Measuring the Impact of Tooth Removal and Delayed Dental Services On Well-Being and Life Satisfaction: A Comparison with Major Chronic Diseases, Texas 2010

BACKGROUND: The study’s purpose is to encourage prioritizing oral health issues within a chronic disease setting in Texas by measuring the health impact of permanent tooth removal and delayed dental care services.   

METHODS: Data came from the 2010 Texas Behavioral Risk Factor Surveillance System. Three binary variables were used to characterize oral health issues: removal of six or more permanent teeth due to tooth decay or gum disease (yes/no), last visit with dental health professional >5 years ago (yes/no), and last professional teeth cleaning >5 years ago (yes/no). Three binary variables were used to characterize impact on health: >5 days poor physical health in past month (yes/no), >5 days poor mental health in past month (yes/no), and life satisfaction (very satisfied/satisfied versus dissatisfied/very dissatisfied).  Cardiovascular disease, diabetes, and asthma status were determined by self-reported doctor diagnosis. Logistic regression models were used to provide measures of associations (odds ratios (ORs) with associated 95% confidence intervals (CI)). Models were adjusted for age, sex, race/ethnicity, education level, income status, body mass index, marital status, current smoking status, and physical activity level. Sex and age-group (18-39, 40-64, ≥ 65) were treated as potential effect modifiers. All analyses were conducted in Stata v 11.0.  

RESULTS: Similar percentages of adults reported delayed dental services (15.0%) as having had six or more teeth removed (12.3%). Respondents reporting delayed dental services were more likely to be male, non-White, unemployed, current smokers, obese, not married, and less physically active. Respondents reporting major tooth removal were significantly older and majority female. There was a stronger adjusted association between delayed teeth cleaning and life dissatisfaction (OR: 2.52 (95% CI: 1.71-3.70)) than for the presence of at least one major chronic illness (1.39 (.97-1.99)). Using models that adjusted for the co-presence of major chronic illnesses, major tooth loss remained associated with poor mental health (1.45 (1.15-1.83)) and poor physical health (1.58 (1.29-1.93)). The adjusted associations between delayed dental services/tooth removal and all three outcomes of interest declined with increasing age with young adults experiencing the strongest associations. 

CONCLUSIONS: Delayed dental care and tooth removal have strong associations with lack of well-being and life dissatisfaction in the Texas adult population. These associations are comparable to and even stronger for certain quality of life measures than the impact of major chronic diseases. Results indicate higher priority should be placed on oral health issues in health promotion and chronic disease prevention activities.