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Objective: Both diabetes mellitus (DM) and poor oral health are common chronic conditions and risk factors of Alzheimer’s disease and related dementia among older adults. This study assessed the effects of DM and complete tooth loss (TL) on cognitive function, accounting for their interactions. Methods: Longitudinal data were obtained from the 2006, 2012, and 2018 waves of the Health and Retirement Study. This cohort study included 7,805 respondents aged 65 years or older with 18,331 person-year observations. DM and complete TL were self-reported. Cognitive function was measured by the Telephone Interview for Cognitive Status. Random-effect regressions were used to test the associations, overall and stratified by sex. Results: Compared with older adults without neither DM nor complete TL, those with both conditions (b = -1.35, 95% confidence interval [CI]: -1.68, -1.02), with complete TL alone (b = -0.67, 95% CI: -0.88, -0.45), or with DM alone (b = -0.40, 95% CI: -0.59, -0.22), had lower cognitive scores. The impact of having both conditions was significantly greater than that of having DM alone (p < .001) or complete TL alone (p = 0.001). Sex-stratified analyses showed the effects were similar in males and females, except having DM alone was not significant in males. Conclusion: The co-occurrence of DM and complete TL poses an additive risk for cognition. Healthcare and family-care providers should pay attention to the cognitive health of patients with both DM and complete TL. Continued efforts are needed to improve older adults’ access to dental care, especially for individuals with DM.

Objective Social isolation and loneliness have been linked to numerous determinants of health and well‐being. However, the effects of social isolation and loneliness on oral health remain unclear. The purpose of this study was to examine the effects of social isolation and loneliness on the number of remaining teeth and the rate of tooth loss over time among Chinese older adults. Methods We used three waves of data (2011/2012, 2014 and 2018) from the Chinese Longitudinal Healthy Longevity Survey with 4268 older adults aged 65 and older who were interviewed in at least two waves. The number of remaining teeth was first evaluated at baseline and then subsequently at follow‐up visits. Mixed‐effects Poisson regression was used to examine the associations between social isolation, loneliness, and both the number of remaining teeth and the rate of tooth loss. Results Social isolation was associated with fewer remaining teeth (β = −.06, 95% CI = −0.13 to 0.00, p < .05) and accelerated tooth loss (β = −.02, 95% CI = −0.02 to −0.01, p < .01) after adjusting for sociodemographic covariates, lifestyle and oral hygiene behaviours, physical and cognitive health, and loneliness. Loneliness was neither associated with the number of remaining teeth (β = .15, 95% CI = −0.01 to 0.30, p = .06) nor with the rate of tooth loss (β = −.01, 95% CI = −0.02 to 0.00, p = .16) after adjusting for all other factors. Conclusions This study provides strong evidence that social isolation was associated with fewer remaining teeth and accelerated tooth loss among Chinese older adults. These findings expand our knowledge about the impact of social disconnection on tooth loss. More future studies are needed to further examine the associations between social connections and oral conditions using longitudinal cohort studies and intervention studies.

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The aim of this study was to develop an integrative framework on aging, immigration, and oral health. The methodology was a critical review that used immigration as a social determinant framework through which to evaluate its impact on the oral health of older immigrants. We reviewed recent empirical evidence on factors related to oral health in older immigrants. In a systematic search across multiple databases, we identified 12 eligible studies in this review. Among the eligible studies, most were conducted among East Asian immigrants (8 articles), followed by non-Hispanic White/European origin (2 articles), Mexican origins (1 article), and Iran and other Middle East regions (1 article). The research revealed knowledge gaps in the evidence base, including the dynamic relationship between acculturation and oral health, the role of environmental factors on oral health for immigrants, psychosocial stressors and their relationship with oral health, and oral health literacy, norms, and attitude to dental care utilization and oral hygiene practices. The development of the integrative framework suggests the pathways/mechanisms through which immigration exerts influences on oral health in later life. This provides opportunities for researchers, practitioners, and policy makers to gain greater insights into the complex associations between immigration and oral health among older adults.

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Objective: China's dental care system is bifurcated between urban and rural areas. However, very few studies have examined the dental services utilization inequities in China's megacities, particularly in these urban and rural areas. This study aims to examine the urban-rural disparities in dental services utilization among adults living in China's megacities based on the Andersen dental services utilization model.Methods: This study used data from 4,049 residents aged 18–65 who participated in the “2019 New Era and Living Conditions in Megacities Survey.” Multivariate logistic regressions were employed to examine the associations between place of residence and dental services utilization for individuals from ten megacities in China. Predisposing variables (age, gender, marital status, living arrangement, and education), enabling variables (socioeconomic status, occupational status, income, insurance coverage, health attitude, and health behavior), and need variables (self-rated health, oral health status, gum bleeding) were controlled for.Results: The mean age of the 4,049 adults was 45.2 (standard deviation = 13.0), and 30.4% (n = 1,232) had no dental visits at all. Adults who resided in urban areas were more likely to use dental services [odds ratio (OR) = 1.57, 95% confidence interval (CI) = 1.30 to 1.91] than those residing in rural areas after controlling for key covariates. Factors associated with higher odds of visiting dentists include having a higher income (OR = 1.44, P &lt; 0.001), higher education level (OR = 1.53, P = 0.042), being covered by insurance for urban residents/employees (OR = 1.49, P = 0.031), having a positive attitude toward healthy diets (OR = 1.43, P &lt; 0.001), attending regular physical examination (OR = 1.66, P &lt; 0.001), having more tooth loss (OR = 1.05, P &lt; 0.001), and having frequent gum bleeding (OR = 2.29, P &lt; 0.001).Conclusion: The findings confirm that place of residence is associated with dental services utilization while adjusting for key covariates. Despite rapid economic development in China, many adults had never visited dentists at all. More efforts should be taken to encourage widespread dental care, such as providing more dental coverage and better access to dental care services.

The aims of the study were to present the prevalence of dental service utilization among adults (age between 18 and 65) in Chinese megacities and to examine the associations of health insurance and city of residence with dental visits. This study was a cross-sectional analysis of the 2019 New Era and Living Conditions in Megacities Survey data with a sample of 4835 participants aged 18–65 from 10 different megacities in China. The data including gross domestic product (GDP) per capita of each megacity obtained from the National Bureau of Statistics of China as a city-level characteristic. After adjusting sampling weights, approximately 24.28% of the participants had at least one dental visit per year. Findings from multilevel mixed-effects linear models showed that participants residing in megacities with higher GDP per capita (β = 0.07, p < 0.001) who had Urban Employee Basic Medical Insurance (β = 0.25, p < 0.001) or Urban Resident Basic Medical Insurance (β = 0.19, p < 0.01) had more frequent dental visits after adjusting demographic characteristics, socioeconomic status, health status, health behavior and attitude, and oral health indicators. Margins post-estimation model results demonstrated disparities in the predicted probability of having never visited a dentist by types of health insurance and city of residence. In conclusion, the prevalence of dental visits in China was found to be low. This study highlights socioeconomic inequalities in dental service utilization. There is a great need to develop more dental care programs and services and expand health insurance to cover dental care in China.