A community-based oral public health approach to promote health equity

Abstract

Objectives: We explored the interrelationships among diabetes, hypertension, and missing teeth among underserved racial/ethnic minority elders.

Methods: Self-reported sociodemographic characteristics and information about health and health care were provided by community-dwelling ElderSmile participants, aged 50 years and older, who took part in community-based oral health education and completed a screening questionnaire at senior centers in Manhattan, New York, from 2010 to 2012.

Results: Multivariable models (both binary and ordinal logistic regression) were consistent, in that both older age and Medicaid coverage were important covariates when self-reported diabetes and self-reported hypertension were included, along with an interaction term between self-reported diabetes and self-reported hypertension.

Conclusions: An oral public health approach conceptualized as the intersection of 3 domains-dentistry, medicine, and public health-might prove useful in place-based assessment and delivery of services to underserved older adults. Further, an ordinal logit model that considers levels of missing teeth might allow for more informative and interpretable results than a binary logit model.

FIGURE 1—

The evolution of public health dentistry as a subfield of dentistry, to oral public health as the intersection of 3 broad domains—dentistry, medicine, and public health.

FIGURE 2—

Distribution of the number of missing teeth among ElderSmile program participants (third molars excluded): New York, NY; 2010–2012. Note. The number of missing teeth was categorized according to the level of functionality of the dentition: functional dentition (0-8 missing teeth), limited functional capacity (9-27 missing teeth), and edentulous (28 missing teeth). The sample size was n = 556 participants. The mean number of missing teeth was 15 (median = 14; interquartile range = 18).