Clemencia M. Vargas

Oral health status of older rural adults in the United States

BACKGROUND Little is known about the oral health care of older rural residents. The authors describe oral health indicators for the older adult population by place of residence in the United States. METHODS The authors analyzed data from the Third National Health and Nutrition Examination Survey and the 1995, 1997 and 1998 National Health Interview Surveys. Oral health indicators included perceived oral health (self-reported dental status and unmet dental needs) and dental status (untreated caries; decayed, missing and filled permanent teeth, or DMFT; and edentulism). Dental care utilization and access were measured by number of dental visits, frequency of dental visits and dental insurance status. RESULTS Older rural adults were more likely than their urban counterparts to be uninsured for dental care (72.1 percent versus 66.1 percent, respectively) and were less likely to report dental visits in the past year (46.9 percent versus 58.4 percent, respectively). A higher proportion of rural residents than urban residents were edentulous (36.7 percent versus 28.2 percent, respectively) and reported poor dental status (50.7 percent versus 42.2 percent, respectively). There were no differences in unmet dental needs, percentage of people with untreated caries or in mean DMFT by place of residence. CONCLUSIONS Older rural residents inadequately utilize dental care and have less favorable oral health indicators than do older urban residents. CLINICAL IMPLICATIONS This article shows the need for more dental practitioners in rural areas. With the low density of dentists per person and the high need for care, rural America offers an excellent opportunity for oral health professionals to provide much needed services.

Disparities in Early Childhood Caries

Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of familys competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.

Trends in paediatric dental caries by poverty status in the United States, 1988–1994 and 1999–2004

BACKGROUND Recent reports have suggested that dental caries among some young children is increasing in the United States. AIM To describe changes in paediatric caries prevalence by poverty status in the United States. DESIGN National Health and Nutrition Examination Survey (NHANES) data for children aged 2-11 years for 1988-1994 and 1999-2004 were used. RESULTS Caries in the primary dentition increased among poor and non-poor boys aged 2-8 years (45-53% and 23-31%, respectively) and among non-poor boys aged 2-5 years (13-21%) from 1988-1994 to 1999-2004. Caries experience also increased on buccal-lingual, mesio-distal, and occlusal primary dental surfaces among poor children aged 2-8 years and this increase may be attributed to an increase in the number of dental surfaces restored. In the mixed dentition, caries remains relatively unchanged. Caries continues to decline in the permanent dentition for many children, but is increasing among poor non-Hispanic whites aged 6-8 years (8-22%) and poor Mexican-Americans aged 9-11 years (38-55%). CONCLUSIONS For many older children, caries continues to decline or remain unchanged. Nevertheless, for a subgroup of younger children, caries is increasing and this increase is impacting some traditionally low-risk groups of children.

Relationship Between Children’s Dental Needs and Dental Care Utilization: United States, 1988–1994

OBJECTIVES This study describes the relationship between dental needs and dental care utilization among children. METHODS Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to analyze dental care needs and dental care utilization. RESULTS Younger children with perceived needs (needs perceived by the child or responsible adult) were more likely to be episodic users of dental care than children without perceived needs. Younger children with normative needs (defined by the presence of untreated caries diagnosed by a dentist) were less likely to be regular users. Older children with perceived or normative needs were more likely to be episodic users and less likely to have had a previous-year visit than children with no needs. CONCLUSIONS Despite their presence, dental needs do not drive dental care use among children, and childrens dental care utilization is inadequate.

How Dental Care Can Preserve and Improve Oral Health

Oral health is associated with overall health, and lack of access to dental care has consequences that go far beyond aesthetics. Most oral diseases are preventable and are relatively easy and inexpensive to address at early stages. However, multiple barriers make dental care unreachable for a sizable portion of the United States population, who consequently has higher incidence and prevalence of disease. Achieving meaningful improvements in oral health status among these groups will require a revamping of the dental infrastructure, augmenting the productivity and skills of the dental workforce, and increasing the populations oral health literacy.

Dental service mix among working-age adults in the United States, 1999 and 2009.

OBJECTIVE In the United States, health-care costs are increasing while state and federal budgets contract. In order to establish a baseline and provide data for alternative oral health workforce models, this report describes the types of dental procedures received by US working-age adults in 2009 and looks at trends since 1999. METHODS Data for this analysis came from the 1999 and 2009 Medical Expenditure Panel Surveys. The primary outcome variable represented the types of dental procedures undergone during a dental visit in the preceding year. Descriptive variables included dental insurance coverage and income. Analysis was restricted to adults aged 21-64 years. RESULTS In 2009, diagnostic and preventive procedures accounted for >75 percent of all dental services received by working-age adults. Those with public insurance and those who were uninsured, as well as those with lower income, were less likely to receive these services than their peers. Between 1999 and 2009, small but statistically significant increases in the proportion of preventive and diagnostic procedures received occurred in the nation. The likelihood that a preventive service would be received during a visit also increased during this period, while the probability that a restorative procedure would be undergone went down. CONCLUSIONS Preventive-type procedures represented the vast majority of dental services received by working-age adults in 2009. Between 1999 and 2009, receipt of preventive-type procedures generally increased while receipt of surgical-type procedures decreased. These findings emphasize the health-promoting role of the dental team and provide a baseline for the measurement of future trends.

Dental service mix among older adults aged 65 and over, United States, 1999 and 2009

OBJECTIVES The oral health of older Americans will assume increasing importance because of their increasing numbers and the evolving connections between oral health and general health. To establish a baseline and provide data for oral health workforce models, this report describes the types of dental procedures received by US adults 65 years and older in 2009 and looks at trends since 1999. METHODS Data for this analysis came from the 1999 and 2009 Medical Expenditure Panel Survey. The primary outcome variable represented the types of dental procedures that were received during a dental visit in the preceding year. Descriptive variables included dental insurance and poverty status. Analysis was restricted to adults aged 65 and over. RESULTS In 2009, diagnostic and preventive procedures accounted for almost three-quarters of all services. Compared with services received by those with private insurance, there were significantly fewer diagnostic and endodontic procedures among those with public coverage. Between 1999 and 2009, the proportion of preventive services significantly increased, whereas the proportion of restorative and endodontic services significantly decreased. Also, the likelihood of receiving preventive procedures increased, whereas the probability of receiving restorative or endodontic services decreased. CONCLUSIONS Findings point to a shift in the mix of dental services received by older adults during the two periods. The predominance of diagnostic and preventive procedures has important access and workforce implications. An expanded role for dental hygienists in helping to meet the oral health needs of older adults is possible given a hygienists current scope of practice.

Early childhood caries and intake of 100 percent fruit juice: Data from NHANES, 1999-2004

BACKGROUND The results of several studies conducted in the United States show no association between intake of 100 percent fruit juice and early childhood caries (ECC). The authors examined this association according to poverty and race/ethnicity among U.S. preschool children. METHODS The authors analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) for 2,290 children aged 2 through 5 years. They used logistic models for caries (yes or no) to assess the association between caries and intake of 100 percent fruit juice, defined as consumption (yes or no), ounces (categories) consumed in the previous 24 hours or usual intake (by means of a statistical method from the National Cancer Institute). RESULTS The association between caries and consumption of 100 percent fruit juice (yes or no) was not statistically significant in an unadjusted logistic model (odds ratio [OR], 0.76; 95 percent confidence interval [CI], 0.57-1.01), and it remained nonsignificant after covariate adjustment (OR, 0.89; 95 percent CI, 0.63-1.24). Similarly, models in which we evaluated categorical consumption of 100 percent juice (that is, 0 oz; > 0 and ≤ 6 oz; and > 6 oz), unadjusted and adjusted by covariates, did not indicate an association with ECC. CONCLUSIONS Our study findings are consistent with those of other studies that show consumption of 100 percent fruit juice is not associated with ECC.

Dental procedures among children age birth to 20, United States, 1999 and 2009

OBJECTIVE To describe dental procedures received by US children and adolescents by poverty status and dental insurance coverage. METHODS Data for this analysis came from the 1999 and 2009 Medical Expenditure Panel Surveys. The primary outcome variable represented the types of dental procedures that were received during dental visits in the preceding year. Descriptive variables included dental insurance and poverty status. Analysis was restricted to children from birth to 20 years. RESULTS Overall, diagnostic (41.2 percent) and preventive (35.8 percent) procedures accounted for most of the procedures received by children from birth to 20 years of age, while restorative procedures accounted for just 5 percent. Children from low-income families received a higher proportion of restorative procedures than children in higher-income families. The proportion of diagnostic and preventive services was lower among uninsured children than among publicly insured children. Orthodontic services, on the other hand, represented a greater percentage of these procedures among uninsured children than among publicly insured children. DISCUSSION The vast majority of procedures received by children from birth to 20 years were diagnostic and preventive. Most children with at least one dental visit received a diagnostic or preventive service. Between 1999 and 2009, the proportion of all services received accounted for by diagnostic or preventive services increased. However, the proportion in which each type of procedure was received by children who made at least one visit who received did not change.

Oral health status of children in Los Angeles County and in the United States, 1999–2004

OBJECTIVE To ascertain and compare the oral health status and related sociodemographic risk indicators in children in Los Angeles (LA) County with children in the United States. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 were used to calculate prevalence estimates for children aged 2-13 years living in LA County and in the United States. Sociodemographic indicators were evaluated using multiple logistic regression modeling. RESULTS Overall, children in LA County were more likely to experience dental caries than children in the United States in 1999-2004. In the primary dentition, nearly 40% of preschool children residing in LA County had dental caries compared to 28% of same-age children in the United States. Among children aged 6-13, 44% living in LA County had dental caries in the permanent dentition compared to 27% in the United States. Mexican American children in LA County had higher caries experience in permanent teeth (but not in primary teeth) than US Mexican American children. Among children aged 6-9 years, there was no difference in the prevalence of dental sealants in permanent teeth between those living in LA County and in the United States. However, among children aged 10-13 years, dental sealants were more than twice as prevalent in US children (40.8%) than in LA County children (17.5%). Among LA County children, the adjusted odds of having caries experience or untreated dental caries in permanent teeth were not higher among children from lower income families than in lower income children in the United States. CONCLUSIONS Children residing in LA County had less favorable oral health than children in the United States in 1999-2004. The usual sociodemographic caries risk indicators identified among children in the United States were not consistently observed among children in LA County. Unlike in the wider United States, poverty was not a risk indicator for dental caries in older children in LA County.