Luis Limo

Objetivos: El objetivo fue evaluar la asociación entre las dinámicas individuales del entorno familiar y la experiencia de caries de aparición temprana (CAT), así como determinar si estas asociaciones varían según el grado de afectación del tejido dental. Materiales y métodos: Se analizaron datos de 210 niños de 3 a 5 años en Callao, Perú, a partir de cuestionarios y exámenes dentales. Las dinámicas familiares evaluadas incluyeron la propiedad de la vivienda, la convivencia parental, la estructura familiar y el tamaño de la familia. La experiencia de CAT se evaluó mediante el examen clínico de los dientes primarios cariados, obturados o ausentes, diferenciando las lesiones cavitadas y no cavitadas. Las covariables fueron demográficas, socioeconómicas, conductas de salud y acceso a los servicios odontológicos. Para el análisis, utilizamos modelos de regresión multivariable por bloques, estimando cocientes de prevalencia e intervalos de confianza al 95%, y reportamos nuestros hallazgos de acuerdo con las directrices STROBE. Resultados: Los modelos totalmente ajustados indicaron que la prevalencia de experiencia de CAT fue mayor en niños que residían en viviendas alquiladas (RP 1,29; IC 95% 1,17; 1,41), en hogares monoparentales (RP 1,75; IC 95% 1,61; 1,91), en familias extensas además de la familia nuclear (RP 1,19; IC 95% 1,08; 1,29) y en aquellos que compartían el hogar con al menos cuatro miembros adicionales (RP 1,05; IC 95% 0,94; 1,14). El análisis de subgrupos de acuerdo con el grado de afectación del tejido dental mostró que la estructura familiar y el tamaño del hogar estaban significativamente asociados con lesiones no cavitadas, mientras que la asociación con lesiones cavitadas fue más pronunciada en relación con la convivencia parental, después de ajustar por todas las covariables. Conclusiones: Los indicadores relacionados con las dinámicas individuales del entorno familiar están asociados con la experiencia de caries de aparición temprana (CAT) en niños pequeños en el Perú. Sin embargo, se requieren análisis adicionales para comprender plenamente los mecanismos subyacentes y otros determinantes que contribuyen al desarrollo de la caries en esta población de estudio.

Introduction: Emerging studies on the links between suboptimal oral health and multimorbidity (MM), or the co-existence of multiple chronic conditions, have raised controversy as to whether enhancing access to dental care may mitigate MM in those with suboptimal oral health. In this study, we aim to assess the extent of the association between suboptimal oral health and MM and whether access to dental care can modify this association. Methods: We conducted a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) (N = 44,815, 45 to 84 y old). Edentulism, self-reported oral health (SROH), and other oral health problems (e.g., toothache, bleeding gums) were used as indicators of suboptimal oral health. MM was defined according to the Public Health Agency of Canada as having 2 or more of the following chronic conditions: cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. For robustness, we also used a cutoff of having 3 or more of these chronic conditions. Variables for access to dental care included (1) dental visits within the past year, (2) availability of dental insurance, and (3) cost barriers to dental care. We constructed robust Poisson regression models to estimate the association between suboptimal oral health and MM and then assessed the effect measure modification by indicators of access to dental care on a multiplicative scale. We also calculated the relative excess risk due to interaction for prevalence ratio (PR) on an additive scale. Results: Indicators of suboptimal oral health were significantly associated with MM (edentulism PR 1.17, 95% confidence interval [CI] 1.08, 1.27; poor SROH PR 1.44, 95% CI 1.33, 1.54; other oral health problems PR 1.52, 95% CI 1.44, 1.78). The magnitude of this association was higher in individuals who reported fewer dental visits within the past year, lacked dental insurance, and avoided dental care due to costs. Conclusion: The association between suboptimal oral health and MM may be exacerbated by barriers to accessing dental care. Policies aiming to enhance access to dental care may help mitigate MM in middle-aged and older Canadians with suboptimal oral health. Knowledge Transfer Statement: This study offers insights into the connection among suboptimal oral health, multimorbidity, and access to dental care factors in middle-aged and older Canadians. The findings can be of value for clinicians and policy makers aiming to enhance medical-dental integration and improve accessibility to dental care and to patients seeking information about the connections between oral health and chronic conditions. Implementation has the potential to enhance individual well-being and drive systemic improvements in health care.

INTRODUCTION: Emerging research on the links between sub-optimal oral health and multimorbidity (MM), or the co-existence of multiple chronic conditions, has raised queries on whether enhancing access to dental care may mitigate the MM burden, especially in older age. Here, we aim to assess the association between sub-optimal oral health and MM and whether access to dental care can mitigate the risk of MM in individuals with sub-optimal oral health. METHODS: We conducted a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) (n=44,815, 45-84 years old). Edentulism, self-reported oral health (SROH), and other oral health problems (e.g., toothache, bleeding gums), were each used as indicators of sub-optimal oral health. MM was defined according to the Public Health Agency of Canada as having 2 or more chronic conditions out of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. Variables for access to dental care included the number of dental visits within the last year, dental insurance status, and cost barriers to dental care. We constructed multivariable step-wise logistic regression models and interaction terms with 95% confidence intervals and estimated prevalence ratio (PR) to assess the associations of interest, adjusting for a priori determined sociodemographic and behavioural factors. RESULTS: Each of the sub-optimal oral health indicators were significantly associated with MM (edentulism PR=1.48, 95%CI 1.31, 1.68; poor SROH PR=1.81, 95%CI 1.62, 2.01; other oral health problems PR = 1.91, 95%CI 1.78, 2.06). The magnitude of this association was exacerbated in individuals who lacked dental insurance, could not afford dental care, and those who reported fewer dental visits within the last year. CONCLUSION: The association between sub-optimal oral health and MM may be exacerbated by the lack of access to dental care. Policies aiming to enhance access to dental care may help mitigate the risk of MM.