Little knowledge and contradictory results exist on the association of oral diseases with systemic diseases and with health predictors such as dental care utilization and health insurance. This research project aimed to examine 1) the association between Coronary heart disease (CHD) and periodontal disease using meta-analysis, 2) to examine the association between dental care utilization, health insurance coverage and periodontal disease with the prevalence of CVD, 3) the association between dental caries, periodontal disease and blood glucose level. For meta-analysis, literature searches were conducted using the PubMed computerized database (1966-2019), Cochrane Controlled Trials Register (1970-2019), EMBASE (1980-2019), and CINAHL (1982-2019). A systematic review of the literature identified fifteen prospective cohort studies and seven case control studies that meet the inclusion criteria. Maximum likelihood random effects analysis was used to compute the combining relative risk (RR) and odd ratio (OR). Data on periodontal disease, dental caries, dental care utilization, health insurance coverage, cardiovascular disease and blood glucose level were obtained from the National Health and Nutrition Examination Survey (2011–2014) for dentate community-dwelling persons 30 years of age and over. The outcome was cardiovascular disease (heart attack, hypertension, CHD, congestive heart failure and stroke) and glucose level (HbA1c and OGTT). The main independent variable was dental care utilization, insurance, periodontal disease and dental caries. Covariates included in the analysis were race/ethnicity, age, sex, income, education levels, body mass index, diabetes status, smoking status and alcohol drinking status. To obtain unbiased point estimates and correct variance estimation, proper sampling weights and statistical survey procedures were used. A-meta-analysis of the fifteen prospective cohort studies indicated that patients with periodontal disease are at 1.19 times increased the risk of having CHD compared to periodontally healthy patients (RR: 1.19, 95% CI (1.12 – 1.26)). The result of the seven case control studies, showed a significant association between periodontitis and CHD with odds ratio 2.37 (95% CI 1.72-3.28). In addition, lower dental care utilization and insurance were significantly increased the odd of developing CVD respectively; (OR 1.65, 95%CI 1.01–2.69, OR 1.52, 95% 1.09–2.11). Looking into the association between oral diseases and blood glucose level. Dental caries was significantly associated with increased the odd of high OGTT and HbA1c values respectively (OR 2.47, 95% 1.56-3.90, OR 1.37, 95% 1.14-1.64). However, periodontal disease was significantly associated with high HbA1c values only (OR 2.77, 95% 2.40-3.20). In conclusion, our analysis supports the association between periodontal disease and CHD. Additionally, using a large national representative sample, our analysis showed that health insurance and dental care utilization were significantly associated with the prevalence of CVD. Also, having either periodontal disease or dental caries increased the odds of poor glycemic control among US population.

Thesis (MSD) -- Boston University, Henry M. Goldman School of Dental Medicine, 2010 (Department of Health Policy and Health Services Research). / Includes bibliographic references: leaves 73-75. / Objectives: To describe the oral health of Rhode Island Seniors and to evaluate gender differences in oral health. Methods: This is a cross-sectional study of individuals who underwent oral screening at the HeathLink Wellness Health Fair, RI, in June, 2008. Data was collected using a self-administered questionnaire on self-reported general and oral health, and a dental examination for those who attended the HealthLink Wellness Progran’s health fair. Data was coded and entered into Epi-Info version 3.4.1, then analyzed using SAS version 9.1. The clinical oral health outcome variables studied were: number of teeth, edentulousness, root tips, untreated caries, dentures, and DMFT. The self-perceived oral health outcome variables were: difficulty relaxing, avoided going out or feeling nervous or self-conscious, felt pain or distress due to teeth, gums or denture, and overall poor self-perceived oral health. The main predictor variable was gender. Other predictor variables included age, self-reported chronic diseases (diabetes, hypertension, heart disease, and dry mouth), smoking history and current smoking status, self-perceived oral health, number of teeth, dentures, and DMFT. Descriptive statistics, bivariate analyses, and multivariate logistic and linear regression analyses were performed. Results: The study sample consisted of 166 subjects with a mean age of 72.3[plus or minus]7.8 years (range=42-89 years). Descriptive analyses of the study sample’s oral health showed that the subjects had overall good oral health, with 47% having good oral hygiene, 19% had untreated caries, 8% had root tips, 46% had at least one denture (upper or lower, complete or partial), and 12% were completely edentulous. On average, study subjects retained at least half of their natural dentition (mean=16.8[plus or minus]0.8 teeth). The mean DMFT score was 18.5[plus or minus]0.5 teeth. The mean number of teeth with untreated caries was 0.4[plus or minus]0.1 teeth. Multiple logistic regression models and linear regression models were performed after controlling for potential confounders and statistically significant associations were found between the main predictor, gender; and the outcome variables, self-perceived oral health, and clinical oral health. Females were 3.3 times more likely to feel difficulty relaxing due to their teeth, gums or denture (95% CI=1.5-7.6, p=0.002), were 10 times more likely to avoid going out or felt nervous or self-conscious due to their teeth, gums or denture (95%CI=2.1- 48.2, p=0.004), were 5.9 times more likely to have felt pain or distress due to their teeth, gums or denture (95% CI=1.8-19.8, p=0.005), and were 3.2 times more likely to avoid eating some foods due to their teeth gums or denture (95% CI=1.0-10.1, p=0.03). When a new variable was constructed, that reflected an overall score for self-perceived oral health, a multiple linear regression model showed that females had overall poorer self-perceived oral health (p=[less than]0.0001) than males. When clinical oral health outcome variables and gender was analyzed, females were less likely to have decayed teeth (p=0.005), had lower DMFT (p=0.02), and had a greater number of teeth (p=0.03) than males. Conclusion: In this study sample, there is an association between clinical oral health and self-perceived oral health and gender compared to the national data. Also, despite the fact that males had poorer clinical oral health than females, females reported poorer self-perceived oral health than males.

The study's overall objective is to demonstrate the correlation between refugee status and poor oral health outcomes by thoroughly explaining the refugee experience and showing the prevalence of associated oral diseases. All data and information regarding the oral health status of refugees and asylum-seekers are from numerous studies and different institutions. Refugees often experience traumatizing events such as assault, torture, starvation, and extreme dehydration, resulting in the rapid deterioration of health. However, despite the high prevalence of oral diseases such as caries, gum infections, and, oral health continues to be neglected once they arrive at their new destination. In countries like Germany, refugees from Syria and Iraq have a higher incidence of dental caries(Solyman and Schmidt-Westhausen, 2018). In comparison to their German citizen counterparts, who have shown significantly lower caries rates, a possible result from the advancement of a successful caries prevention program for children and adolescents (Splieth et al., 2019). By comparing the oral health status of refugees versus the native population of the country they have entered, the neglect of refugees' oral health becomes evident. This study aims to assess the barriers often experienced by refugee and asylum seekers that lead to poor oral health and examine the role of language, refugee perspective and health literacy education in the promoting dental care in this population. It is clear that a strong association exists between the social and physical barriers refugee experience and oral health. This is especially clear from evaluating the phases of a refugee's migration journey. There is an association between social barriers such as language and health literacy on oral health. It is well documented that when individuals are forced to relocate to new countries where a different language is spoken, healthcare systems can be challenging to navigate. Additionally, language plays a crucial role in shaping refugee perspectives of the oral health community, sometimes negatively; thus, arrival in their new home does not necessarily lead to improved care. Data comparing oral disease in natives versus refugees indicates significantly worse oral health status among recent refugees.

Magister Chirurgiae Dentium (MChD) / The evaluation aimed to assess the effectiveness of the school oral health education (ORE) programme in Thamaga, a rural village about 40km west of the capital Gaborone. The Oral Health Division (Botswana) had introduced the programme in schools throughout the country in 1984. The school ORE programme in Thamaga was introduced less than five years previously but not all schools could be covered before the time of the study. The delivery of weekly dental services at the primary hospital in the area had been inconsistent. The evaluation assessed the effectiveness of the programme in a cross-sectional study by comparing dental health knowledge, reported oral hygiene practices, DMFS scores and gingival bleeding index of randomly selected standard five schoolchildren, aged 10-16 years (n=135). Two schools in Thamaga were selected for the study, designated as programme (experimental) and non-programme (control) schools in this comparative study. The hypothesis proposed that children from the programme school will have better oral health (less dental caries and gingivitis), have better dental health knowledge and better oral hygiene practices than children from the non-programme school. The effects of this school ORE programme were measured firstly by a clinical examination for dental caries using the WHO DMFS index and for gingivitis using a bleeding index derived from the WHO CPI. This was to compare the proportion of children with these dental diseases in the two schools. Secondly, a close-ended questionnaire was administered to the children to assess most importantly, their knowledge of dental diseases (dental caries and gum disease) and their reported OH practices. The extent of correct dental health knowledge was minimal but about 88 percent of all the schoolchildren from both the programme and non-programme schools (n=135) reported their source of information as being the school. Generally, children from the non-programme school had higher average scores of correct responses on dental caries and gingivitis than those from the programme school. This difference in knowledge was not statistically significant (p>O.05).It was apparent from the results of the interview that the majority of the children have misinformation about disease-specific signs and symptoms, causes and prevention of dental disease, the use and benefits of fluorides and dental floss. The majority of the children reported that they do self-examination of their teeth and gums daily and the commonly reported OH practices were the use of a toothbrush and toothpaste at least twice a day. However, these reported oral hygiene practices were not commensurate with the level of gingivitis recorded. Out of all the study participants, only one child from the programme school reported using a chewing stick for cleaning teeth. The majority of the children were found to have poor periodontal health indicated by gingivitis. About 90 percent and 82 percent of the children from the programme and non-programme schools respectively had gingivitis. Only 10 percent (programme) and 18 percent (nonprogramme) of the children did not have any bleeding-gingival sites (GBI=O). The poor oral hygiene found in children from the programme school might imply that the practical aspects of plaque control and oral hygiene were not intensive enough to motivate the children. Most children were found to have minimal caries; mean DMFS scores of 0.14 (SD=0.49) and 0.12 (SD=0.45) for programme and non-programme schools respectively and 91 percent caries-free for each of the two schools. These differences were not statistically significant (p>0.05). The low prevalence of caries and the minimal difference between groups might be attributed to the following; the low prevalence of dental caries at baseline and the action of fluoride in drinking water. The study indicates that the programme has had a minimal impact if any, in the programme school. The findings suggest a need to correct the prevailing basic misinformation about dental health and motivation of teachers and the dental team to be more involved in the programmes.

El proyecto fue desarrollado en el distrito de La Molina del departamento de Lima, durante el periodo de mayo a junio en el presente año 2020 en una vivienda habitada por 4 personas de las cuales una actuó como promotor de salud. El proyecto fue realizado durante la pandemia Covid19 o Sars-Cov-2. Al analizar el entorno a través de indicadores de salud, se encontró que el distrito tiene excelentes condiciones, tiene un alto porcentaje de cobertura de necesidades básicas, excelentes cifras de Índice de Desarrollo Humano y bajas tasas de analfabetismo. Se encontró en los involucrados cinco problemas principales relacionados a salud oral, actividad física, calidad de sueño, alimentación y postura en el trabajo, algunas de estas, causadas por el confinamiento obligatorio, forzándolos a cambiar su estilo de vida y trabajo. Mediante diversas actividades educativas y de monitoreo se logró tener un impacto positivo en todos los involucrados, logrando el 100% de cobertura y eficacia, así como la asistencia a todas las actividades. Se observo un incremento en el conocimiento y una mejora en los hábitos de los miembros del entorno familiar. Los resultados fueron evaluados a través de indicadores y representados en gráficos. / The project was developed in La Molina, a district located in Lima, Peru from May to June of the current year in a 4-person household. One of which acted as the health promotor. This project was executed during the Coronavirus (COVID-19) pandemic. District´s condition was found in excellent conditions when it was studied, with very low deficiencies in basic needs and analphabetism. Also, it had the best Human Development Index (HDI) in the country. There were 5 key problems detected amongst the people involved related to oral health, sports, sleep quality, nutrition and ergonomics in the work environment; some of this caused by the mandatory confinement related to the virus, forcing the people involved to change their work and lifestyle. Changes in these problems were reached by using different activities focused on teaching and monitoring, obtaining 100% attendance, coverage and efficacy. An increase of knowledge and improvement of habits is displayed on the graphs as well. / Trabajo de investigación

Stress occurs within everyone’s life, from the onset of life until a person takes their last breath. The National Center for Complementary and Integrative Health describe stress as a physical and emotional reaction to an experience that will occur within one’s life as changes occur. Stress is an action that occurs when the body encounters an experience triggered by a stressor, either internally or externally, that brings the body beyond its normal homeostatic threshold. In return the body shuts down to protect itself from overloading and overwhelming itself, from the stressor that is causing this reaction. Stress is a normal feeling, but chronic and long-term stress can lead to many disruptions to an individual’s health and disrupt their normal lifestyle. In 2019 it has been estimated that 70% of primary care visits are related to problems related to stress and lifestyle. Stress can present itself in numerous forms depending on the individual. Stress alters numerous aspects of life, it can be emotionally, physically, psychologically, etc. There are a wide range of health problems that stem from chronic stress; stress can disrupt eating habits, normal body functions, cause mood swings and unwanted behavioral changes, trigger latent diseases and many other problems. One of the biggest, yet unnoticed changes that stress can cause is how chronic stress leads to a decline in oral health, as an effect of the constant changes going on within the body. The oral cavity is one of the biggest indicators that there are changes going on within a patient. This literature review will evaluate the various oral conditions that stress can cause within the oral cavity and the resulting impact to one’s overall health. Oral health is direly important to overall health. A routine exam of the oral cavity can associate many systemic diseases affecting an individual based on the oral manifestations that are presented. While other symptoms often go unnoticed and get neglected until it is too late, the oral cavity is an early indicator that there is something that is causing a disruption to the body. The oral manifestations that were focused on for this literature review included some very common cases while others were more circumstantial. The goal was to link the oral manifestations to common oral conditions that stress brought upon the body, including periodontal disease, bruxism, habitual biting of the oral mucosa and geographic tongue. Bruxism, and periodontal disease yielded the most significant findings and its relation to stress while geographic tongue did lack some critical findings because of the condition being transient in nature and underreported. A reduction in stress can lead to a lower incidence of these oral conditions and systemic diseases in the population. Numerous research studies were evaluated to access the relation to stress and its effects on oral health, although if this review were to be done again, more data collected over a 5-year span on each condition and manifestation would be supportive.

Indiana University-Purdue University Indianapolis (IUPUI) / Poor oral health is associated with pain, decreased chewing function, negative social perceptions, and reduced quality of life. Low-income adults disproportionally have worse oral health and use dental services at lower rates than higher-income adults. This disparity is associated with individual demographic and socioeconomic factors, cost and coverage barriers, as well as the supply and location of dental providers. Although the full causal pathway remains elusive, evidence suggests an association with poor oral health and an exacerbation of chronic diseases symptoms. Thus, adequate provision of dental care has important population health implications. Despite this importance, dental care use among low-income adults is particularly underexplored. Furthermore, existing research lacks robust methodological designs to mitigate bias from unobserved confounders. Dental coverage for low-income adults through Medicaid is emerging as a way to provide services to this population. However, given state budget constraints, comprehensive public dental benefits are uncommon or at risk of being cut. Therefore, it is important to quantify the individual and economic value of dental care use among adult Medicaid enrollees. This dissertation examines factors and outcomes associated with dental care use among Medicaid-enrolled adults in Indiana. This dissertation includes three studies 1) a pooled cross-sectional analysis that measures the association of individual and community level factors with dental care use, 2) a repeated measures study with individual fixed effects to examine whether receipt of preventive dental care is associated with fewer subsequent non-preventive dental visits and lower total annual dental expenditures, and 3) an empirical study that utilizes an instrumental variable estimation method to examine the effect of preventive dental visits on medical and pharmacy expenditures. Overall, this dissertation attempts to understand the correlates of dental care use, the effectiveness of preventive dental care, and the association between preventive dental care and medical expenditures.

Objective: The purpose of this project was to develop evidence‐based clinical practice guidelines (CPGs) for the management of oral health (OH) for patients with Parkinson’s disease (PD). Background: Individuals with PD have significantly poorer OH than the general population. Poor OH is a risk factor for systemic diseases, including cardiovascular disease, diabetes, and respiratory infections. Materials and Methods: After an extensive literature review was completed, available evidence was evaluated for inclusion in the initial draft of the guidelines. The draft was then reviewed for content validity by experts in the areas of dentistry, dental hygiene and neurology using the Delphi method. After consensus among the content experts, final guidelines were completed. The final CPG was presented to individuals with PD and their caregivers at a support group. Participants were asked to review the information in the guidelines for 2 weeks and then submit a survey regarding the usefulness of the CPG. The CPG was also evaluated by practicing nurse practitioners (NPs) and dental hygienists using the AGREE II tool. Results: Twenty people from the PD support group participated in the educational intervention, and surveys were received from 14 participants. Overall, participants agreed or strongly agreed with each statement related to the applicability and usefulness of the guidelines. The CPG was evaluated using the AGREE II tool, and scores were >80% in all domains with an overall score of 97.1%. Conclusion: Development of these guidelines represent an initial step in improving the oral health and overall health of individuals with PD.

This thesis aims to examine the current state of oral health promotion with respect to fluoridation, the impact that the lack of dental care has financially on the patient and the overall health system and a discussion of alternative options that could help to improve the current state of oral health care. While acknowledging research and official reports that indicate dental caries as the most prevalent preventable health condition in the lives of children, this thesis is a literature review studying the positive and negative effects of systemic and topical fluoride on both adults and children. Exploring differing perspectives of fluoridation's benefits and efficacy as a preventative oral health care measure, including community water fluoridation and topical fluoride application, this thesis will examine its effects on dental caries nationally and internationally. Although the prevalence of caries has decreased, to date, no systematic reviews have addressed adequately the disparities between incidence, severity, and recurrence of dental caries especially between children and adults. Likewise, substantial research has not yet adequately addressed the differences found in children that may make them more susceptible than adults to over fluoridation through a combination of systemic, topical fluoridation and water consumption. The literature review also includes the breakdown of costs and cost-effectiveness of dental care, including factors that increase cost, as well as suggestions to shift towards an emphasis on preventative care in attempt to reduce overall costs. Improving access to care especially to the underinsured is discussed. Furthermore, a review of the dental therapist occupation utilized successfully in other countries is discussed as this could be a viable solution for the shortage of dental professionals in areas with minimal access of care here in the United States. This is turn may reduce the number of disparities in oral health care, by reducing the severity of oral health disorders that result from an increased delay or neglect in treating the onset of dental caries from a preventative perspective. The primary measure of impact reported in several studies reviewed was the reduction in advanced care restorations, including surgery, needed with increased preventative care measures. Evidence of the effectiveness of preventative oral health care including systemic and topical fluoridation implementation and city-specific school-wide initiatives to administer dental sealants for children covered by government-sponsored programs are growing. Moving forward towards a more prevention-based system with early detection and better access for all, these changes should help lead to increased oral health initiatives and improved oral and healthcare overall.

No description available.