Oral Hygiene Status in a General Population of Iran, 2011: A Key Lifestyle Marker in Relation to Common Risk Factors of Non-Communicable Diseases

Document Type: Original Article

Authors

1 Center for Disease Control and Prevention, Deputy for Health, Ministry of Health and Medical Education, Tehran, Iran

2 Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran

4 Department of Epidemiology, School of Public Health, ShahidBeheshti University of Medical Sciences, Tehran, Iran

5 National Program for Disease Registries and Health Outcomes, Deputy for Research, Ministry of Health and Medical Education, Tehran, Iran

Abstract

Background
To estimate Oral Hygiene (OH) status in the Iranian population in 2011, and to determine the influence of socio-economic characteristics on OH, and its interrelation with common risk factors of Non-Communicable Diseases (NCDs).
 
Methods
Data including a total of 12,105 individuals aged 6-70 years were obtained from the sixth round of the surveys of NCDs risk factors in Iran. OH was recorded through a structured questionnaire measuring daily frequencies of tooth brushing and dental flossing. Descriptive analyses were performed on demographic characteristics in the complex sample survey setting. We also employed weighted binary logistic regression to compute Odds Ratio (OR) as a measure of association between the response and explanatory factors. Furthermore, to construct an asset index, we utilized Principal Component Analysis (PCA).
 
Results
The percentage with minimum recommended daily OH practices was 3.7% among men and 7.7% among women  (OR= 2.3; P< 0.001). Urban citizens were more likely to have their teeth cleaned compared to rural people (OR= 2.8; P< 0.001). For both genders, a relatively better condition was observed in the 25–34 age group (male: 5.6%; female: 10.3%). In addition, OH status improved significantly by increase in both level of education (P< 0.001) and economic status (P< 0.001). There were also apparent associations between self-care practices and specific behavioral risk factors, though the correlation with dietary habits and tobacco use could be largely explained by socio-economic factors.
 
Conclusion
OH situation in Iran calls for urgent need to assign proper interventions and strategies toward raising public awareness and reducing disparities in access to health facilities.

Keywords

Main Subjects


  1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013; 380: 2224-60. doi: 10.1016/S0140-6736(12)61766-8
  2. World Health Organization (WHO). Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: WHO; 2009.
  3. Mathers C, Fat DM, Boerma J. The global burden of disease: 2004 update. Geneva: WHO;  2008.
  4. Allender S, Lacey B, Webster P, Rayner M, Deepa M, Scarborough P, et al. Level of urbanization and noncommunicable disease risk factors in Tamil Nadu, India. Bull World Health Organ 2010; 88(4): 297-304. doi: 10.2471/blt.09.065847
  5. Hosseinpoor AR, Bergen N, Kunst A, Harper S, Guthold R, Rekve D, et al. Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey. BMC Public Health  2012; 12: 912. doi: 10.1186/1471-2458-12-912
  6. Hessari H, Vehkalahti MM, Eghbal MJ, Murtomaa HT. Oral health among 35-to 44-year-old Iranians. Med Princ Pract 2007;16: 280-5. doi: 10.1159/000102150
  7. Bloom DE, Shannon S. The Demography of Aging. Molecular Aspects of Aging: Understanding Lung Aging. John Wiley & Sons; 2014. p. 1-12.
  8. Mbawalla HS, Masalu JR, Åstrøm AN. Socio-demographic and behavioural correlates of oral hygiene status and oral health related quality of life, the Limpopo-Arusha school health project (LASH): A cross-sectional study. BMC Pediatr 2010; 10: 87. doi: 10.1186/1471-2431-10-87
  9. Sheiham A. Oral health, general health and quality of life. Bull World Health Organ  2005; 83: 644.
  10. Locker D, Quiñonez C. To what extent do oral disorders compromise the quality of life? Community Dent Oral Epidemiol 2011; 39: 3-11. doi: 10.1111/j.1600-0528.2010.00597.x
  11. Tezal M, Scannapieco FA, Wactawski-Wende J, Meurman JH, Marshall JR, Rojas IG, et al. Dental Caries and Head and Neck Cancers. JAMA Otolaryngol Head Neck Surg  2013; 139: 1054-60. doi: 10.1001/jamaoto.2013.4569
  12. Nasrollahzadeh D, Malekzadeh R, Aghcheli K, Sotoudeh M, Merat S, Islami F, et al. Gastric atrophy and oesophageal squamous cell carcinoma: possible interaction with dental health and oral hygiene habit. Br J Cancer 2012; 107: 888-94.
  13. Dar N, Islami F, Bhat G, Shah I, Makhdoomi M, Iqbal B, et al. Poor oral hygiene and risk of esophageal squamous cell carcinoma in Kashmir. Br J Cancer 2013; 109: 1367-72. doi: 10.1111/cas.12210
  14. Abnet CC, Kamangar F, Islami F, Nasrollahzadeh D, Brennan P, Aghcheli K, et al. Tooth loss and lack of regular oral hygiene are associated with higher risk of esophageal squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 2008; 17: 3062-8. doi: 10.1158/1055-9965.epi-08-0558
  15. American Dental Association (ADA). Statement on Regular Brushing and Flossing to Help Prevent Oral Infections. American Dental Association; 2013.
  16. Lapin B, Smith AJ. Dental Care: The Often Neglected Part of Health Care. New Haven, CT: Yale University; 2008.
  17. Glick M, Monteiro da Silva O, Seeberger GK, Xu T, Pucca G, Williams DM, et al. FDI Vision 2020: shaping the future of oral health. Int Dent J 2012; 62: 278-91. doi: 10.1111/idj.12009
  18. Marcenes W, Kassebaum N, Bernabé E, Flaxman A, Naghavi M, Lopez A, et al. Global Burden of Oral Conditions in 1990-2010 A Systematic Analysis. J Dent Res  2013; 92: 592-7. doi: 10.1177/0022034513490168
  19. Petersen PE, Ogawa H. The global burden of periodontal disease: towards integration with chronic disease prevention and control. Periodontology 2000 2012; 60(1): 15-39. doi: 10.1111/j.1600-0757.2011.00425.x
  20. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31: 3-24. doi: 10.1046/j..2003.com122.x
  21. Petersen PE, Baehni PC. Periodontal health and global public health. Periodontology 2000 2012; 60(1): 7-14. doi: 10.1111/j.1600-0757.2012.00452.x
  22. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005; 83: 661-9.
  23. Petersen PE, Hoerup N, Poomviset N, Prommajan J, Watanapa A. Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand. Int Dent J  2001; 51: 95-102. doi: 10.1002/j.1875-595x.2001.tb00829.x
  24. Ismail AI, Sohn W. The impact of universal access to dental care on disparities in caries experience in children. J Am Dent Assoc 2001; 132: 295-303. doi: 10.14219/jada.archive.2001.0172
  25. Paulander J, Axelsson P, Lindhe J. Association between level of education and oral health status in 35, 50, 65and 75yearolds. J Clin Periodontol 2003; 30(8): 697-704. doi: 10.1034/j.1600-051x.2003.00357.x
  26. Manski RJ, Magder LS. Demographic and socioeconomic predictors of dental care utilization. J Am Dent Assoc 1998; 129: 195-200. doi: 10.14219/jada.archive.1998.0177
  27. Sabbah W, Tsakos G, Sheiham A, Watt RG. The role of health-related behaviors in the socioeconomic disparities in oral health. Soc Sci Med 2009; 68: 298-303. doi: 10.1016/j.socscimed.2008.10.030
  28. Polk DE, Weyant RJ, Manz MC. Socioeconomic factors in adolescents’ oral health: are they mediated by oral hygiene behaviors or preventive interventions? Community Dent Oral Epidemiol 2010; 38: 1-9. doi: 10.1111/j.1600-0528.2009.00499.x
  29. Petersen PE. Sociobehavioural risk factors in dental caries–international perspectives. Community Dent Oral Epidemiol 2005; 33: 274-9. doi: 10.1111/j.1600-0528.2005.00235.x
  30. Rao VK, Balan A. The influence of socio economic status on dental caries in Indian children. Int J Adv Life Sci 2013; 6: 527-31.
  31. Johnson NW, Warnakulasuriya S, Gupta P, Dimba E, Chindia M, Otoh E, et al. Global oral health inequalities in incidence and outcomes for oral cancer causes and solutions. Adv Dent Res 2011; 23: 237-46. doi: 10.1177/0022034511402082
  32. Watt R, Sheiham A. Health policy: Inequalities in oral health: a review of the evidence and recommendations for action. Br Dent J 1999; 187(1): 6-12. doi: 10.1038/sj.bdj.4800191
  33. Brennan D, Spencer A. Childhood Oral Health and SES Predictors of Caries in 30-Year-Olds. Caries Res 2014; 48: 237-43. doi: 10.1159/000354044
  34. Petersen PE. Global policy for improvement of oral health in the 21st century–implications to oral health research of World Health Assembly 2007, World Health Organization. Community Dent Oral Epidemiol 2009; 37: 1-8. doi: 10.1111/j.1600-0528.2008.00448.x
  35. Faulks D, Freedman L, Thompson S, Sagheri D, Dougall A. The value of education in special care dentistry as a means of reducing inequalities in oral health. Eur J Dent Educ 2012; 16: 195-201. doi: 10.1111/j.1600-0579.2012.00736.x
  36. Kowash M, Pinfield A, Smith J, Curzon M. Dental health education: effectiveness on oral health of a long-term health education programme for mothers with young children. Br Dent J 2000; 188: 201-5. doi: 10.1038/sj.bdj.4800431a
  37. Petersen PE, Peng B, Tai B, Bian Z, Fan M. Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China. Int Dent J 2004; 54: 33-41. doi: 10.1111/j.1875-595x.2004.tb00250.x
  38. Wierzbicka M, Petersen PE, Szatko F, Dybizbanska E, Kalo I. Changing oral health status and oral health behaviour of schoolchildren in Poland. Community Dent Health  2002; 19: 243-50.
  39. Rong WS, Bian JY, Wang WJ, De Wang J. Effectiveness of an oral health education and caries prevention program in kindergartens in China. Community Dent Oral Epidemiol 2003; 31: 412-6.
  40. Pakshir HR. Oral health in Iran. Int Dent J 2004; 54: 367-72.
  41. Pakpour A, Hidarnia A, Hajizadeh E, Kumar S, Fridlund B. Why Iranian adolescents do not brush their teeth: a qualitative study. Int J Dent Hyg 2012; 10: 86-90. doi: 10.1111/j.1601-5037.2011.00513.x
  42. Sanei AS, Nikbakht–Nasrabadi A. Periodontal health status and treatment needs in Iranian adolescent population. Arch Iranian Med 2005; 8: 290-4.
  43. Yazdani R, Vehkalahti M, Nouri M, Murtomaa H. Oral health and treatment needs among 15-year-olds in Tehran, Iran. Community Dent Health 2008; 25: 221-5.
  44. Pakpour AH, Hidarnia A, Hajizadeh E, Kumar S, Harrison AP. The status of dental caries and related factors in a sample of Iranian adolescents. Med Oral Patol Oral Cir Bucal 2011; 16: e822-7. doi: 10.4317/medoral.17074
  45. Kasmaei P, Shokravi FA, Hidarnia A, Hajizadeh E, Atrkar-Roushan Z, Shirazi KK, et al. Brushing behavior among young adolescents: does perceived severity matter. BMC Public Health 2014; 14: 8. doi: 10.1186/1471-2458-14-8
  46. Christensen LB, Petersen PE, Krustrup U, Kjøller M. Self-reported oral hygiene practices among adults in Denmark. Community Dent Health 2003; 20: 229-35.
  47. Harada S, Akhter R, Kurita K, Mori M, Hoshikoshi M, Tamashiro H, et al. Relationships between lifestyle and dental health behaviors in a rural population in Japan. Community Dent Oral Epidemiol 2005; 33: 17-24. doi: 10.1111/j.1600-0528.2004.00189.x
  48. Kim CS, Han SY, Kim CW. The relationship between regional socioeconomic position and oral health behavior: A multilevel approach analysis. J Korean Acad Oral Health  2013; 37: 208-15. doi: 10.11149/jkaoh.2013.37.4.208
  49. Ronis DL, Lang WP, Farghaly MM, Passow E. Tooth Brushing, Flossing, and Preventive Dental Visits by Detroitarea Residents in Relation to Demographic and Socioeconomic Factors. J Public Health Dent 1993; 53: 138-45. doi: 10.1111/j.1752-7325.1993.tb02692.x
  50. Demirer S, Gursoy U, Ozdemir H, Erdemir E, Uitto V. Periodontal health knowledge and smoking are associated with periodontal treatment need according to tooth brushing levels. West Indian Med J 2012; 61: 191-7.
  51. Varenne B, Petersen PE, Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2006; 56: 61-70. doi: 10.1111/j.1875-595x.2004.tb00260.x
  52. Mashoto KO, Astrom AN, Skeie MS, Masalu JR. Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa district, Tanzania. BMC Oral Health 2010; 10: 7. doi: 10.1186/1472-6831-10-7
  53. Petersen PE. Improvement of global oral health-the leadership role of the World Health Organization. Community Dent Health 2010; 27: 194-8.
  54. Dickinson C, Beatty C, Marshall D. A pilot study: are dental hygienists in Texas ready for the elderly population explosion? Int J Dent Hyg 2012; 10: 128-37. doi: 10.1111/j.1601-5037.2011.00526.x
  55. Rabiei M, Kasemnezhad E, Shakiba M, Pourkay H. Prevalence of oral and dental disorders in institutionalised elderly people in Rasht, Iran. Gerodontology 2010; 27: 174-7. doi: 10.1111/j.1741-2358.2009.00313.x
  56. Marchini L, Vieira P, Bossan T, Montenegro F, Cunha V. Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubaté, Brazil. Gerodontology 2006; 23: 33-7. doi: 10.1111/j.1741-2358.2006.00092.x
  57. Yekaninejad MS, Eshraghian MR, Nourijelyani K, Mohammad K, Foroushani AR, Zayeri F, et al. Effect of a school-based oral healtheducation program on Iranian children: results from a group randomized trial. Eur J Oral Sci 2012; 120: 429-37. doi: 10.1111/j.1600-0722.2012.00993.x
  58. Dawani N, Qureshi A, Syed S. Integrated School-Based Child Oral Health Education. J Dow Univ Health Sci 2012; 6: 110-4.
  59. Bhardwaj VK, Sharma KR, Luthra RP, Jhingta P, Sharma D, Justa A. Impact of school-based oral health education program on oral health of 12 and 15 years old school children. J Educ Health Promot 2013; 2: 33. doi: 10.4103/2277-9531.115820
  60. Sepehr A, Kamangar F, Fahimi S, Saidi F, Abnet CC, Dawsey SM. Poor oral health as a risk factor for esophageal squamous dysplasia in northeastern Iran. Anticancer Res  2005; 25: 543-6.
  61. Singh A, Rouxel P, Watt R, Tsakos G. Social inequalities in clustering of oral health related behaviors in a national sample of British adults. Prev Med 2013; 57: 102-6. doi: 10.1016/j.ypmed.2013.04.018
  62. Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol 2000; 28: 399-406. doi: 10.1034/j.1600-0528.2000.028006399.x
  63. Franchini R, Petri A, Migliario M, Rimondini L. Poor oral hygiene and gingivitis are associated with obesity and overweight status in paediatric subjects. J Clin Periodontol 2011; 38: 1021-8. doi: 10.1111/j.1600-051x.2011.01770.x
  64. Alves LS, Susin C, Damé-Teixeira N, Maltz M. Overweight and obesity are not associated with dental caries among 12-year-old South Brazilian schoolchildren. Community Dent Oral Epidemiol 2013; 41: 224-31. doi: 10.1111/cdoe.12010
  65. Ojima M, Hanioka T, Tanaka K, Aoyama H. Cigarette smoking and tooth loss experience among young adults: a national record linkage study. BMC Public Health 2007; 7: 313. doi: 10.1186/1471-2458-7-313
  66. Moynihan P. The Role of Diet in the Prevention of Dental Diseases. In: Limeback H, editor.  Comprehensive Preventive Dentistry. John Wiley & Sons; 2012. p. 99.
  67. Haber J, Wattles J, Crowley M, Mandell R, Joshipura K, Kent RL. Evidence for cigarette smoking as a major risk factor for periodontitis. J Periodontol 1993; 64: 16-23. doi: 10.1902/jop.1993.64.1.16
  68. Ding D, Zhong X, Lau JT, Oldenburg B. Behavioral medicine and prevention of non-communicable diseases in China: current challenges and future directions. Int J Behav Med 2014; 21: 584-9. doi: 10.1007/s12529-014-9393-7
  69. Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health 2010; 31: 399-418.
  70. Dorri M, Sheiham A, Watt RG. Modelling the factors influencing general and oral hygiene behaviours in adolescents. Int J Paediatr Dent 2010; 20: 261-9. doi: 10.1111/j.1365-263x.2010.01048.x
  71. Rose G. Sick individuals and sick populations. Int J Epidemiol 2001; 30: 427-32. doi: 10.1093/ije/30.3.427