How does the early life environment influence the oral microbiome and determine oral health outcomes in childhood?

This study assessed oral health outcomes (perceived dental treatment need, untreated dental caries, gingival bleeding, periodontal pockets, and pain in teeth and gums), in relation to color/race inequalities among adolescents in each Brazilian region. The database included dental examination and interview of 16,833 15-19-year-old adolescents, surveyed by the Brazilian health authority, from May 2002 to October 2003, in accordance with international diagnostic criteria standardized by the World Health Organization. Prevalence ratios estimated by Poisson regression, and controlled by socioeconomic status and access to fluoridated piped water, assessed oral health differentials among color/race groups and country's regions. Except for periodontal pockets, prevalence figures were higher in the North and Northeast: perceived dental treatment needs, untreated dental caries, gingival bleeding at probing and pain in teeth and gums varied between 80-83%, 75-76%, 38-43%, and 17-18%, respectively, in these regions. Adolescents living in the Southeast - the richest Brazilian region - presented a better general profile of oral health than their counterparts living in the remaining regions; they had a lower prevalence of untreated dental caries (54%) and unfavorable gingival status (29%). However, the Southeast presented color/race inequalities in all oral health outcomes, with a poorer profile systematically affecting browns or blacks, depending on the oral health condition under consideration. These results reinforce the need for expanding the amplitude of health initiatives aimed at adolescent oral health. Socially appropriate health programs should concurrently aim at the reduction of levels of oral disease and its inequalities.

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Oral health inequality in people with severe mental illness: a cross-sectional study using National Health and Nutrition Examination Survey 1999-2016

10.1101/2021.03.17.21253840 ◽

2021 ◽

Author(s):

Jing Kang ◽

Jianhua Wu ◽

Vishal Aggarwal ◽

David Shiers ◽

Tim Doran ◽

...

Keyword(s):

Risk Factors ◽

Mental Illness ◽

Oral Health ◽

General Population ◽

Health Outcomes ◽

Severe Mental Illness ◽

Tooth Loss ◽

List Type ◽

Cross Sectional ◽

Oral Health Outcomes

AbstractOBJECTIVETo explore whether people with severe mental illness (SMI) experience worse oral health compared to the general population, and the risk factors for poor oral health in people with SMI.METHODThis study used cross-sectional data from the National Health and Nutrition Examination Survey (1999-2016) including on self-rated oral health, ache in mouth, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. Candidate risk factors for poor oral health included demographic characteristics, lifestyle factors, physical health comorbidities, and dental hygiene behaviours. The authors used ordinal logistic regression and zero-inflated negative binomial models to explore predictors of oral health outcomes.RESULTS53,348 cases were included in the analysis, including 718 people with SMI. In the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.40, 95% CI: 1.12-1.75). In people with SMI, the risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes.CONCLUSIONSPeople with SMI experience higher rates of tooth loss than the general population, and certain subgroups are particularly at risk. Having a healthy lifestyle such as performing regular physical exercise and flossing may lower the risk of poor oral health. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes.Significant outcomes (x3)People with severe mental illness were at 40% higher risk of tooth loss when compared to the general population.Older adults, smokers and people with diabetes were at particularly high risk of poor oral health.Physical exercise and daily use of dental floss were associated with better oral health outcomes.Limitations (x3)The number of cases with data on periodontal disease was limited.The study was cross-sectional so causation could not be inferred.The analysis used prescriptions of antipsychotic and mood stabilising medication as a proxy measure of severe mental illness, as clinical diagnoses were not available in the dataset.Data availability statementThe NHANES 1999-2016 data is available at CDC website: https://www.cdc.gov/nchs/nhanes/index.htm, and is accessible and free to download for everyone.

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