Changes in Older Adults' Oral Health and Disparities: 1999 to 2004 and 2011 to 2016

Abstract

OBJECTIVES To examine changes in tooth loss and untreated tooth decay among older low‐income and higher‐income US adults and whether disparities have persisted. DESIGN Sequential cross‐sectional study using nationally representative data. SETTING The 1999 to 2004 and 2011 to 2016 National Health and Nutrition Examination Survey. PARTICIPANTS Noninstitutionalized US adults, aged 65 years and older (N = 3539 for 1999‐2004, and N = 3514 for 2011‐2016). MEASUREMENTS Differences in prevalence of tooth loss (having 19 teeth or fewer, 8 teeth or fewer, and no teeth) and untreated decay and mean number of decayed and missing teeth (DMT) between low‐ and high‐income adults 65 years and older in each survey and changes between surveys. Adjusted prevalence and count outcomes were estimated with logistic and negative binomial regression models, respectively. Models controlled for sociodemographic characteristics and smoking status. Reported findings are significant at P < .05. RESULTS In 2011 to 2016, unadjusted prevalence of having 19 teeth or fewer, 8 teeth or fewer, no teeth, and untreated decay among low‐income adults 65 years and older was 50.6%, 42.0%, 28.6%, and 28.6%, respectively. Multivariate analyses indicated that although most tooth loss measures improved between surveys for both income groups, tooth loss among low‐income adults remained at almost twice that among higher‐income adults. The disparity in untreated decay prevalence in 2011 to 2016, 15.2 percentage points (26.1% vs 10.9% for low vs high income) was twice that in 1999 to 2004, 8.5 percentage points (22.9% vs 14.4% for low vs high income). DMT decreased for both groups, with lower‐income adults having about five more affected teeth in both surveys. CONCLUSION Tooth loss is decreasing, but differential access to restorative care by income appears to have increased.

Changes in Institutionalized Older People's Dentition Status in Helsinki, 2003‐2017

“…As the study by Griffins and colleagues among noninstitutionalized older adults previously found, edentulousness has also decreased among older people in institutional care in Helsinki. Griffin et al also reported findings among home‐limited or long‐term care residents from 2011 to 2016.…”

“…To the Editor: Griffin and colleagues investigated changes in tooth loss and whether disparities have persisted among US adults. In their sequential cross‐sectional study, they found that tooth loss largely decreased in all groups of noninstitutionalized older adults.…”

Impact of Making Dental Care Affordable on Quality of Life in Adults Aged 45 Years and Older

“…Between 2008 and 2015, the percentage of adults aged 65+ years with dental insurance increased slightly from 32.6 (standard error = 1.1) to 38.4 (1.2) and the percent with a past year dental visit remained relatively stable, 43.9 (1.2) to 46.7 (1.1) (Manski & Rohde, 2017). In addition, studies examining untreated dental disease, another measure of access, suggest that untreated caries prevalence has remained the same among working-aged (about 40%) (Centers for Disease Control and Prevention, 2019) and older adults (about 28%) (Griffin et al, 2019). The latter study also found that disparities by income had actually increased from 1999-2004 to 2011-2016 (Griffin et al, 2019).…”

Reply to Changes in Institutionalized Older People's Dentition Status in Helsinki 2003 to 2017

“…Older adults are more likely to have chronic disease, and persons with chronic disease have poorer oral health compared to their healthier counterparts. 5 The two leading causes of tooth loss, dental caries and periodontitis, are preventable with routine receipt of primary and secondary prevention. Primary care providers can play an important role in helping patients maintain their oral health.…”