också ett möjligt komplement för att bättre kunna bedöma såväl patientens munhälsa som behov av preventiva insatser.BACKGROUND: Individuals who have experienced difficult life events, limited here todivorce or death of a spouse, show elevated risk regarding general and oral health. AIM: This study investigated how and to what extent difficult life events, i.e., divorce ordeath of a spouse, affect general and oral health. I also sought to determine whether a globalquestion can identify different aspects of oral health. MATERIALS AND METHOD: This cross-sectional quantitative study used an existingquestionnaire already distributed to all (8,313) 65-year-old citizens in two Swedish counties.Within the questionnaire, a global question measured general as well as oral health, and sixadditional questions assessed oral health. Descriptive analysis sought to determinedifferences between groups, and logistic regressions were used to compare them further. RESULTS: The questionnaire response rate was 73.1%. The results showed statisticallysignificant differences in general and oral health among individuals who experienceddivorce or death of a spouse compared with individuals without such experiences. Thedifferences among groups, i.e., better general and oral health among individuals withoutdivorce or death of a spouse, were significant and systemic, p&lt;0.05. Further, differencesremained statistically significant even when using a global question on oral health. However,this global question focused mainly on chewing capacity and appearance. CONCLUSIONS: This study shows the importance of accurate anamnesis, includingquestions on civil status. A global question about self-perceived oral health providesimportant information for judging patients’ oral health and determining preventive actions.The study also suggests that risk for deteriorating oral health lingers long after difficult lifeevents have occurred.ISBN 978-91-85721-48-1</p

Self-perceived taste disturbance : a 20-year prospective study of a Swedish 1942 birth cohort

Objectives: The aim of this study was to assess the impact of dental care factors, general health factors and socio-economic factors on perceived taste disturbance (PTD) over time and to assess the stability of or change in PTD in a panel of individuals as they progressed from middle age (50 years) to early old age (70 years). Materials and methods: Data collection was conducted from a cohort study beginning in 1992, when the participants were 50 years old, and again 5, 10, 15 and 20 years later. Stability and change in PTD were described using cross-tabulation. Perceived taste disturbance over the 20-year survey period was modelled using the generalised estimating equation (GEE). Results: The prevalence of PTD during a 5-year period found in this study ranged from 2.4 to 2.9%, the latter in individuals between 60 and 70 years of age. Women generally had PTD more often than men. The longitudinal analysis showed that problems with bad breath (OR = 3.6), blisters (OR = 3.4), burning mouth (OR = 3.4) and self-perceived health (OR = 2.7) were the most important factors explaining PTD. Conclusions: This study showed that PTD does not increase between 50 and 70 years of age in ordinary community-living individuals. There were no long-term impacts on PTD over time from socio-economic factors, and over time, there were a limited number of factors contributing to the effect. Bad breath, blisters, burning mouth and self-perceived health are important factors for the dentist to discuss with the patient in the case of PTD

Does different wording of a global oral health question provide different results?

Objective. Focusing on 70-year-old adults in Sweden and guided by the conceptual framework of International Classification of Impairments, Disabilities and Handicaps (ICIDH), the purpose of this study was to examine the extent to which socio-demographic characteristics, self-reported oral disease and social/psychological/physical oral health outcome variables are associated with two global measures of self-assessed satisfaction with oral health in Swedish 70-year-olds and if there is a degree of discordance between these global questions. Background. It has become an important task to create a simple way to measure self-perceived oral health. In these attempts to find practical ways to measure health, the 'global oral health question' is a possible tool to measure self-rated oral health, but there is limited knowledge about how important the wording of this question is. Materials and methods. In 2012, a questionnaire was mailed to all persons born in 1942 in two Swedish counties, Orebro (T) and Ostergotland (E). The total population of 70-year-olds amounted to 7889. Bivariate analyses were conducted by cross-tabulation and Chi-square statistics. Multivariate analyses were conducted using binary multiple logistic regression. Results. The two global oral health question of 70-year-olds in Sweden was mainly explained by the number of teeth (OR = 5.6 and 5.2), chewing capacity (OR = 6.9 and 4.2), satisfaction with dental appearance (OR = 19.8 and 17.3) and Oral Impact on Daily Performance (OIDP) (OR = 3.5 and 3.9). Conclusion. Regardless of the wording, it seems that the concept of a global oral health question has the same main determinants

Satisfaction with dental care and life-course predictors : A 20-year prospective study of a Swedish 1942 birth cohort?

Objectives: The aim was to assess the impact of care experience, health factors and socioeconomic factors on satisfaction with dental care across time and to assess the stability or change in levels of self-reported satisfaction with dental care in individuals as they progress from middle age to early old age.Materials and methods: The present work is based on five separate data collections from a cohort study with 3585 individuals responding in all years of the survey. Data collection was conducted in 1992 when the subjects were 50 years of age and again 5, 10, 15 and 20 years later. Absolute stability in satisfaction with dental care was assessed by calculating the proportion of individuals who maintained their position in the same category from one survey period to another. Changes across time were tested using Cochran's Q test. Satisfaction with dental care across the 20-year survey period was modeled using the generalized estimating equation (GEE).Results and conclusion: The result showed that 85% of women and 83% of men remained satisfied with dental care. Binomial GEE revealed no statistical significant change in satisfaction with dental care between 1992-2012. In sum, this study has shown that this age group, born in 1942, was stably satisfied with dental care between age 50 and age 70, despite all changes during this time period. Females are more satisfied than men and the most important factors are the experience of attention during the last visit, satisfaction with dental appearance and good chewing capability

How much information is remembered by the patients? : A selective study related to health education on a Swedish public health survey

The purpose of this study was to investigate the degree to which patients have perceived that they got questions or advice about eating habits and smoking habits at their last visit at the dental clinic and if this information was differently distributed between different age groups. A further aim was to study whether there were differences in the proportions of questions and advice given to individuals who perceived problems regarding caries and gum bleeding compared to those that did not feel they had problems. The results are based on a postal questionnaire survey,"Life and Health 2008". The study was conducted in a population of women and men aged 18-84 years in 5 counties in Sweden. A total of 68,710 questionnaires were sent out and the response rate was 59.2%. Substantial differences in proportions existed between age groups regarding who received questions and advice related to dental caries and periodontal disease. The differences between age groups regarding information were statistically significant since it was less common that older people got questions and advice than younger.These differences also exist, but less pronounced, between those with disease related problems and those without.Three factors were statistically significantly associated with information. Age, education level and problems with caries or bleeding gums had statistical effect on the prevalence of questions and advice related to eating habits or smoking habits respectively. In conclusion, it is an urgent need of education in methods for dental staff if they want to contribute to changes in life style behaviors for their patients since most patients today don't perceive that they got important disease relevant information at the last dental visit

Self-perceived oral health among 19-year-olds in two Swedish counties

The primary purpose of the present study, which focused on a census of 19-yearolds (2006) attending dental clinics in two Swedish counties, was to describe the frequency distribution of clinically- and self-perceived oral health indicators in terms of DSa (Decayed Surfaces approximal), four global dimensions of oral health and one ‘all-embracing’ oral health measure, according to county of residence and gender. A second purpose was to examine to what extent the clinical indicator of oral health and the global dimensions of self-perceived oral health contribute to the explainable variance of the global single-item indicator. Finally, the study examined whether or not the association of clinically- and self-perceived oral health indicators with the single global oral health indicator varied as a function of gender and place of residence. The study base was 46.5% (n=3658) of all children attending for dental checks (n=7866). The questionnaire included thirteen questions, divided into four global dimensions. These were Knowledge, Quality of life, Social and Function. There was also one ‘all-embracing’ oral health question, one question about gender and finally information about clinically-registered disease. The findings of this study were that females reported more serious problems than males in the Social and Quality of life dimensions and there were differences between counties in knowledge about oral diseases. The group with poor self-reported oral health in the ‘all-embracing’ oral health question had significantly more problems with all global dimensions, especially Quality of life and Social dimensions. Statistically-significant two-way interactions occurred between county and Knowledge and between county and Quality of life. This study supports the idea of one or several questions concerning self-perceived oral health to be used as a complement to the traditional epidemiological clinical registration of oral diseases

Self-perceived oral health and obesity among 65 years old in two Swedish counties

The aim of this study was to explore the association between oral health and obesity. The study was conducted in the spring of 2007 as a postal survey of all inhabitants born in 1942 and living in the two Swedish counties of Örebro and Östergötland. This questionnaire survey has been conducted every five years since 1992 but has been updated continually with additional questions and for the sweep used here, height and weight data were collected. A total of 8,313 individuals received the questionnaire and 6,078 of those responded (73,1%).The outcome variable oral health was measured using one global question and four detailed questions representing different aspects of oral health. The independent variable Body Mass Index (BMI) was calculated using self-reported height and weight. A difference in oral health between various BMI groups was found. The difference was both statistically significant and of clinical importance, particularly among the group with severe obesity who reported poorer self-perceived chewing capacity lower satisfaction with dental appearance, increased mouth dryness and fewer teeth and lower overall satisfaction with oral health. In view of the increased risk of poor oral health demonstrated in this study for those with severe obesity, it may be of value to increase cooperation between dental care and primary health care for these patients

Self-reported dry mouth in 50- to 80-year-old Swedes: Longitudinal and cross-sectional population studies

Xerostomia is a common condition among elderly. The objectives were to examine prevalence, persistence, progression, yearly incidence of xerostomia, associated background factors and its influence on oral impacts on daily performances (OIDP) in 50‐ to 80‐year‐old people. In 1992, a questionnaire was sent to all 50‐year‐old (n = 8888) and in 2007 to all 75‐year‐old persons (n = 5195) living in two Swedish counties. In 2012, the same questionnaire was sent to both age cohorts, now 70‐ and 80‐year‐old. Response rate was for the 50‐, 70‐ 75‐ and 80‐year‐old groups 71.4%, 72.2%, 71.9% and 66.4%, respectively. In the 50‐ to 70‐year‐old sample, 40.3% of the participants answered all five examinations and in the 75‐80 group 49.5% (intact samples). In all age groups, xerostomia was significantly more prevalent in women than in men. At age 80, “often mouth dryness at night” was reported by 24.3% and 16.2% of women and men, respectively. Prevalence increased with age and was more frequent at night‐time. Persistence of xerostomia was reported by 61.4%‐77.5%, progression by 11.5%‐33.0% and remission by 5.7%‐11.3%. Average yearly incidence was 0.99%‐3.28%. Xerostomia was more prevalent in those who reported a negative impact on OIDP. Highest odd ratios for xerostomia were burning mouth (OR 12.0), not feeling healthy (OR 5.1) and medicine usage (OR 3.9). Xerostomia is common in older age, persistence is high and progression common. The comorbidity between xerostomia, oral health problems and impaired general health needs to be taken into consideration when providing dental care to elderly patients