Mark D. Macek

Sociodemographic correlates of tooth pain among adults: United States, 1989

Abstract This study presents the sociodemographic distribution of tooth pain and the dental care utilization of affected individuals. Data for adults 20 years of age and over were derived from the 1989 National Health Interview Surveys supplements on dental health, orofacial pain, and health insurance (n=33 073). Prevalence of tooth pain by socioeconomic status (SES) and adjusted odds ratios of reporting tooth pain in the past 6 months and of having no dental visits in the past year among persons reporting pain in the previous 6 months were computed taking into account the surveys complex sample design. Tooth pain in the past 6 months was reported by 14.5% (95% CI 14.0, 15.0) of adults aged 20–64 years and by 7.0% (95% CI 6.1, 7.9) of those 65 years and over. In the younger age group, tooth pain was more likely to be reported by those with low SES than it was by those with high SES; in the older age group, tooth pain was more likely reported by non‐Hispanic blacks than it was by non‐Hispanic whites or Hispanics. Of those reporting pain, younger and older non‐Hispanic blacks and persons with lower educational attainment were more likely not to have a dental visit in the previous 12 months. Persons with low SES characteristics were more likely to report tooth pain and to endure their pain without the benefit of dental care while the pain was present.

Dental Insurance Visits and Expenditures Among Older Adults

OBJECTIVES We examined the effect of age, income, and coverage on dental service utilization during 1996. METHODS We used data from the 1996 Medical Expenditure Panel Survey. RESULTS Edentulous and poorer older adults are less likely to have coverage and less likely to report a dental visit than dentate or wealthier older adults. CONCLUSIONS These analyses help to describe the needs of older adults as they cope with diminishing resources as a consequence of retirement, including persons previously accustomed to accessing oral health services with dental insurance.

Measuring conceptual health knowledge in the context of oral health literacy: preliminary results.

OBJECTIVES Health literacy encompasses several abilities including word recognition, reading comprehension, communication skills, and conceptual knowledge. To date, conceptual knowledge has not been included in oral health literacy research. This study assesses the validity and reliability of a new instrument and describes conceptual oral health knowledge among a sample of low-income adults. METHODS One hundred Baltimore adults were administered the Rapid Estimate of Adult Literacy in Medicine (REALM), Short Test of Functional Health Literacy in Adults (Short-TOFHLA), and a new survey of conceptual oral health knowledge. Respondents were also asked about sociodemographics, dental health, and utilization. RESULTS Psychometric analysis was used to identify a subset of oral health knowledge questions from the new survey instrument. The resulting Comprehensive Measure of Oral Health Knowledge (CMOHK) was categorized into three levels of knowledge (poor, fair, good). Nearly one-third of Baltimore adults exhibited the lowest level. CMOHK scores were significantly associated with age, education level, and word recognition (REALM). CMOHK scores were not associated with reading comprehension (Short-TOFHLA) or dental care visits. Instrument reliability was good (Cronbach alpha = 0.74). CONCLUSIONS This preliminary study yielded a new measure of oral health conceptual knowledge, available for use in future oral health literacy studies. The author presents a conceptual framework of oral health literacy that separates health literacy into four unique components and places decision-making at the center. Future studies are needed to determine whether this framework is supported by empirical data and leads to improvements in oral health and reductions in health disparities.

Comparison of patient visits to emergency departments, physician offices, and dental offices for dental problems and injuries

OBJECTIVES Our understanding of the use of emergency departments (EDs) and physician offices for the management of dental problems is limited. We undertook this study to examine whether there are differences in their use by low-income White and minority adults as compared with higher-income adults. METHODS Participantsincluded White, Black, and Hispanic adults who had experi enced a dental problem during the previous 12 months and who visited a physician, ED, or dentist for treatment. We selected a stratified random sample of 27,002 Maryland households with listed telephones to screen for eligibility. We identified 1,387 households with an eligible adult, selected 423 for interviews, and completed interviews with 401 (94.8%). RESULTS To restore correct proportionality to the sample, and to adjust for nonresponse and the distribution of demographic characteristics, weights were created for use in the analyses. Only 7.1 percent of respondents contacted an ED, while 14.3 percent contacted a physician and 90.2 percent a dentist. The vast majority of respondents who contacted an ED (96.0%) or a physician (92.2%) also contacted a dentist. Lower-income respondents were more likely to seek care from an ED, while higher-income respondents were more likely to seek care from a dentist. Over whelmingly, respondents visiting EDs (89.4%) and physicians (51.7%) were instructed to see a dentist or given prescriptions/samples. Treatment provided by EDs, physicians, and dentists was not associated with the respondents income or race/ethnicity. CONCLUSIONS Respondents visiting EDs and physicians typically did not receive definitive care and subsequently visited a dentist for treatment.

Toothache pain: Behavioral impact and self-care strategies

A computer-assisted telephone interview in Maryland of adults who had low income and were Hispanic, Black, and White and who had experienced a toothache during the previous 12 months was conducted. Respondents reported a high prevalence of toothaches, with 44.3% having experienced more than five toothaches during the preceding 10 years. Pain intensity associated with the most recent toothache was high with 45.1% of the respondents reporting the highest pain possible. Pain interfered with many aspects of normal functioning. Self-care strategies generally took precedence over professional health services. Pain sufferers used a combination of self-care and formal care strategies. Initial strategies most often focused on nonprescription medicines(home remedies and prayer. The majority of respondents ultimately sought pain relief from a dentist. We identified a number of significant differences in the strategies used across racial/ethnic groups.

Dental care visits among dentate adults with diabetes, United States, 2003.

OBJECTIVES Regular dental assessments are beneficial to adults with diabetes. This analysis evaluates nationally representative data to test the relation between diabetes status and dental care visits, and to compare diabetes care, foot care, eye care, and dental care visits among dentate adults with diabetes. METHODS Data from the 2003 National Health Interview Survey were used to test whether diabetes status was associated with dental care visits among dentate adults aged > or =25 years, controlling for available covariates. RESULTS There was a significant interaction between diabetes status and sex for the odds of having a dental care visit. Among dentate men, there was no significant association between diabetes status and dental care visits. Dentate women with diabetes were significantly less likely to have had a dental care visit than were dentate women without diabetes. Of the four types of health care visits compared, dentate adults with diabetes were least likely to have had a dental care visit in the preceding year. Disparities in health care visit rates across race/ethnicity, poverty status, and education categories were most pronounced for dental care. CONCLUSIONS Having diabetes is associated with a variety of adverse health outcomes, including periodontitis. Adults with diabetes would benefit from regular health care visits to address these concerns, but this report shows that women with diabetes are underutilizing dental care services. The underutilization may be a result of the barriers to dental care that disproportionately affect women. Additional research should test the plausibility of these explanations and the influence of sex.

Dental care visits among dentate adults with diabetes and periodontitis.

OBJECTIVES Two national surveys have shown that dentate adults with diabetes are less likely to visit a dentist than are those without diabetes; one survey showed this association only among women. We hypothesize that periodontal health among those with diabetes could explain this disparity. This report investigates the influence of periodontitis on the association between diabetes and dental care visits. It also tests whether disparities are limited to women. METHODS Data from the 1999-2004 National Health and Nutrition Examination Survey were used. Covariates included age, sex, race/ethnicity, poverty status, education level, dental insurance, and periodontitis status. Weighted analyses were limited to dentate adults aged > or =25 years. RESULTS Overall, 56.8 percent of dentate adults with diabetes reported having a dental care visit in the preceding year compared with 64.7 percent for those without diabetes. In a multivariable model, diabetes status was significantly associated with having a dental care visit, independent of periodontitis status and covariates. Neither periodontitis status nor sex served as effect modifiers for the association between diabetes status and dental care visits. CONCLUSIONS These data revealed that dental care visits for dentate adults with diabetes were unrelated to their periodontal health, suggesting that fear of periodontal therapy did not influence visit patterns. These data also showed that dental care visit disparities existed for all adults with diabetes, not just women. Future research should investigate whether factors that are indirectly related to diabetes status, such as competing costs, attitudes, and knowledge, are influencing dental care visit patterns among dentate adults with diabetes.

Blood lead concentrations in children and method of water fluoridation in the United States, 1988-1994.

Some have hypothesized that community water containing sodium silicofluoride and hydrofluosilicic acid may increase blood lead (PbB) concentrations in children by leaching of lead from water conduits and by increasing absorption of lead from water. Our analysis aimed to evaluate the relation between water fluoridation method and PbB concentrations in children. We used PbB concentration data (n = 9,477) from the Third National Health and Nutrition Examination Survey (1988–1994) for children 1–16 years of age, merged with water fluoridation data from the 1992 Fluoridation Census. The main outcome measure was geometric mean PbB concentration, and covariates included age, sex, race/ethnicity, poverty status, urbanicity, and length of time living in residence. Geometric mean PbB concentrations for each water fluoridation method were 2.40 μg/dL (sodium silicofluoride), 2.34 μg/dL (hydrofluosilicic acid), 1.78 μg/dL (sodium fluoride), 2.24 μg/dL (natural fluoride and no fluoride), and 2.14 μg/dL (unknown/mixed status). In multiple linear and logistic regression, there was a statistical interaction between water fluoridation method and year in which dwelling was built. Controlling for covariates, water fluoridation method was significant only in the models that included dwellings built before 1946 and dwellings of unknown age. Across stratum-specific models for dwellings of known age, neither hydrofluosilicic acid nor sodium silicofluoride were associated with higher geometric mean PbB concentrations or prevalence values. Given these findings, our analyses, though not definitive, do not support concerns that silicofluorides in community water systems cause higher PbB concentrations in children. Current evidence does not provide a basis for changing water fluoridation practices, which have a clear public health benefit.

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.