Oral health among white, black, and Mexican-American elders: an examination of edentulism and dental caries

Abstract

Objectives To examine racial/ethnic disparities in oral health among older Americans. Methods Differences in frequency of edentulism and number of decayed, missing, and filled teeth were assessed in 2,679 non-Hispanic white, 742 non-Hispanic black, and 934 Mexican-American individuals aged 60 and older from the National Health and Nutrition Examination Survey (1999-2004). Results Controlling for potential confounding variables, blacks and Mexican-Americans had significantly higher numbers of decayed teeth but fewer numbers of filled teeth than whites. Although blacks had a lower likelihood of being edentulous than whites, dentate blacks had a higher number of missing teeth. Compared with whites, Mexican-Americans were less likely to be edentulous, and dentate Mexican-Americans had fewer missing teeth. Our study also showed that blacks and Mexican-Americans had less frequent dental checkups than whites. Conclusions Oral health disparities are persistent across racial/ethnic groups for older Americans despite the fact that the differences between groups typically diminish when socioeconomic, health-related, and behavioral factors are considered in the models. Our study suggests that reducing racial/ethnic oral health disparities requires multiple clinical approaches.

A Multilevel Approach on Self-Reported Dental Caries in Subjects of Minority Ethnic Groups: A Cross-Sectional Study of 6440 Adults

“…On the other hand, Celeste and Nadanovsky [28] showed that among adults a longer time since last dental visit was associated with dental caries; also unmet dental need was related to presence of caries in a rural Indian fishing community [29], corroborating our results. Although the variable smoking status was not contemplated in the present study, smoking was associated with a greater number of decayed teeth in blacks and MexicanAmericans, [26] nevertheless, Colombia has one of the lowest prevalence of smoking in Latin America [30,31] and this fact could not affect the frequency on SRDC in the present study. Besides, smoking is more associated with oral cancer, periodontitis and worst wound healing [32,33].…”

“…This result suggests that contextual factors affect SRDC. Contextual consequences were also observed for dental caries in several studies [13,14,23,24,26].…”

“…In line, a significant variation in the severity of caries between low-income African-American neighborhood clusters was documented [13]. Lower education levels and lower income were also associated with a higher number of decayed teeth in blacks and Mexican-Americans in the National Health and Nutrition Examination Survey in the United States (1999)(2000)(2001)(2002)(2003)(2004) [26]. Furthermore, living in under-resourced communities was associated with greater prevalence of caries in a birth cohort of Indigenous Australians aged 16-20 years [14].…”

“…Moreover, lower education levels were also associated with a higher number of decayed teeth in blacks and Mexican-Americans [26]. This emphasizes the life cycle nature of the advancement of oral health barriers; it accentuates the importance of prevention and timely intervention for racial/ ethnic and socioeconomic minorities in preventing oral health disparities in later life [9].…”

Accumulated knowledge and prevention practices in oral health

“…For this reason, some authors prefer to consider social injustice as a criterion of the difference between inequality and inequity. 14 There is broad knowledge on social determination, inequality and inequity, 16,17,18,19,20,21 yet there is little or no discussion on inequity and social justice. These should guide a discussion based on the principles of rightness, such as distributives of social justice (principle of right, merit and need) 22 or principles of social justice (guarantee of freedom, equitable equality of opportunities and presence of inequalities only to favor the disfavored).…”