摘要：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. The complex interplay among oral health, systemic inflammation, and health outcomes precludes straightforward explanations as to their relationships. 1 Nonetheless, there is increasing recognition by oral health professionals of the need to assess their patients for general health conditions that may affect oral health or complicate treatment plans. 2 Furthermore, access to quality dental care is an equity issue, because racial/ethnic minorities, underserved populations, and Medicaid beneficiaries (those who are poor or disabled) face substantial barriers that require flexibility and ingenuity to overcome. 3 Understanding the developmental processes of dental diseases and their socioeconomic patterns across the life course is crucial in determining optimal times for interventions to better limit the population health burden and reduce socioeconomic inequalities in oral health and health care. 4 We believe that social disparities in health and health care are particularly evident in the mouth, even as they are inextricably tied to other systems of the body, 5 and that it is never too early or too late in life to intervene to improve health and well-being. 6 The community-based ElderSmile clinical program of the Columbia University College of Dental Medicine represents an innovative approach to screening and providing treatment to older adults with complex needs, regardless of their ability to pay for services. 7 Rather than viewing public health dentistry as a subfield of dentistry in interdisciplinary initiatives such as this one, oral public health is more broadly conceptualized as the intersection of 3 domains: dentistry, medicine, and public health ( Figure 1 ). Open in a separate window 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. Previous research has sought to identify causal pathways between general and oral health, as well as between poor oral health and mortality. 8 For instance, it has been theorized that chronic oral infections caused by periodontal disease and the resultant presence of inflammatory markers may lead to the onset of hypertension and stroke. 9,10 Further, a number of recent studies have identified relationships between chronic health conditions, such as diabetes and heart disease, and increased numbers of missing teeth in adults. 11–14 Few programs have integrated general and oral health screening and provided follow-up social, medical, and dental services for underserved older adults in community-based settings that are both accessible and affordable. A notable exception to this rule is the ElderSmile program. In November 2010, the focus of this initiative was expanded to include general health, that is, community-based education and screening for diabetes and hypertension were added to the oral health activities that remain its core functions. 15 Importantly, data collection is ongoing, which permits the assessment of relationships between oral and general health, and progress in achieving health equity for its largely racial/ethnic minority, socioeconomically disadvantaged older adult participants over time. Our study had 2 objectives: (1) to examine the relationships between general health conditions (diabetes and hypertension) and missing teeth in the ElderSmile population, and (2) to determine if an ordinal logistic regression model that used 3 response categories for missing teeth (edentulous or 28 missing teeth of a total of 28 teeth, excluding third molars; limited functional capacity or 9–27 missing teeth; and functional dentition or 0–8 missing teeth) provided more information while retaining ease of interpretation compared with a binary logistic regression model that used 2 response categories (edentulous and dentate).
