Patrick Rouxel

Tooth Loss Associated with Physical and Cognitive Decline in Older Adults

To examine the effect of total tooth loss (edentulousness) on decline in physical and cognitive functioning over 10 years in older adults in England.

Social inequalities in clustering of oral health related behaviors in a national sample of British adults

OBJECTIVES 1. To assess clustering of oral health related behaviors among a sample of British adults. 2. To determine the variation in clustering of oral health related behaviors by socioeconomic position. METHOD We used secondary analysis of the Adult Dental Health Survey 2009 data. Health behaviors referred to smoking, tooth brushing frequency, dental visits and sugar consumption. Clustering was assessed by pairwise correlations, counts of clustering of health compromising behaviors and comparison of observed/expected ratios. Logistic regression was used to assess variation in clustering of oral health related behaviors by socioeconomic position crudely and adjusted for age, gender and self-rated oral health. RESULTS There were weak correlations between four health behaviors. Very low prevalence of clustering was reported. Higher observed to expected ratio was observed for clustering patterns with lower prevalence. Multivariate logistic regression showed clear, strong and significant educational gradients in associations between different clustering patterns of health compromising behaviors and educational attainment. These educational gradients remained significant after adjusting for age, gender and self-reported oral health. CONCLUSION Very clear and strong educational gradients were observed throughout patterns of clustering of oral health compromising behaviors, suggesting chances of having detrimental behavioral clustering are lower in more educated groups in population.

Social capital: theory, evidence, and implications for oral health.

In the last two decades, there has been increasing application of the concept of social capital in various fields of public health, including oral health. However, social capital is a contested concept with debates on its definition, measurement, and application. This study provides an overview of the concept of social capital, highlights the various pathways linking social capital to health, and discusses the potential implication of this concept for health policy. An extensive and diverse international literature has examined the relationship between social capital and a range of general health outcomes across the life course. A more limited but expanding literature has also demonstrated the potential influence of social capital on oral health. Much of the evidence in relation to oral health is limited by methodological shortcomings mainly related to the measurement of social capital, cross-sectional study designs, and inadequate controls for confounding factors. Further research using stronger methodological designs should explore the role of social capital in oral health and assess its potential application in the development of oral health improvement interventions.

Is Social Capital a Determinant of Oral Health among Older Adults? Findings from the English Longitudinal Study of Ageing

There are a number of studies linking social capital to oral health among older adults, although the evidence base mainly relies on cross-sectional study designs. The possibility of reverse causality is seldom discussed, even though oral health problems could potentially lead to lower social participation. Furthermore, few studies clearly distinguish between the effects of different dimensions of social capital on oral health. The objective of the study was to examine the longitudinal associations between individual social capital and oral health among older adults. We analyzed longitudinal data from the 3rd and 5th waves of the English Longitudinal Study of Ageing (ELSA). Structural social capital was operationalized using measures of social participation, and volunteering. Number of close ties and perceived emotional support comprised the functional dimension of social capital. Oral health measures were having no natural teeth (edentate vs. dentate), self-rated oral health and oral health-related quality of life. Time-lag and autoregressive models were used to explore the longitudinal associations between social capital and oral health. We imputed all missing data, using multivariate imputation by chained equations. We found evidence of bi-directional longitudinal associations between self-rated oral health, volunteering and functional social capital. Functional social capital was a strong predictor of change in oral health-related quality of life – the adjusted odds ratio of reporting poor oral health-related quality of life was 1.75 (1.33–2.30) for older adults with low vs. high social support. However in the reverse direction, poor oral health-related quality of life was not associated with changes in social capital. This suggests that oral health may not be a determinant of social capital. In conclusion, social capital may be a determinant of subjective oral health among older adults rather than edentulousness, despite many cross-sectional studies on the latter.

Dental caries, sugars and food policy

At the recent UN summit on the prevention and control of non-communicable diseases, oral conditions were highlighted as one of the major global health priorities.1 In childhood, dental caries (tooth decay) is the main oral disease. Dental caries although preventable still affects many children, particularly those from more disadvantaged social backgrounds. In high- and middle-income countries, caries rates overall have declined in recent decades. In low-income countries, however, the prevalence of caries is rising rapidly due to the increasing availability and consumption of sugary foods and drinks. Dental caries has a significant impact on a childs quality of life. The consequences of caries include pain and discomfort, chronic infection, sleepless nights and hospitalisation for tooth extractions. The consumption of sugary foods and drinks is the key cause of dental caries. High sugars consumption is also associated with weight gain and obesity. Current clinical caries preventive approaches are ineffective in tackling oral health inequalities, and are too costly for most populations. A paradigm shift in preventive approaches is urgently required to tackle the underlying causes of dental caries. The aim of this paper is to highlight the public health significance of dental caries and to stress the key aetiological role played by sugars consumption in both caries development and obesity. Proposals are then outlined for public health strategies to reduce sugars consumption to promote child health. Despite being a preventable condition, dental caries is highly prevalent and has a significant negative impact on the individuals affected and wider society.2 Globally, epidemiological studies indicate that between 40% and 90% of 12-year-old children have dental caries, with the highest rates found in South …

Oral Health—A Neglected Aspect of Subjective Well-Being in Later Life

Abstract Objectives This study examined whether oral health is a neglected aspect of subjective well-being (SWB) among older adults. The key research question was whether deterioration in oral health among dentate older adults living in England was associated with decreases in SWB, using measures of eudemonic, evaluative, and affective dimensions of well-being. Methods This secondary analysis used data from the third (2006–2007) and fifth (2010–2011) waves of respondents aged 50 and older from the English Longitudinal Study of Ageing (ELSA). We fitted multivariable regression models to examine the effects of changes in oral impacts on daily life and edentulism (complete tooth loss) on SWB (quality of life, life satisfaction, and depressive symptomatology). Results A worsening in both oral health measures was associated with an increase in depressive symptoms even after adjusting for time-varying confounders including declining health, activities of daily living, and reduced social support. Becoming edentate was also associated with decreases in quality of life and life satisfaction. Discussion A deterioration in oral health and oral health–related quality of life increases the risk of depressive symptoms among older adults and highlights the importance of oral health as a determinant of subjective well-being in later life.

Retirement and Socioeconomic Differences in Diurnal Cortisol: Longitudinal Evidence From a Cohort of British Civil Servants.

Abstract Objectives Early old age and the period around retirement are associated with a widening in socioeconomic inequalities in health. There are few studies that address the stress-biological factors related to this widening. This study examined whether retirement is associated with more advantageous (steeper) diurnal cortisol profiles, and differences in this association by occupational grade. Method Data from the 7th (2002–2004), 8th (2006), and 9th (2007–09) phases of the London-based Whitehall II civil servants study were analysed. Thousand hundred and forty three respondents who were employed at phase 8 (mean age 59.9 years) and who had salivary cortisol measured from five samples collected across the day at phases 7 and 9 were analysed. Results Retirement was associated with steeper diurnal slopes compared to those who remained in work. Employees in the lowest grades had flatter diurnal cortisol slopes compared to those in the highest grades. Low-grade retirees in particular had flatter diurnal slopes compared to high-grade retirees. Discussion Socioeconomic differences in a biomarker associated with stress increase, rather than decrease, around the retirement period. These biological differences associated with transitions into retirement for different occupational groups may partly explain the pattern of widening social inequalities in health in early old age.

Longitudinal associations between television in the bedroom and body fatness in a UK cohort study

Objective:To assess longitudinal associations between screen-based media use (television (TV) and computer hours, having a TV in the bedroom) and body fatness among UK children.Methods:Participants were 12 556 children from the UK Millennium Cohort Study who were followed from age 7 to age 11 years. Associations were assessed between screen-based media use and the following outcomes: body mass index (BMI), fat mass index (FMI), and overweight.Results:In fully adjusted models, having a bedroom TV at age 7 years was associated with significantly higher BMI and FMI (excess BMI for boys=0.29, 95% confidence interval (CI) 0.06–0.52; excess BMI for girls=0.57, 95% CI 0.31–0.84; excess FMI for boys=0.20, 95% CI 0.04–0.37; excess FMI for girls=0.39, 95% CI 0.21–0.57) and increased risk of being overweight (relative risk (RR) for boys=1.21, 95% CI 1.07–1.36; RR for girls=1.31, 95% CI 1.15–1.48) at age 11 years, compared with having no bedroom TV. Hours spent watching TV or digital versatile disks were associated with increased risk of overweight among girls only. Computer use at age 7 years was not related to later body fatness for either gender.Conclusion:Having a TV in the child’s bedroom was an independent risk factor for overweight and increased body fatness in this nationally representative sample of UK children. Childhood obesity prevention strategies should consider TVs in children’s bedrooms as a risk factor for obesity.

Social Capital and Oral Health Among Adults 50 Years and Older: Results From the English Longitudinal Study of Ageing.

Objectives This study examines the differential associations of structural and functional social capital with objective and subjective measures of oral health, and the interactions between social capital and other sociodemographic and health factors. Methods Secondary analysis of data on 8552 adults 50 years and older from the third wave (2006–2007) of the English Longitudinal Study of Ageing was conducted. Oral health outcomes were self-rated oral health, edentulousness (having no natural teeth), and Oral Impacts on Daily Performances. Structural social capital was measured by membership of social organizations and volunteering. Functional social capital was measured by the number of close ties and perceived emotional social support. Logistic regression models were sequentially adjusted for demographic, socioeconomic, health-related factors, and smoking status. Results Structural social capital was primarily associated with edentulousness. Not being a member of any organization was associated with higher odds of being edentate (odds ratio [OR] = 1.77, 95% confidence interval [CI] = 1.43–2.16). Functional social capital was associated with self-rated oral health and oral impacts. Low social support was associated with poor self-rated oral health (OR = 1.41, 95% CI = 1.16–1.72) and Oral Impacts on Daily Performances (OR = 1.69, 95% CI = 1.27–2.24). Conclusions The association of structural social capital with edentulousness may reflect health selection effects. The availability of a supportive social network seems to be the aspect of social capital most strongly associated with oral health.

Socioeconomic and ethnic inequalities in oral health among children and adolescents living in England, Wales and Northern Ireland

Abstract Objectives Although adolescence is a sensitive developmental period in oral health, the social equalization hypothesis that suggests health inequalities attenuate in adolescence has not been examined. This study analyses whether the socioeconomic gap and ethnic disadvantage in oral health among children aged 5 reduces among adolescents aged 15. Methods Data from the cross‐sectional Childrens Dental Health Survey 2013 were analysed, comprising of 8541 children aged 5, 8, 12 and 15 attending schools in England, Wales and Northern Ireland. Oral health indicators included decayed and filled teeth, plaque, gingivitis and periodontal health. Ethnicity was measured using the 2011 UK census ethnic categories. Socioeconomic position was measured by family, school and residential deprivation. Negative binomial and probit regression models estimated the levels of oral health by ethnicity and socioeconomic position, adjusted for demographic and tooth characteristics. Results The predicted rate of decayed teeth for White British/Irish children aged 5 was 1.54 (95%CI 1.30‐1.77). In contrast, the predicted rate for Indian and Pakistani children was about 2‐2.5 times higher. At age 15, ethnic differences had reduced considerably. Family deprivation was associated with higher levels of tooth decay among younger children but not among adolescents aged 15. The influence of residential deprivation on the rate of tooth decay and filled teeth was similar among younger and older children. Moreover, inequalities in poor periodontal health by residential deprivation was significantly greater among 15‐year‐old children compared to younger children. Conclusions This study found some evidence of smaller ethnic and family socioeconomic differences in oral health among British adolescents compared to younger children. However, substantial differences in oral health by residential deprivation remain among adolescents. Community levels of deprivation may be particularly important for the health of adolescents.