Inequalities in oral health: Understanding the contributions of education and income

Farmer, Julie; Phillips, Rebecca C; Singhal, Sonica; Quiñonez, Carlos

doi:10.17269/cjph.108.5929

Cited by 23 publications

(29 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For each outcome, overall proportion, proportion stratified by dental insurance status, and marginal effect of having dental insurance are shown with 95% confidence intervals. Analysis is modelled in logistic regression and adjusted as described below [13,47,48]. The impetus for creating a universal dental care policy is developing in Canada.…”

Section: Discussionmentioning

confidence: 99%

Providing dental insurance can positively impact oral health outcomes in Ontario

Zivkovic

Aldossri

Gomaa

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background: Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. Methods: We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013-2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada's most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. Results: Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9-24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6-11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9-19.8 vs. ME lowest: 27.2; 95% CI: 25.0-29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: − 13.2 to − 9.9 vs. ME lowest: -27.2; 95% CI: − 29.5 to − 24.8).Conclusions: Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.

show abstract

Section: Discussionmentioning

confidence: 99%

Providing dental insurance can positively impact oral health outcomes in Ontario

Zivkovic

Aldossri

Gomaa

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Within-countries variations in income-related oral health inequalities by time are also confirmed (Borrell and Talih 2012;Do et al 2010;Kramer et al 2015;Roncalli et al 2015;Slade et al 2014). Finally, some studies have confirmed variations in income-related oral health inequalities according to oral health outcomes within the same population (Farmer et al 2017;Mejia et al 2014;Ravaghi et al 2013b). Only two studies have compared income-related inequalities between oral and general health outcomes in the same population and found higher in oral health outcomes rather than general health (Ravaghi et al 2013a;Sabbah et al 2007).…”

Section: Brief Summary Of Evidencementioning

confidence: 97%

“…Social gradients and differences in oral health status according to income are confirmed by numerous studies. Few and relatively recent studies quantified income-related oral health inequalities using composite inequality measures and compared between populations by time or geography and/or oral health outcomes (Sanders et al 2009; Do et al 2010; Celeste, Nadanovsky, et al 2011; Borrell and Talih 2012; Ravaghi et al 2013a, 2013b; Shen et al 2013; Mejia et al 2014; Slade et al 2014; Tchicaya and Lorentz 2014; Guarnizo-Herreño et al 2015; Kramer et al 2015; Peres et al 2015; Roncalli et al 2015; Manski et al 2016; Farmer et al 2017). Cross-national variations in income-related inequalities are confirmed from cross-sectional studies on self-rated oral health (Guarnizo-Herreño et al 2015), oral health–related quality of life (Sanders et al 2009), and dental care (Tchicaya and Lorentz 2014; Manski et al 2016).…”

Section: What Is the Extent Of Income-related Oral Health Inequalitiementioning

confidence: 99%

The Relationship between Income and Oral Health: A Critical Review

2019

View full text Add to dashboard Cite

In this critical review, we summarized the evidence on associations between individual/household income and oral health, between income inequality and oral health, and income-related inequalities in oral health. Meta-analyses of mainly cross-sectional studies confirm that low individual/household income is associated with oral cancer (odds ratio, 2.41; 95% confidence interval [CI], 1.59–3.65), dental caries prevalence (prevalence ratio, 1.29; 95% CI, 1.18–1.41), any caries experience (odds ratio, 1.40; 95% CI, 1.19–1.65), tooth loss (odds ratio, 1.66; 95% CI, 1.48–1.86), and traumatic dental injuries (odds ratio, 0.76; 95% CI, 0.65–0.89). Reviews also confirm qualitatively that low income is associated with periodontal disease and poor oral health–related quality of life. Limited evidence from the United States shows that psychosocial and behavioral explanations only partially explain associations between low individual/household income and oral health. Few country-level studies and a handful of subnational studies from the United States, Japan, and Brazil show associations between area-level income inequality and poor oral health. However, this evidence is conflicting given that the association between area-level income inequality and oral health outcomes varies considerably by contexts and by oral health outcomes. Evidence also shows cross-national variations in income-related inequalities in oral health outcomes of self-rated oral health, dental care, oral health–related quality of life, outcomes of dental caries, and outcomes of tooth loss. There is a lack of discussion in oral health literature about limitations of using income as a measure of social position. Future studies on the relationship between income and oral health can benefit substantially from recent theoretical and methodological advancements in social epidemiology that include application of an intersectionality framework, improvements in reporting of inequality, and causal modeling approaches. Theoretically well-informed studies that apply robust epidemiological methods are required to address knowledge gaps for designing relevant policy interventions to reduce income-related inequalities in oral health.

show abstract

“…Another potential limitation of the study is that we did not take into account the level of education of the participants. It has been reported that education level is correlated with oral health status 34 . However, the aim of the study was to engage the patient based on the communication style and not on the level of education.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that education level is correlated with oral health status. 34 However, the aim of the study was to engage the patient based on the communication style and not on the level of education. Hence, despite potential differences in education level, this tailored approach should have allowed all participants to adequately engage in the conversation to embrace self-care.…”

Section: Discussionmentioning

confidence: 99%

The effect of a behavioural management tool in adults with mild to moderate periodontitis. A single‐blind, randomized controlled trial

Donos

Suvan

Calciolari

et al. 2020

J of Periodontal Research

View full text Add to dashboard Cite

Objective To compare a behavioural management program (test) to a standard communication approach (control) to reduce plaque, improve clinical outcomes and patient's compliance with oral self‐care. Background Since psychological factors affect oral health–related behaviours, approaches directed at changing behaviours and improving compliance might improve the effect of oral health education. Materials and Methods This was a randomized, single‐blind, parallel‐design trial involving 71 patients with mild to moderate periodontitis. During a run‐in period, all participants began using a power toothbrush. Two sessions of non‐surgical periodontal therapy were performed post‐baseline, along with one of the two oral healthcare communication approaches. Plaque and bleeding scores, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the screening visit, baseline visit and at 8 and 14 weeks post‐baseline. Patients were asked to fill in oral self‐care diaries. Experience questionnaires were administered to both clinicians and patients to assess subjective experience of the clinician‐patient interactions during the visits. Results In both groups, a significant reduction in plaque and bleeding scores was observed from baseline to 8 weeks after baseline, which then remained stable at week 14, but no differences between the groups were noted. An improvement in CAL and PPD was recorded at week 8 post‐baseline in the test compared to the control group. No inter‐group differences in the clinician's and subject's experience questionnaires were observed. Conclusion Both approaches significantly promoted periodontal health. However, changing lifestyle requires repeated communication/engagement over time and a behavioural management program based upon two visits did not provide additional benefit compared to a standard approach.

show abstract

Inequalities in oral health: Understanding the contributions of education and income

Cited by 23 publications

References 25 publications

Providing dental insurance can positively impact oral health outcomes in Ontario

Providing dental insurance can positively impact oral health outcomes in Ontario

The Relationship between Income and Oral Health: A Critical Review

The effect of a behavioural management tool in adults with mild to moderate periodontitis. A single‐blind, randomized controlled trial

Contact Info

Product

Resources

About