This paper describes the burden of oral disorders in a population of adults aged 50 years and over living independently in the community. In so doing it uses clinical, functional, experiential and psychosocial impact measures to document the oral health status of this section of the population. The data reveal that substantial proportions of subjects report that their quality of life was compromised in some way by oral problems. Although only 24.1 per cent were edentulous, 30.5 per cent were unable to chew one or more foods; 37.2 per cent reported oral or facial pain in the previous four weeks and 67.5 per cent experienced one or more other oral symptoms. One third reported problems with eating and communication--social interaction, 18.7 per cent worried a great deal about their oral health and 30.8 per cent were dissatisfied with some aspect of their oral health status. Income was consistently associated with all health status measures examined, demonstrating the scope of inequalities in oral health. In addition, regression analysis showed that low income groups had higher scores on a psychosocial impact scale after controlling for clinical, functional and experiential oral health indicators. The paper illustrates the utility of a model of disease and its consequences derived from the international classification of impairments, disabilities and handicaps in exploring oral health.
This paper reports on a study of dental anxiety among adults aged 50 years and over living independently in two communities in Ontario, Canada. Subjects were identified by means of a telephone survey based on random-digit dialing. Data on dental anxiety were collected from 580 subjects by means of a self-completed questionnaire and were measured by the Dental Anxiety Scale (DAS) (Corah, 1969). The mean DAS score was 7.8, and 8.4% of subjects were classified as dentally anxious. Age was the only demographic factor associated with dental anxiety. Older individuals had lower DAS scores than younger individuals (p less than 0.0001). There was also a significant association between dental anxiety and general fearfulness measured by the Fear Survey Schedule II (Geer, 1965) (r = 0.31; p less than 0.001). A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioral and oral health outcomes. While these results confirm that dental anxiety is less prevalent among older adults than in younger populations, it has a number of important consequences with respect to dental care provision.
The literature on inequalities in health provides convincing evidence that lower socioeconomic groups have poor oral health when compared to higher socioeconomic groups. Since conventional measures of socioeconomic status such as occupation, income and education have a number of weaknesses which may limit their ability to describe and explain health inequalities, alternatives in the form of area-based measures are increasingly being used. In this paper, a conventional measure, household income, and an area-based measure of socioeconomic status are compared in terms of their ability to identify inequalities in oral health. The data used in the analysis were taken from a telephone interview survey of the oral health of older adults in the province of Ontario, Canada. While household income proved to be a marginally better predictor of these inequalities than the area-based measure, the latter had a number of distinct advantages from an epidemiological and planning perspective. Moreover, it identified variations in measures of oral health that were independent of household income, and the region of the province in which subjects lived.
In the literature, it is usual to find women and younger subjects reporting higher levels of dental anxiety than men and older subjects. Fear of pain was found to be the most important predictor of dental anxiety and issues of control were also related to such anxiety. Therefore, it was predicted that gender and age differences would be reflected in attitudes to pain and control. Subjects were randomly selected from the voters' list in metropolitan Toronto and mailed a questionnaire with a request for cooperation in a study of their thoughts, feelings, and behaviour regarding dental treatment. The questionnaire included demographic data, measures of dental anxiety and painful experiences as well as the Pain Anxiety Symptoms Scale and the Iowa Dental Control Index. The results supported the main predictions. In addition, attitudes to pain and control were found to be complex phenomena with characteristic gender differences.
Because the promotion of healthier life styles has become a public health issue of increasing interest, a survey was conducted to compare levels of preventive oral and general health behaviors.
A randomly selected population of voters aged 19 years and older living in a multicultural suburb of metropolitan Toronto, Canada, participated in a mail survey.
Dentate respondents (n = 976) reported high optimal levels for at least daily toothbrushing (96%); moderate levels of preventive yearly dental examination (69%); and low levels for flossing (22%), using an interdental device (25%), not snacking between meals (12%), and consuming fewer than two cariogenic foods on the previous day (26%). For the general health behaviors, the majority did not smoke (75%), had low alcohol intake (89%), used seat belts (69%), and exercised three times weekly (50%). Additive indices for the oral and general health behaviors were significantly, although weakly, correlated (r = 13; P
This study examined risk indicators and risk markers for periodontal disease experience in 624 adults aged 50 years and over living independently in four communities in Ontario, Canada. The data were collected as part of the baseline phase of a longitudinal study of the oral health and treatment needs of this population. Periodontal disease experience was assessed in terms of attachment loss, measured at two sites on each remaining tooth. Bivariate and multivariate analyses were used to examine the relationship between a number of sociodemographic, general health, psychosocial, and oral health variables and three indicators of periodontal disease experience. These were: mean attachment loss, the proportion of sites examined with loss of 2 mm or more, and the probability of the subjects having severe disease, arbitrarily defined as a mean attachment loss in the upper 20th percentile of the distribution. Mean attachment loss was 2.95 mm (SD = 1.41 mm), and 76.6% of sites examined had loss of 2 mm or more. In bivariate analyses, the most consistent predictors of periodontal disease experience were: age, education, income, smoking, dental visiting, the number of remaining teeth, the number of decayed coronal surfaces, and the number of decayed root surfaces. In multivariate analyses, age, education, current smoking status, and the number of teeth had the most consistent independent effects. These data confirm the results of recent US studies indicating that periodontal disease experience is influenced by social and behavioral factors.
This paper reports the results of a survey of 1000 certified dental assistants in Ontario, Canada. The aim was to obtain data on work-related stress, its sources and predictors. Of those responding to the survey, 38.8% said that their work was moderately stressful and 14.5% said it was very or extremely stressful. Approximately one-third had been bothered by stress at work on three or more days in the previous week. The main sources of stress were working under constant time pressures, running behind schedule and feeling undervalued by the dentist. Stepwise regression analysis revealed that the main predictors of work stress were not having a clear job description, working long hours, life stress while not at work and age. However, these variables explained less than 10% of the variance in job stress scores. Overall, 22.8% said it was very likely that they would seek work in another practice or seek work outside dentistry in the coming year. There was a significant association between work stress and job intentions; 43.0% of those reporting high levels of stress intended to change jobs compared to 8.9% of those who said that their job was not at all stressful (P less than 0.0001). These findings have implications for the way in which dental practice is organised and managed.