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- Berglund, Erik, et al.
(författare)
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Social and health-related factors associated with refraining from seeking dental care : A cross-sectional population study
- 2017
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Ingår i: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 45:3, s. 258-265
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Tidskriftsartikel (refereegranskat)abstract
- Background: Social inequities are considered to affect healthcare utilization, whereas less is known about the factors associated with refraining from seeking dental care. This study aimed to investigate whether people with no social support, long-term illness, caregiver burden and low socioeconomic status (SES) refrained from seeking dental care in higher proportion than the general Swedish population.Methods: This study used cross-sectional questionnaire data from repeated nationwide health surveys during 2004-2013 of a total of 90 845 people. The questionnaire included questions on demographic characteristics, social support, long-term illness, caregiving burden, SES and dental care-seeking behaviour. Descriptive statistics, chi-square tests, correlation analyses and logistic regressions were used to investigate associations between independent variables and dental care-seeking behaviour.Results: In the total sample, 15.1% of respondents reported refraining from seeking dental care. Having no emotional social support or having no instrumental social support was separately associated with reporting refraining from seeking dental care in adjusted multivariate models (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.18-1.34 and OR: 1.89, 95% CI: 1.67-2.13, respectively). Having a long-term illness was associated with refraining from seeking dental care in adjusted models (adjusted OR: 1.43, 95% CI: 1.35-1.51). Furthermore, being an informal caregiver was associated with refraining from seeking dental care (adjusted OR: 1.15, 95% CI: 1.07-1.23). Low SES was associated with higher refraining from seeking dental care; the strongest association was with having financial problems (adjusted OR: 3.57, 95% CI: 3.19-4.00). Interaction effects were found between education level and SES, and between social support and long-term illness, and the outcome.Conclusions: The findings in this study imply that having no social support, having long-term illness, being informal caregiver or having financial problems are factors associated with reporting refraining from seeking dental care, on a population basis.
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| 3. |
- Berthelsen, Hanne, et al.
(författare)
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It is not just about occupation, but also about where you work
- 2017
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Ingår i: Community Dentistry and Oral Epidemiology. - : John Wiley & Sons. - 0301-5661 .- 1600-0528. ; 45:4, s. 372-379
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Dentistry is characterized by a meaningful but also stressful psychosocial working environment. Job satisfaction varies among staff working under different organizational forms. The aim of this study was to identify (i) to what extent crucial psychosocial work environment characteristics differ among occupations in general public dental clinics in Sweden, and (ii) how much of the variation within each occupation is attributable to the organizational level. Methods: All staff (N=1782) employed in four public dental organizations received an email with personal log-in to an electronic questionnaire based on the Copenhagen Psychosocial Questionnaire. After two reminders, a response rate of 75% was obtained. Responses from 880 nonmanagerial dentists, dental hygienists and dental nurses working in general practices were included in our analyses. Results: First, we compared the three dental occupations. We found that job demands, task resources (eg influence, possibilities for development and role clarity), strain symptoms and attitudes to work differed among occupations, dentists having the least favourable situation. Next, we compared the four organizations for each occupational group, separately. For dentists, a significant and relevant amount of variance (P<.05 and ICC >.05) was explained by the organizational level for 15 of 26 subscales, least pronounced for task resources. By contrast, for dental nurses and hygienists, the corresponding number was 2 subscales of 26. The psychosocial working environment of people working at the organization with the highest levels of strain indicators and the least positive work-related attitudes differed systematically from the organization with the most favourable profile, in particular regarding job demands and leadership aspects. Conclusion: In conclusion, the psychosocial working environment depended to a large degree on occupation and, for dentists in particular, also on their organizational affiliation. The findings suggest a potential for designing interventions at organizational level for improvements of the psychosocial working environment for dentists.
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- Gülcan, Ferda, et al.
(författare)
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Social predictors of less frequent dental attendance over time among older people : population-averaged and person-specific estimates
- 2016
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Ingår i: Community Dentistry and Oral Epidemiology. - Hoboken, USA : Wiley-Blackwell. - 0301-5661 .- 1600-0528. ; 44:3, s. 263-273
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Longitudinal studies considering social disparities in the utilization of dental services are scarce. Repeated measures should be accounted for by the use of appropriate statistical methods. The purpose of this study was first to describe the patterns of less frequent dental attendance (less than once a year) over time from the age of 65-70 in Norwegian and Swedish 1942 cohorts. Second, this study estimated the influence of predisposing, enabling and need-related social predictors using marginal model with robust variance estimators and random intercept model, RIM, to account for the clustered structure of the repeated observations. Third, the study aimed to compare the estimates of associations between social predictors and less frequent dental attendance derived from marginal and random intercept models.Methods: In 2007 and 2012, all residents born in 1942 in selected counties of Norway and Sweden were invited to participate in a questionnaire survey. In Norway, the response rate was 58.0% (n = 4211) in 2007 and 54.5% (n = 3733) in 2012 with a follow-up rate of 70%. The corresponding figures in Sweden were 73.1% (n = 6078) and 72.2% (n = 5697), with a follow-up rate of 80%. Marginal and random intercept models were fitted for population-averaged and person-specific estimates. Design effects were calculated by comparing the results from ordinary logistic regression analyses and the marginal model with robust variance estimators. The proportion of the total variation due to differences between persons was reported using the intraclass correlation coefficient (ICC).Results: Less frequent dental attendance declined from 14.5% to 12.2% in Norway and from 13.6% to 12.9% in Sweden. According to marginal and random intercept models, time-invariant (gender, country of birth, education) and time-variant social predictors (working status, social network, marital status, smoking and perceived health) contributed to less frequent dental attendance. A likelihood ratio test confirmed that adjustment for clustered observations was appropriate. The ICC was 0.90 in Norway and 0.85 in Sweden.Conclusions: The prevalence of less frequent dental attendance was low and dropped by increasing age from 65 to 70 years. Both at population and at person-specific levels, being advantaged on social aspects protects against less frequent dental attendance after 65 years of age in the Norwegian and Swedish cohorts investigated.
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- Haworth, Simon, et al.
(författare)
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Tooth loss is a complex measure of oral disease : determinants and methodological considerations
- 2018
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Ingår i: Community Dentistry and Oral Epidemiology. - : John Wiley & Sons. - 0301-5661 .- 1600-0528. ; 46:6, s. 555-562
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status.METHODS: An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years.RESULTS: In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants).CONCLUSIONS: Incident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population-specific. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies.
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| 8. |
- Hägglund, Patricia, et al.
(författare)
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Older people with swallowing dysfunction and poor oral health are at greater risk of early death
- 2019
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Ingår i: Community Dentistry and Oral Epidemiology. - : John Wiley & Sons. - 0301-5661 .- 1600-0528. ; 47:6, s. 494-501
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden.Methods: This prospective cohort study investigated 391 older people in 36 intermediate care units (clusters). Swallowing function was assessed with the timed water swallow test (TWST), and oral health with the revised oral assessment guide (ROAG) at baseline. Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI). Time to mortality was recorded during the following year. The mixed effects Cox regression model with cluster as a random factor was used to estimate hazards ratios (HR) with 95% confidence intervals (CI).Results: The median age of the participants was 84 years (interquartile range [IQR]: 11), and 53.3% were females. Mortality within one year was 25.1%. In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality (adjusted HR [aHR]: 1.67, 95% CI 1.02‐2.75; P = .041 and aHR: 1.98, 95% CI 1.07‐3.65; P = .029, respectively). Participants with combined swallowing dysfunction and poor oral health showed the highest mortality (35.0%) and 2.6 (95% CI 1.15‐5.89; P = .022) times higher mortality risk than those with normal swallowing function and good oral health (13.0%).Conclusions: Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations.
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| 9. |
- Isaksson, Helén, et al.
(författare)
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Parental factors in early childhood are associated with approximal caries experience in young adults - A longitudinal study
- 2019
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Ingår i: Community Dentistry and Oral Epidemiology. - : John Wiley & Sons. - 0301-5661 .- 1600-0528. ; 47:1, s. 49-57
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To test the hypothesis that parental factors in early childhood influence approximal caries experience in young adults.METHODS: A cohort of 494 individuals was followed longitudinally from 1 to 20 years of age. Data were retrieved from parental interviews and questionnaires when the child was 1 and 3 years of age. At age 20, the participants underwent bitewing radiographic examination. Based on the number of approximal caries lesions (Da), stratified into initial (Di ) or manifest caries (Dm ) and approximal fillings (Fa), the participants were divided into two main groups: those with: (a) 0 Dim Fa (n = 244) and (b) >0 Dim Fa (n = 250). A subgroup was also created (≥8 Dim Fa; n = 33).RESULTS: Toothbrushing with fluoride toothpaste at 3 years of age less than twice a day (OR 1.6, 95% CI 1.0-2.6) and the participants' mothers' self-estimation of their oral health care as "less than optimal" were important risk factors for developing caries (>0 Dim Fa OR 2.0, 95% CI 1.3-3.1). An interaction effect between toothbrushing at 3 years of age less than twice a day and consumption of caries risk products > 3 times a day further increased the caries experience in young adults (≥8 Dim Fa OR 8.3, 95% CI 1.8-37.8) together with maternal anxiety about dental treatment (OR 7.4 95% CI 1.6-34.6).CONCLUSIONS: Parental factors in early childhood are associated with caries experience at 20 years of age.
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