Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Oral health among the elderly in 7 Latin American and Caribbean cities, 1999-2000: a cross-sectional study

BMC Oral Health201515:46

https://doi.org/10.1186/s12903-015-0030-x

Received: 19 August 2014

Accepted: 24 March 2015

Published: 9 April 2015

Abstract

Background

To describe the prevalence of missing teeth, use of bridges and dentures and unmet dental needs among those aged 60 years and above. The associations of these conditions with socio-demographics, type 2 diabetes mellitus and depression were also studied. The work was carried out in 7 Latin American and Caribbean (LAC) cities in 1999-2000.

Methods

A secondary analysis was conducted on the Survey of Health and Well-Being of Elders (SABE) dataset. The 7 cities were Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. This survey did not employ any oral examinations. Descriptive statistics, chi-square and regression analysis were used to test for associations.

Results

Data for 10 902 persons were analyzed. Females made up 62% of the population. Across the SABE population, between 93.7% (Mexico City) to 99.9% (Santiago) reported missing teeth, with an average of 97.5%. Of those with missing teeth, between 55.1% (Mexico City) and 82.4% (São Paulo) reported having bridges or dentures, with an average of 70.1% across all SABE cities. The proportion of the SABE population with ‘unmet dental needs’ ranged from 85.8% (Santiago) to 98.4% (Havana), with an average of 94.5%. Bridgetown, São Paulo and Mexico City demonstrated a statistically significant association between aging and tooth loss. Generally a greater proportion of females (97.6%) reported tooth loss compared with males (96.8%), but in only São Paulo and Montevideo was there a statistically significant association between sex and tooth loss. Generally those with higher education reported less tooth loss, primary education (97.6% had tooth loss), secondary (96.8%) and tertiary (94.7%). All the SABE cities except Buenos Aires demonstrated a statistically significant association between tooth loss and education.

Conclusions

The prevalence of missing teeth, use of bridges and dentures and unmet dental needs were high in the SABE cities in 1999-2000. In general across the SABE cities, the elderly with the most missing teeth were less educated or less likely to be a professional. They tended to be not working and were receiving a pension. Additionally they were less likely to report their health as ‘excellent’, were diabetic and were more likely to give responses suggestive of depression.

Keywords

Public health dentistry Dental health survey Elderly Latin America Caribbean

Background

The Latin America and the Caribbean (LAC) population is ageing at unprecedented rates. The UN Database reports that by 2025 the elderly will increase by 300% in developing countries, especially in Latin America [1,2]. As life expectancy increases, so too does the desire for improved quality of life (QoL). QoL is dependent upon many factors including nutrition and enjoyment of food which involves adequate mastication and oral health [1].

Older people have more complex oral health needs. Oro-facial and dental pain or missing, discoloured and broken teeth can adversely affect people’s health, confidence and well-being. The resultant facial shape change which occurs may lead to an unwillingness to carry out everyday activities [1,3-5]. Many elderly also suffer from non-communicable diseases (NCDs) that can affect general and oral health. The required medications for these NCDs often cause reduced quantity and quality of saliva, thereby increasing the risk for tooth decay and other oral diseases [6]. Additionally, ill-fitting dentures affect patients’ QoL by making certain foods difficult to chew. Finally, oral cancer is also common in this age group and may develop after years of tobacco and alcohol abuse [7].

Whilst oral health care services are available in developed countries, utilisation is low among the elderly [8]. In low income countries where access to health care is poor especially in rural areas, elderly people experience high levels of oral health problems. In addition to socioeconomic factors, issues of limited availability and access to oral care make the elderly more vulnerable to developing oral diseases. The problem is further compounded in developing countries with diets rich in refined carbohydrates, and little allocation of health budgets to the prevention of oral diseases. Dental health resources cost developed countries 5-10% of health care expenditure per year [7] and oral disease is the fourth most expensive disease to treat [7]. Research in Latin America reveal that 60-70% of Mexicans over age 65 years have few or no teeth and gum disease and untreated caries are highly prevalent [7]. In South Brazil, poorer QoL are associated with depression and difficulty to chew food [9]. Aging populations therefore pose a significant challenge to healthcare systems. Appropriate oral health policies and strategies are needed to address these challenges.

This paper employed a secondary analysis of the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean (SABE) dataset [10] to achieve the following objectives:
  1. 1.

    To describe the prevalence of oral health issues in the elderly population in 7 Latin American and Caribbean cities in 1999-2000.

     
  2. 2.

    To investigate associations between demographic variables, oral health and NCDs in this population.

     

Although dated, the information can provide a background of past oral health in preparation for future policies, strategies and research.

Method

The Survey on Health, Well-Being, and Aging in Latin America and the Caribbean (SABE) [10] was a cross-sectional study conducted between October 1999 and December 2000. It set out to examine health (including oral health) conditions and limitations of persons aged 60 years and above, and living in private households. The surveys were undertaken in seven cities: Buenos Aires (Argentina), Bridgetown (Barbados), São Paulo (Brazil), Santiago (Chile), Havana (Cuba), Mexico City (Mexico) and Montevideo (Uruguay). SABE was funded by the Pan American Health Organisation (PAHO/WHO) [10]. The data base is to be used only for statistical reporting and analysis and is publicly available from: http://www.icpsr.umich.edu/icpsrweb/NACDA/studies/3546?archive=NACDA&q=SABE.

Demographic variables such as age, sex, race, education, birthplace, religion, ethnicity, marital status, and income were collected along with cognitive, health (including dental), functional and nutritional status, and use and accessibility of services. Dental health was measured by self-reporting rather than oral examination [11].

Sampling target populations

The sampling target population from the SABE dataset were the sixty years (60) and older population living at home in urban areas of the respective cities [10].

Sample design

Eligible participants were selected through a multistage clustered sample with stratification of the units. The sample was chosen in three selection stages of primary, secondary and tertiary sampling units; with two stages employed in Barbados and Brazil [10].

Questionnaire

The SABE questionnaire was designed to produce information and to compare unique ageing processes in the LAC cities with other populations [10]. The modules extracted and included in this current paper are demographics, work history and income, self-reported overall health, oral health, diabetes and depression.

SABE and Oral Health

The dentition aspects investigated in SABE are -
  • ➢ The prevalence of oral disease in the elderly, ascertained from the question: Are you missing any teeth?

  • ➢ Access to dental care: Do you have any bridges/dentures/false teeth?

  • ➢ Unmet Dental Needs: In the SABE, the Geriatric Oral Health Assessment Index (GOHAI) scale was used to quantify the ’Unmet needs for oral health services’ of older adults [12,13]. If a participant had a score of 57 or less out of 60, they were regarded as having an ‘unmet dental need’.

Other information collected included self-reported overall assessment of health where responses ranged from ‘Excellent’ and ‘Very Good’ to ‘Bad’. Also collected was information on depression, the Yesavage Geriatric Depression Scale (GDS) Short form was used [14].

Ethical issues

Ethical approval was granted for the conduct of the survey by the Pan American Health Organization Ethical Review Committee and the appropriate institutional review board in each city.

Analysis

Descriptive statistics was used to compare proportions of affected elderly between the various cities and chi-square analysis was done to investigate whether any associations exist between demographic and disease variables and dentition in the elderly. Regression analysis for the ‘Unmet needs’ oral health variable against the demographic and disease variables was conducted to determine possible predictors of ‘Unmet dental health needs’ in the various cities. Statistical Package for the Social Sciences (SPSS) v. 12 was used. Statistical significance was set at p < 0.05.

Results

The overall sample size of the SABE population was 10,902, females comprised 62%. The response rate ranged from 62.5% in Buenos Aires to 95.3% in Havana [10]. Across the SABE population, between 93.7% (Mexico City) to 99.9% (Santiago) reported missing teeth, with an average for all countries of 97.5%. See Tables 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10.
Table 1

Age and dentition for the SABE population

Row %

Are you missing any teeth?

Do you have bridges/dentures?

Unmet dental needs?

 

N (%)

N (%)

N (%)

Age groups

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1474

 

N = 1417

 

N = 1477

 

60 yrs and >

291 (96.4)

11 (3.6)

0.038

177 (61.9)

109 (38.1)

0.104

285 (94.1)

18 (5.9)

 

61 - 65 yrs.

310 (97.8)

7 (2.2)

 

171 (56.4)

132 (44.6)

 

307 (96.2)

12 (3.8)

0.182

66 - 70 yrs.

298 (99.3)

2 (0.7)

 

180 (62.5)

108 (37.5)

 

276 (93.9)

18 (6.1)

 

71 - 75 yrs.

248 (99.2)

2 (0.8)

 

161 (66.0)

83 (34.0)

 

230 (92.0)

20 (8.0)

 

76 - 80 yrs.

175 (99.4)

1 (0.6)

 

95 (56.2)

74 (43.8)

 

163 (92.6)

13(7.4)

 

81 yrs. and up

133 (98.5)

2 (1.5)

 

69 (54.3)

58 (45.7)

 

131 (97.0)

4 (3.0)

 

Buenos Aires

N = 1027

 

N = 998

 

N = 1028

60 yrs and >

46 (95.8)

2 (4.2)

0.441

30 (66.7)

15 (33.3)

0.164

47 (97.8)

1 (2.1)

0.423

61 - 65 yrs.

241 (98.0)

5 (2.0)

 

178 (73.6)

64 (26.4)

 

237 (96.3)

9 (3.7)

 

66 - 70 yrs.

252 (98.4)

4 (1.6)

 

185 (73.4)

67 (26.6 )

 

243 (94.9)

13 (5.1)

 

71 - 75 yrs.

233 (97.1)

7 (2.9)

 

176 (76.5)

54 (23.5)

 

235 (97.9)

5 (2.1)

 

76 - 80 yrs.

134 (98.5)

2 (1.5)

 

97 (74.0)

34 (26.0)

 

134 (97.8)

3 (2.2)

 

81 yrs. and up

101 (100)

0 (0.0)

 

79 (80.6)

19 (19.4)

 

96 (95.0)

5 (5.0)

 

São Paulo

N = 2143

 

N = 2129

 

N = 2143

60 yrs and >

76 (100)

0 (0.0)

0.045

66 (86.8)

10 (13.2)

0.022

73 (96.1)

3 (3.9)

0.747

61 - 65 yrs.

429 (98.8)

5 (1.2)

 

331 (77.2)

98 (22.8)

 

413 (95.2)

21 (4.8)

 

66 - 70 yrs.

366 (99.2)

3 (0.8)

 

308 (84.2)

58 (15.8)

 

356 (96.5)

13 (3.5)

 

71 - 75 yrs.

379 (98.7)

5 (1.3)

 

311 (82.3)

67 (17.7)

 

373 (97.1)

11 (2.9)

 

76 - 80 yrs.

421 (100)

0 (0.0)

 

352 (83.6)

69 (16.4)

 

404 (96.0)

17 (4.0)

 

81 yrs. and up

459 (100)

0 (0.0)

 

358 (78.0)

101 (22.0)

 

438 (95.6)

21 (4.6)

 

Santiago

N = 1299

 

N = 1281

 

N = 1301

60 yrs and >

63 (100)

0 (0.0)

0.365

41 (67.2)

20 (32.8)

0.017

55 (87.3)

8 (12.7)

0.108

61 - 65 yrs.

278 (100)

0 (0.0)

 

180 (65.7)

94 (34.3)

 

244 (87.1)

36 (12.9)

 

66 - 70 yrs.

327 (100)

0 (0.0)

 

202 (72.5)

121 (27.5)

 

290 (88.7)

37 (11.3)

 

71 - 75 yrs.

247 (100)

0 (0.0)

 

178 (72.7)

67 (27.3)

 

216 (87.4)

31 (12.6)

 

76 - 80 yrs.

182 (100)

0 (0.0)

 

133 (73.9)

47 (26.1)

 

153 (84.1)

29 (15.9)

 

81 yrs. and up

201 (99.5)

1 (0.5)

 

147 (74.2)

51 (25.8)

 

162 (80.2)

40 (19.8)

 

Havana

N = 1905

 

N = 1877

 

N = 1905

60 yrs and >

112 (99.1)

1 (0.9)

0.838

69 (61.6)

43 (38.4)

0.007

113 (100)

0 (0.0)

0.452

61 - 65 yrs.

438 (98.0)

9 (2.0)

 

293 (66.9)

145 (33.1)

 

440 (98.4)

7 (1.6)

 

66 - 70 yrs.

389 (98.7)

5 (1.3)

 

285 (73.3)

104 (26.7)

 

384 (97.5)

10 (2.5)

 

71 - 75 yrs.

326 (99.1)

3 (0.9)

 

226 (69.3)

100 (30.7)

 

321 (97.6)

8 (2.4)

 

76 - 80 yrs.

251 (98.4)

4 (1.6)

 

192 (76.5)

59 (23.5)

 

252 (98.8)

3 (1.2)

 

81 yrs. and up

361 (98.4)

6 (1.6)

 

270 (74.8)

91 (25.2)

 

329 (97.8)

8 (2.2)

 

Mexico City

N = 1873

 

N = 1717

 

N = 1876

60 yrs and >

628 (89.0)

78 (11.0)

0.000

339 (54.1)

288(45.9)

0.620

662 (93.5)

46 (6.5)

0.255

61 - 65 yrs.

337 (90.8)

34 (9.2)

 

171 (51.0)

164 (49.0)

 

352 (94.9)

19 (5.1)

 

66 - 70 yrs.

280 (93.6)

19 (6.4)

 

155 (55.6)

124 (44.4)

 

282 (94.3)

17 (5.7)

 

71 - 75 yrs.

201 (95.7)

9 (4.3)

 

109 (54.5)

91 (45.5)

 

190 (94.5)

20 (9.5)

 

76 - 80 yrs.

150 (95.5)

7 (4.5)

 

89 (59.7)

60 (41.3)

 

150 (95.5)

7 (4.5)

 

81 yrs. and up

127 (97.7)

3 (2.3)

 

71 (55.9)

56 (45.1)

 

120 (94.5)

7 (5.5)

 

Montevideo

N = 1450

 

N = 1365

 

N = 1450

60 yrs and >

64 (91.4)

6 (9.6)

0.166

52 (79.7)

13 (21.3)

0.078

66 (94.3)

4 (5.7)

0.259

61 - 65 yrs.

291 (92.7)

23 (7.2)

 

209 (72.8)

78 (27.2)

 

301 (95.9)

13 (4.1)

 

66 - 70 yrs.

366 (94.8)

20 (5.2)

 

289 (79.2)

76 (20.8)

 

376 (97.4)

10 (2.6)

 

71 - 75 yrs.

282 (96.2)

11 (3.8)

 

214 (76.4)

66 (23.6)

 

277 (94.5)

16 (5.5)

 

76 - 80 yrs.

220 (96.5)

8 (3.5)

 

163 (75.1)

54 (24.9)

 

217 (95.2)

11 (4.8)

 

81 yrs. and up

153 (96.2)

6 (3.8)

 

129 (84.9)

23 (15.1)

 

156 (98.1)

3 (1.9)

 
Table 2

Gender and dentition for the SABE population

Row N %

Are you missing any teeth?

Do you have bridges/dentures?

Unmet dental needs?

N (%)

N (%)

N (%)

Sex

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1474

 

N = 1417

 

N = 1477

Male

887 (97.9)

13 (2.1)

0.349

515 (61.9)

356 (38.1)

0.299

843 (93.5)

59 (6.5)

0.104

Female

562( 98.6)

12 (1.4)

 

338 (59.1)

208 (41.9)

 

549 (95.5)

26 (4.5)

 

Buenos Aires

N = 1027

 

N = 998

 

N = 1028

Male

370 (97.9)

12 (2.1)

0.765

268 (73.2)

98 (26.8)

0.143

368 (97.4)

10 (2.6)

0.255

Female

637 (98.2)

8 (1.8)

 

477 (75.5)

155 (25.5)

 

624 (96.0)

26 (4.0)

 

São Paulo

N = 2143

 

N = 2129

 

N = 2143

Male

872 (99.0)

9 (1.0)

0.039

634 (72.7)

238 (27.3)

0.000

846 (96.0)

35 (4.0)

0.937

Female

1258 (99.7)

4 (0.3)

 

1092 (86.9

165 (13.1)

 

1211 (96.0)

51 (4.0)

 

Santiago

N = 1299

 

N = 1281

 

N = 1301

Male

445 (99.8)

1 (0.2)

0.167

236 (53.8)

203 (46.2)

0.000

376 (84.3)

70 (15.7)

0.180

Female

853 (100)

0 (0.0)

 

645 (76.7)

197 (23.3)

 

744 (87.0)

111 (13.0)

 

Havana

N = 1905

 

N = 1877

 

N = 1905

Male

700 (98.9)

8 (1.1)

0.343

454 (64.9)

246 (35.1)

0.000

698 (98.6)

10 (1.4)

0.239

Female

1177 (98.3)

20 (1.7)

 

881 (74.9)

296 (25.1)

 

1171 (97.8)

26 (2.2)

 

Mexico City

N = 1873

 

N = 1717

 

N = 1876

Male

465 (91.7)

42 (8.3)

0.789

216 (46.8)

246 (53.2)

0.000

481 (94.9)

26 (5.1)

0.172

Female

1258 (92.1)

108 (7.9)

 

718 (57.2)

537 (42.8)

 

1275 (93.1)

94 (6.9)

 

Montevideo

N = 1450

 

N = 1365

 

N = 1450

Male

490 (92.5)

40 (7.5)

0.001

318 (65.4)

168 (34.6)

0.000

514 (97.0)

16 (3.0)

0.175

Female

886 (96.3)

34 (3.7)

 

737 (83.8)

142 (16.2)

 

879 (95.4)

41 (4.5)

 
Table 3

Education level and dentition for the SABE population

Row N (%)

Are you missing any teeth? N (%)

Do you have bridges/dentures? N (%)

Unmet dental needs? N (%)

Education level

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1456

 

N = 1399

 

N = 1459

Primary

1119 (98.7)

15 (1.3)

0.049

665 (60.9)

427 (39.1)

0.281

1071 (94.2)

66 (5.8)

0.843

Secondary

217 (96.4)

8 (1.6)

 

126 (59.4)

86 (41.6)

 

214 (95.1)

11 (4.9)

 

Higher/oth

96 (99.0)

1 (1.0)

 

50 (52.6)

45 (47.4)

 

91 (93.8)

6 (6.2)

 

Buenos Aires

N = 989

 

N = 960

 

N = 990

Primary

690 (98.4)

11 (1.6)

0.209

505 (74.5)

173 (25.6)

0.301

677 (96.6)

24 (3.4)

0.838

Secondary

184 (97.4)

5 (2.6)

 

136 (73.5)

49 (26.5)

 

182 (95.8)

8 (4.2)

 

Higher/oth

95 (96.0)

4 (4.0)

 

78 (80.4)

19 (19.6)

 

96 (97.0)

3 (3.0)

 

São Paulo

N = 1600

 

N = 1586

 

N = 1600

Primary

1347 (99.6)

6 (0.4)

0.001

1140 (84.7)

206 (15.3)

0.729

1293 (95.6)

60 (4.4)

0.622

Secondary

70 (97.2)

2 (2.8)

 

59 (84.3)

11 (15.7)

 

69 (95.8)

3 (4.2)

 

Higher/oth

170 (97.1)

5 (2.9)

 

140 (82.4)

30 (17.6)

 

170 (96.1)

5 (3.9)

 

Santiago

N = 1138

 

N = 1126

 

N = 1139

Primary

90 (100)

0 (0.0)

*

62 (68.9)

28 (31.1)

0.936

77 (85.6)

13 (14.4)

0.877

Secondary

143 (100)

0 (0.0)

 

96 (67.6)

46 (32.4)

 

125 (87.4)

18 (12.6)

 

Higher/oth

905 (100)

0 (0.0)

 

618 (69.1)

276 (31.9)

 

778 (85.9)

128 (14.1)

 

Havana

N = 1901

 

N = 1873

 

N = 1901

Yes

1793 (98.7)

23 (1.3)

0.001

1270 (70.8)

523 (29.2)

0.126

1782 (98.1)

34 (1.9)

0.751

No

80 (94.1)

5 (5.9)

 

63 (78.8)

17 (21.2)

 

83 (97.6)

2 (2.4)

 

Mexico City

N = 1553

 

N = 1415

 

N = 1554

Primary

1014 (92.1)

87 (7.9)

0.020

531 (52.5)

480 (47.5)

0.000

1033 (93.7)

69 (6.3)

0.276

Secondary

115 (95.0)

6 (5.0)

 

77 (67.0)

38 (33.0)

 

115 (95.0)

6 (5.0)

 

Higher/oth

291 (87.9)

40(22.1)

 

210 (72.7)

79 (27.3)

 

303 (91.5)

28 (8.5)

 

Montevideo

N = 1382

 

N = 1300

 

N = 1382

Primary

859 (96.5)

31 (3.5)

0.000

656 (76.7)

199 (23.3)

0.239

858

32 (3.6)

0.886

Secondary

221 (94.8)

12 (5.2)

 

177 (81.6)

40 (19.4)

 

224

9 (3.9)

 

Higher/oth

231 (89.2)

28(11.8)

 

172 (75.4)

56 (24.5)

 

248

11 (4.2)

 

*Santiago has 100% missing teeth for this variable unable to determine an association.

Havana has no education level variable, so “Did you attend school - yes/no” was used.

Table 4

Marital status and dentition for the SABE population

Row %

Are you missing any teeth?

Do you have bridges/dentures?

Unmet dental needs? N (%)

Marital status

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1459

 

N = 1402

 

N = 1462

Unmarried

292 (98.7)

4 (1.3)

0.373

186 (63.9)

105 (36.1)

0.368

284 (94.4)

17 (5.6)

 

Married

499 (97.7)

12 (2.3)

 

292 (59.8)

196 (40.2)

 

488 (95.1)

25 (4.9)

 

Widow/er

407 (99.3)

3 (0.7)

 

232 (58.1)

167 (41.9)

 

382 (93.2)

28 (6.8)

0.164

Separated

151 (98.1)

3 (1.9)

 

94 (63.9)

53 (36.1)

 

149 (96.1)

6 (3.9)

 

Divorced

81 (97.6)

2 (2.4)

 

42 (54.5)

35 (45.5)

 

74 (89.2)

9 (10.8)

 

Buenos Aires

N = 1025

 

N = 996

 

N = 1026

Unmarried

54 (94.7)

3 (5.3)

*

46 (82.1)

10 (17.9)

0.212

56 (98.2)

1 (1.8)

 

Married

432 (97.7)

10 (2.3)

 

315 (72.7)

118 (27.3)

 

426 (96.4)

16 (3.6)

 

Widow/er

42 (98.6)

6 (1.4)

 

313 (76.3)

97 (23.7)

 

413 (96.5)

15 (3.5)

0.886

Separated

88 (98.9)

1 (1.1)

 

60 (69.0)

27 (31.0)

 

85 (95.5)

4 (4.5)

 

Divorced

10 (100)

0 (0.0)

 

9 (90.0)

1 (10.0)

 

10 (100)

0 (0.0)

 

São Paulo

N = 2142

 

N = 2128

 

N = 2142

Unmarried

103 (100)

0 (0.0)

*

80 (77.7)

23 (22.7)

0.139

95 (92.2)

8 (7.8)

 

Married

1112 (99.2)

9 (0.8)

 

899 (80.9)

12 (19.1)

 

1082 (95.5)

39 (3.5)

 

Widow/er

757 (99.6)

3 (0.4)

 

626 (82.7)

131 (17.3)

 

728 (95.8)

32 (4.2)

0.035

Separated

135 (99.3)

1 (0.7)

 

101 (74.8)

34 (25.2)

 

132 (97.1)

4 (2.9)

 

Divorced

22 (100)

0 (0.0)

 

20 (90.9)

2 (19.1)

 

19 (86.4)

3 (13.6)

 

Santiago

N = 1284

 

N = 1266

 

N = 1286

Unmarried

94 (98.9)

1 (1.1)

*

56 (61.5)

35 (39.5)

0.013

85 (89.5)

10 (10.5)

 

Married

560 (100)

0 (0.0)

 

362 (65.3)

192 (34.7)

 

495 (88.4)

65 (11.6)

 

Widow/er

458 (100)

0 (0.0)

 

334 (73.7)

119 (26.3)

 

379 (82.4)

81 (17.6)

0.015

Separated

166 (100)

0 (0.0)

 

113 (69.3)

50 (31.7)

 

147 (88.6)

19 (11.4)

 

Divorced

5 (100)

0 (0.0)

 

5 (100)

0 (0.0)

 

3 (60.0)

2 (40.0)

 

Havana

N = 1902

 

N = 1874

 

N = 1902

Unmarried

61 (93.8)

4 (6.2)

*

31 (50.8)

30 (49.2)

0.001

64 (98.5)

1 (1.5)

 

Married

700 (98.5)

11 (1.5)

 

484 (69.1)

216 (30.9)

 

702 (98.7)

9 (1.3)

 

Widow/er

658 (98.9)

7 (1.1)

 

494 (75.1)

164 (24.9)

 

648 (97.4)

17 (2.6)

0.534

Separated

247 (99.6)

1 (0.4)

 

179 (72.5)

68 (27.5)

 

243 (98.0)

5 (2.0)

 

Divorced

208 (97.7)

5 (2.3)

 

145 (69.7)

63 (30.3)

 

209 (98.1)

4 (1.9)

 

Mexico City

N = 1868

 

N = 1712

 

N = 1871

Unmarried

89 (94.7)

5 (5.3)

0.002

52 (58.4)

37 (41.6)

0.063

92

2 (2.1)

 

Married

978 (91.1)

95 (8.9)

 

515 (52.9)

458 (47.1)

 

1010

64 (6.0

 

Widow/er

457 (94.0)

29 (6.0)

 

259 (56.6)

199 (44.4)

 

452

36 (7.4)

0.291

Separated

170 (92.9)

13 (7.1)

 

86 (51.2)

82 (48.8)

 

169

14 (7.7)

 

Divorced

24 (75.0)

8 (5.0)

 

19 (79.2)

5 (20.8)

 

29

3 (9.4)

 

Montevideo

N = 1444

 

N = 1360

 

N = 1444

Unmarried

49 (94.2)

3 (5.8)

0.288

28 (57.1)

21 (42.9)

0.000

49 (94.2)

3 (5.8)

 

Married

659 (93.7)

44 (6.2)

 

495 (75.8)

158 (24.2)

 

673 (95.7)

30 (4.3)

0.456

Widow/er

511 (96.4)

19 (3.6)

 

416 (82.1)

91 (17.9)

 

515 (97.2)

15 (2.8)

 

Separated

82 (96.5)

3 (3.5)

 

55 (67.9)

26 (32.1)

 

80 (94.1)

5 (5.9)

 

Divorced

70 (94.6)

4 (5.4)

 

57 (81.4)

13 (18.6)

 

70 (94.6)

4 (5.4)

 

*Buenos Aires, São Paulo, Santiago and Havana has many cells with N < 5 for this variable therefore unable to determine an association.

Table 5

Past occupation and dentition for the SABE population

Row %

Are you missing any teeth?

Do you have bridges/dentures?

Unmet dental needs? N (%)

Past occupation

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1404

 

N = 1348

 

N = 1407

Professionals

108 (54.3)

91 (45.7)

0.079

108 (54.3)

91 (45.7)

0.129

197 (93.8)

13 (6.2)

0.166

Office workers

371 (59.1)

257 (41.9)

 

371 (59.1)

257 (40.9)

 

622 (95.4)

30 (4.6)

 

Manual/unskill

325 (62.4)

196 (31.6)

 

325 (62.4)

196 (37.6)

 

506 (92.8)

39 (7.2)

 

Buenos Aires

N = 925

 

N = 898

 

N = 883

Professionals

129 (97.7)

3 (2.3)

0.810

99 (78.0)

28 (22.0)

0.345

84 (93.3)

6 (6.7)

0.288

Office workers

248 (98.4)

4 (1.6)

 

187 (74.8)

63 25.2)

 

243 (96.3)

9 (3.6)

 

Manual/unskill

533 (98.5)

8 (1.5)

 

375 (72.0)

146 (28.0)

 

525 (97.0)

16 (3.0)

 

São Paulo

N = 2000

 

N = 1986

 

N = 2000

Professionals

141 (97.2)

4 (2.8)

0.003

125 (88.7)

16 (11.3)

0.002

139 (95.9)

6 (4.1)

0.985

Office workers

535 (99.3)

4 (0.7)

 

409 (76.6)

125 (23.4)

 

517 (95.9)

22 (4.1)

 

Manual/unskill

1311 (99.6)

5 (0.4)

 

1075 (82.)

236 (18)

 

1260 (95.7)

56 (4.3)

 

Santiago

N = 1053

 

N = 1038

 

N = 1055

Professionals

77 (100)

0 (0.0)

*

58 (77.3)

17 (22.7)

0.211

67 (87.0)

10 (13.0)

0.700

Office workers

207 (100)

0 (0.0)

 

136 (67.3)

66 (32.7)

 

178 (85.2)

31 (14.8)

 

Manual/unskill

769 (100)

0 (0.0)

 

514 (67.5)

247 (32.5)

 

672 (87.4)

97 (12.6)

 

Havana

N = 1584

 

N = 1561

 

N = 1584

Professionals

266 (96.4)

10 (3.6)

0.003

180 (67.7)

86 (32.3)

0.538

274 (99.3)

2 (0.7)

0.160

Office workers

568 (99.3)

4 (0.7)

 

405 (71.3)

163 (28.7)

 

558 (97.6)

14 (2.4)

 

Manual/unskill

727 (98.8)

9 (1.2)

 

515 (70.8)

212 (29.2)

 

725 (98.5)

11 (1.5)

 

Mexico City

N = 1532

 

N = 1410

 

N = 1533

Professionals

113 (86.9)

17 (13.1)

0.035

85 (75.2)

28 (24.8)

0.000

119 (91.5)

11 (8.5)

0.323

Office workers

477 (93.7)

32 (6.3)

 

262 (55.3)

212 (44.7)

 

469 (92.1)

40 (7.9)

 

Manual/unskill

823 (92.2)

70 (7.8)

 

404 (49.1)

419 (50.9)

 

840 (94.0)

54 (6.0)

 

Montevideo

N = 1310

 

N = 1233

 

N = 1310

Professionals

183 (89.3)

22 (10.7)

0.000

140 (78.2)

39 (21.8)

0.019

196 (4.4)

9 (95.5)

0.470

Office workers

304 (96.5)

11 (3.5)

 

248 (81.8)

55 (18.2)

 

306 (2.9)

9 (97.1)

 

Manual/unskill

756 (95.7)

34 (4.3)

 

555 (73.9)

196 (26.1)

 

755 (4.4)

35 (95.5)

 

*Santiago has 100% missing teeth for this variable therefore no cell for a p value.

Table 6

Working status and dentition for the SABE population

Row %

Are you missing any teeth?

Do you have bridges/dentures?

Unmet dental needs? N (%)

Working status

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1409

 

N = 1353

 

N = 1412

Yes

247 (97.2)

7 (2.8)

0.191

138 (56.6)

106 (43.4)

0.255

243 (95.7)

11 (4.3)

0.267

No

137 (98.4)

18 (1.6)

 

671 (60.5)

438 (39.5)

 

1087 (93.9)

71 (6.1)

 

Buenos Aires

N = 929

 

N = 902

 

N = 929

Yes

246 (97.6)

6 (2.4)

0.258

186 (75.3)

61 (24.7)

0.508

239 (94.8)

13 (5.2)

0.138

No

668 (98.7)

9 (1.3)

 

479 (73.1)

176 (26.9)

 

656 (96.9)

21 (3.1)

 

São Paulo

N = 2004

 

N = 1990

 

N = 2004

Yes

432 (98.9)

5 (1.1)

0.145

344 (79.8)

87 (20.2)

0.476

422 (96.6)

15 (3.4)

0.371

No

1559 (99.5)

8 (0.5)

 

1268 (81.3)

291 (18.7)

 

1498 (95.6)

69 (4.4)

 

Santiago

    

N = 1188

Yes

313 (100)

0.0

*

191 (61.8)

118 (39.2)

0.007

274 (87.3)

40 (12.7)

0.659

No

873 (100)

0.0

 

604 (70.2)

257 (29.8)

 

754 (86.1)

120 (13.7)

 

Havana

N = 1905

 

N = 1807

 

N = 1905

Yes

346 (98.3)

6 (1.7)

0.685

236 (68.2)

110 (31.8)

0.185

346 (98.3)

6 (1.7)

0.777

No

1531 (98.6)

22 (1.4)

 

1099 (71.8)

432 (29.2)

 

1523 (98.1)

30 (1.9)

 

Mexico City

N = 1569

 

N = 1443

 

N = 1571

Yes

573 (88.7)

73 (11.3)

0.000

284 (49.6)

289 (51.4)

0.019

603

43 (6.7)

0.904

No

873 (94.6)

50 (5.4)

 

486 (55.9)

383 (44.1)

 

862

63 (6.8)

 

Montevideo

N = 1327

 

N = 1250

 

N = 1327

Yes

227 (91.9)

20 (8.1)

0.015

170 (75.2)

56 (24.8)

0.645

238

9 (3.6)

0.661

No

1023 (95.6)

47 (4.4)

 

785 (76.7)

239 (23.3)

 

1034

46 (4.3)

 
Table 7

Pension and dentition for the SABE population

Row %

Are you missing any teeth?

Do you have bridges/dentures?

Unmet dental needs? N (%)

Pension?

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

n = 1454

 

N = 1397

 

N = 1457

Yes

995 (99.0)

10 (1.0)

0.003

581 (60.1)

385 (39.9)

0.884

944 (93.7)

63 (6.3)

0.229

No

435 (96.9)

14 (3.1)

 

261 (60.6)

170 (30.4)

 

429 (95.3)

21 (4.7)

 

Buenos Aires

N = 1014

 

N = 902

 

N = 1014

Yes

668 (98.2)

12 (1.8)

0.710

186 (75.3)

61 (24.7)

0.508

657 (96.5)

24 (3.5)

0.949

No

326 (97.9)

7 (2.1)

 

479 (73.1)

126 (26.9)

 

321 (96.4)

12 (3.6)

 

São Paulo

N = 2135

 

N = 2121

 

N = 2135

Yes

1689 (99.4)

10 (0.6)

0.812

1373 (81.3)

316 (18.7)

0.727

1631 (96.0)

68 (4.0)

0.905

No

433 (99.3)

3 (0.7)

 

348 (80.6)

84 (19.4)

 

418 (95.9)

18 (4.1)

 

Santiago

N = 1297

 

N = 1279

 

N = 1299

Yes

1284 (100)

0 (0.0)

0.000

868 (68.5)

399 (61.5)

0.085

1107 (86.1)

179 (13.9)

0.879

D/K

12 (92.3)

1 (7.7)

 

11 (91.7)

1 98.3)

 

11 (84.6)

2 (15.4)

 

Havana

N = 1448

 

N = 1427

 

N = 1444

Yes No

1427 (98.5)

21 (1.5)

*

1015 (71.1)

412 (28.9)

*

1421 (98.1)

27 (1.9)

*

Mexico City

N = 1852

 

N = 1696

 

N = 1854

Yes

406 (93.1)

30 (6.9)

0.286

252 (62.5)

151 (37.5)

0.000

408 (93.6)

28 (6.4)

0.955

No

1296 (91.5)

120 (8.5)

 

667 (51.6)

626 (48.4)

 

1328 (93.7)

90 (6.3)

 

Montevideo

N = 1445

 

N = 1361

 

N = 1445

Yes

1108 (95.4)

54 (4.6)

0.155

859 (78.1)

241 (21.9)

0.117

1122 (96.6)

40 (3.4)

0.143

No

264 (93.3)

19 (6.7)

 

192 (73.6)

69 (26.4)

 

268 (94.7)

15 (5.3)

 

*Havana has 100% elderly persons receiving pension therefore no cell for a p value.

Table 8

Depression and Dentition for the SABE population

Row %

Are you missing any teeth? N (%)

Do you have bridges/dentures? N (%)

Unmet dental needs N (%)

Depression

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1474

 

N = 1445

 

N = 1508

No

1403 (98.3)

24 (1.7)

0.816

834 (60.4)

546 (39.6)

0.041

1358 (94.6)

81 (5.6)

0.571

Yes

46 (97.9)

1 (2.1)

 

31 (47.7)

34 (52.3)

 

64 (92.8)

5 (7.2)

 

Buenos Aires

N = 1027

 

N = 1013

 

N = 1043

No

916 (97.9)

20 (2.1)

0.159

673 (74.0)

236 (26.0)

0.833

903 (96.4)

34 (3.6)

0.352

Yes

91 (100)

0 (0.0)

 

76 (73.9)

28 (26.9)

 

104 (98.1)

2 (1.9)

 

São Paulo

N = 2143

 

N = 2129

 

N = 2143

No

1860 (99.4)

12 (0.6)

0.590

1503 (80.8)

356 (19.2)

0.495

1797 (96.0)

75 (4.0)

0.967

Yes

270 (99.6)

1 (0.4)

 

223 (82.6)

47 (17.4)

 

260 (95.9)

11 (4.1)

 

Santiago

N = 1299

 

N = 1281

 

N = 1301

No

1004 (99.1)

1 (0.1)

0.588

687 (69.5)

301 (30.5)

0.281

859 (85.3)

148 (14.7)

0.130

Yes

294 (100)

0 (0.0)

 

195(66.2)

99 (33.8)

 

261 (88.8)

33 (11.2)

 

Havana

N = 1905

 

N = 1877

 

N = 1905

No

1656 (98.6)

23 (1.4)

0.323

1185 (71.6)

471 (28.4)

0.256

1649 (98.2)

30 (1.8)

0.368

Yes

221 (97.8)

5 (2.2)

 

150 (67.9)

71 (32.1)

 

220 (97.3)

6 (2.7)

 

Mexico City

N = 1873

 

N = 1717

 

N = 1817

No

1377 (91.1)

135 (8.9)

0.003

784 (57.2)

587 (42.8)

0.000

1414 (93.3)

101 (6.7)

0.327

Yes

346 (95.8)

15 (4.2)

 

150 (43.4)

196 (56.6)

 

342 (94.7)

19 (5.3)

 

Montevideo

N = 1450

 

N = 1365

 

N = 1450

No

1229 (95.1)

64 (4.9)

0.445

949 (77.9)

269 (22.1)

0.112

1238 (95.7)

55 (4.3)

0.070

Yes

147 (93.6)

10 (6.4)

 

106 (72.1)

41 (27.9)

 

155 (98.7)

2 (1.3)

 
Table 9

Diabetes and Dentition for the SABE population

Row %

Are you missing any teeth?

Do you have bridges/dentures?

Unmet dental needs? N (%)

Diabetes

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1469

 

N = 1412

 

N = 1472

Yes

315 (99.10

3 (0.9)

0.237

191 (62.4)

115 (37.6)

0.401

291 (90.9)

29 (9.1)

 

No

1129 (98.1)

22 (1.9)

 

661 (59.8)

445 (40.2)

 

1096 (95.1)

56 (4.9)

0.004

Buenos Aires

N = 1023

 

N = 985

 

N = 1024

Yes

128 (98.5)

2 (1.5)

0.713

494 (75.0)

165 (25.0)

0.649

125 (96.2)

5 (3.8)

0.827

No

875 (98.0)

18 (2.0)

 

240 (73.6)

86 (26.4)

 

863 (96.5)

31 (3.5)

 

São Paulo

N = 2126

 

N = 2112

 

N = 2143

Yes

377 (99.2)

3 (0.6)

0.840

304 (80.6)

73 (19.4)

0.060

370 (97.4)

10 (2.6)

0.210

No

1736 (99.4)

10 (0.4)

 

1412 (81.4)

323 (18.6)

 

1670 (95.6)

76 (4.4)

 

Santiago

N = 1283

 

N = 1265

 

N = 1285

Yes

173 (100)

0 (0.0)

0.693

126 (72.8)

47 (27.2)

0.224

153 (88.4)

20 (11.6)

0.333

No

1109 (99.9)

1 (0.1)

 

745 (68.2)

347 (31.8)

 

953 (85.7)

159 (14.3)

 

Havana

N = 1903

 

N = 1876

 

N = 1899

Yes

288 (99.3)

2 (0.7)

0.254

226 (78.5)

62 (21.5)

0.003

280 (96.6)

10 (3.4)

0.315

No

1588 (98.5)

25 (1.5)

 

1109 (69.8)

479 (30.2)

 

1587 (98.4)

126 (1.6)

 

Mexico City

N = 1862

 

N = 1708

 

N = 1864

Yes

347 (93.5)

24 (6.5)

0.224

171 (49.7)

173 (50.3)

0.045

346 (93.0)

26 (7.0)

0.628

No

1366 (91.6)

125 (8.4)

 

760 (55.7)

604 (44.3)

 

1398 (93.7)

94 (6.3)

 

Montevideo

N = 1445

 

N = 1360

 

N = 1445

Yes

175 (93.1)

13 (6.9)

0.232

134 (77.0)

40 (23.0)

0.888

182 (96.8)

6 (3.2)

0.569

No

1196 (95.1)

61 (4.9)

 

919 (77.5)

267 (22.5)

 

1206 (95.9)

51 (4.1)

 
Table 10

Self-reported overall health and dentition for the SABE population

Row %

Are you missing any teeth?

Do you have bridges/dentures?

Unmet dental needs? N (%)

Self reported health

Yes

No

pvalue

Yes

No

pvalue

Yes

No

pvalue

Bridgetown

N = 1474

 

N = 1445

 

N = 1508

Excellent

56 (98.2)

1 (1.8)

0.218

33 (60.0)

22 (40.0)

0.391

57 (98.3)

1 (1.7)

0.368

Very good

163 (98.8)

2 (1.2)

 

89 (56.0)

70 (44.0)

 

164 (94.8)

9 (5.2)

 

Good

501 (97.3)

14 (2.7)

 

289 (57.5)

214 (42.5)

 

496 (94.3)

30 (5.7)

 

Fair

648 (98.8)

8 (1.2)

 

405 (62.3)

245 (37.7)

 

626 (93.4)

44 (6.6)

 

Bad

81 (100)

0 (0.0)

 

49 (62.8)

29 (37.2)

 

79 (97.5)

2 (2.5)

 

Buenos Aires

N = 995

 

N = 982

 

N = 1042

Excellent

44 (97.8)

1 (2.2)

0.301

30 (71.4)

12 (28.6)

0.800

43 (93.5)

3 (6.5)

0.271

Very good

148 (100)

0 (0.0)

 

104 (73.2)

38 (26.8)

 

144 (97.3)

4 (2.7)

 

Good

447 (97.6)

11 (2.4)

 

334 (74.4)

115 (25.6)

 

447 (96.3)

17 (3.7)

 

Fair

284 (97.3)

8 (2.7)

 

220 (73.8)

78 (26.2)

 

294 (97.7)

7 (2.3)

 

Bad

52 (100)

0 (0.0)

 

35 (68.6)

16 (31.4)

 

50 (96.2)

2 (3.8)

 

São Paulo

N = 2143

 

N = 2129

 

N = 2143

Excellent

90 (96.8)

3 (3.2)

0.001

79 (87.8)

11 (12.2)

0.171

90 (96.8)

3 (3.2)

0.927

Very good

128 (97.7)

3 (2.3)

 

107 (83.6)

21 (16.4)

 

125 (95.4)

6 (4.6)

 

Good

730 (99.6)

3 (0.4)

 

596 (81.8)

133 (18.2)

 

702 (95.8)

31 (4.2)

 

Fair

983 (99.7)

3 (0.3)

 

792 (80.6)

191 (19.4)

 

946 (95.9)

40 (4.1)

 

Bad

199 (99.5)

1 (0.5)

 

152 (76.4)

47 (23.6)

 

194 (97.0)

6 (3.0)

 

Santiago

N = 1299

 

N = 1281

 

N =1301

Excellent

27 (100)

0 (0.0)

0.661

14 (51.9)

13 (48.1)

0.038

22 (81.5)

5 (18.5)

0.885

Very good

53 (100)

0 (0.0)

 

38 (77.6)

11 (22.3)

 

46 (86.8)

7 (13.2)

 

Good

380 (99.7)

1 (0.3)

 

239 (64.6)

131 (35.4)

 

332 (87.1)

49 (12.9)

 

Fair

559 (100)

0 (0.0)

 

397 (71.4)

159 (28.6)

 

483 (86.1)

78 (13.9)

 

Bad

279 (100)

0 (0.00

 

103 (69.2)

86 (30.8)

 

237 (84.9)

42 (15.1)

 

Havana

N = 1905

 

N = 1877

 

N = 1905

Proxy

170 (96.6)

6 (3.4)

0.293

109 (64.1)

61 (32.9)

0.009

174 (98.9)

2 (1.1)

0.090

Excellent

33 (100)

0 (0.0)

 

19 (57.6)

14 (42.4)

 

32 (97.0)

1 (3.0)

 

Very good

57 (100)

0 (0.0)

 

41 (71.9)

16 (28.1)

 

57 (100)

0 (0.0)

 

Good

547 (98.7)

7 (1.3)

 

388 (70.9)

159 (29.1)

 

548 (98.9)

6 (1.1)

 

Fair

850 (98.6)

12 (1.4)

 

634 (74.6)

216 (25.4)

 

844 (97.9)

18 (2.1)

 

Bad

220 (98.7)

3 (1.3)

 

144 (65.5)

76 (34.5)

 

214 (96.0)

9 (4.0)

 

Mexico City

N =1868

 

N =1713

 

N = 1871

Excellent

42 (89.4)

5 (10.6)

0.000

33 (78.6)

9 (21.4)

0.002

43 (91.7)

4 (8.3)

0.728

Very good

67 (83.8)

13 (16.2)

 

43 (64.2)

24 (35.8)

 

77 (96.2)

3 (3.8)

 

Good

395 (89.2)

48 (10.8)

 

228 (57.7)

167 (42.3)

 

415 993.7)

28 (6.3)

 

Fair

900 (92.7)

71 (7.3)

 

466 (52.0)

431 (48.0)

 

907 (93.1)

67 (6.9)

 

Bad

314 (96.0)

13 (4.0)

 

163 (52.2)

149 (47.8)

 

309 (94.5)

18 (5.5)

 

Montevideo

N = 1450

 

N = 1365

 

N = 1450

Excellent

84 (84.8)

15 (15.2)

0.000

71 (84.5)

12 (15.5)

0.068

96

3 (3.0)

0.626

Very good

143 (89.9)

16 (10.1)

 

105 (75.5)

36 (24.5)

 

152

7 (4.4)

 

Good

663 (96.10

26 (3.9)

 

495 (78.6)

135 (21.4)

 

631

28 (4.2)

 

Fair

426 (97.3)

12 (2.7)

 

324 (76.6)

99 (23.4)

 

420

18 (4.1)

 

Bad

90 (94.7)

5 (5.3)

 

60 (68.2)

28 (31.8)

 

94

1 (1.1)

 

Socio-demographics (Age, education, marital status, occupational status) and prevalence of missing teeth

Across the SABE cities 2.5% of the population aged 60 years and above reported no missing teeth. A notable exception was the 60-65 years age groups in Mexico City and Montevideo where 8-11% reported having complete dentition. Bridgetown, São Paulo and Mexico City demonstrated a statistically significant association between aging and tooth loss. In all cities except Havana (M:F = 1.01:1), a greater proportion of females (97.6%) reported tooth loss compared with males (96.8%). In only São Paulo and Montevideo was there a statistically significant association between sex and tooth loss.

Generally those with higher education reported less tooth loss, among those with primary education, 97.6% reported tooth loss, secondary (96.8%) and tertiary (94.7%). All the SABE cities except Buenos Aires demonstrated a statistically significant association between tooth loss and education.

Greater proportions of manual and unskilled (92.5%), service workers and office employees (92.3%) reported having missing teeth compared with professionals (88.8%). São Paulo, Havana, Mexico City and Montevideo all demonstrated a statistically significant association between tooth loss and past employment. Across all SABE cities, among those with missing teeth, there were higher proportions currently not working (97.9%) than currently working (96.1%). Whilst among those with no missing teeth, there were more persons working (3.9%) than not (2.1%). This achieved statistical significance in Mexico City and Montevideo. Across the entire SABE population, among those with missing teeth, greater proportions were receiving a pension (97.5%) than not (95.2%); and among those with no missing teeth, greater proportions were not receiving a pension (4.8%) than those who were receiving a pension (2.5%). This achieved statistical significance in Bridgetown.

Throughout the SABE cities, all the categories of marital status report tooth loss range from 75% - 100%. With an average of 98.1%, Havana and Mexico City demonstrated a significant statistical association between tooth loss and marital status.

Health conditions (depression and diabetes), self-reported overall health and prevalence of missing teeth

For all SABE cities except Montevideo, among those with missing teeth there were greater levels of depression (average 11.2%) compared with those not missing teeth (average 6.5%). This achieved statistical significance in Mexico City.

For all SABE cities except São Paulo and Montevideo, among those with missing teeth there were greater levels of diabetes (average = 16.5%) compared with those not missing teeth (average = 12.3%). This did not achieve statistical significance in any of the SABE cities.

Among those with missing teeth, 0.3% (Mexico City) to 6% (Montevideo) reported ‘Excellent’ health, with an average of 3.5% across 6 cities (excluding Havana which had different descriptors on the Likert scale). Among those with no missing teeth, between 0% (Montevideo) and 23.1% (São Paulo) reported ‘Excellent’ health, with an average of 9.3%. The association between ‘self-reported’ overall health and missing teeth achieved statistical significance for São Paulo, Mexico City and Montevideo.

Socio-demographics and reporting bridges or dentures

Of those with missing teeth, between 55.1% (Mexico City) and 82.4% (São Paulo) reported having bridges or dentures, with an average of 70.1%.

São Paulo, Santiago and Havana all demonstrated a statistically significant association between aging and reporting the use of dentures or bridges. On average more females (73.4%) have bridges and dentures than males (62.7%), except in Bridgetown where it is the reverse. São Paulo, Santiago, Havana, Mexico City and Montevideo all demonstrated a statistically significant association between sex and reporting the use of dentures or bridges. The proportions of those with bridges/dentures was distributed on average equally among those with lower (70.1%) versus those with higher educational achievement (72.1%) across all SABE cities except in Mexico City. Here there was a statistically significant association between educational achievement and reporting the use of bridges or dentures.

Santiago, Havana and Montevideo all demonstrated a statistically significant association between marital status and reporting the use of dentures or bridges.

Generally larger proportions of professionals (74.2%) reported bridges or dentures compared with office or manual and unskilled workers (68.9%). In São Paulo, Mexico City and Montevideo there was a statistically significant association between occupation and reporting the use of bridges or dentures. Among those reporting using bridges or dentures there were no consistent pattern of current employment, except in Santiago and Mexico City. In these 2 cities there was a statistically significant association with greater proportions of those wearing dentures ‘not currently working’.

In 4 of the SABE cities among those reporting having bridges or dentures there were higher proportions receiving pensions. Only in Mexico City was there a statistically significant association.

Health conditions and reporting bridges or dentures

In the SABE cities among those with missing teeth and reported wearing bridges or dentures 12.3% were ascertained to be depressed compared with 15.7% among those not wearing bridges or dentures. In Bridgetown and Mexico City this association achieved statistical significance.

Among the elderly with missing teeth and reporting use of bridges and dentures the proportion with diabetes was 17.9%, compared with those without bridges and dentures, diabetes was present in 20.7%. In Havana and Mexico City there was a statistically significant association among those wearing bridges and dentures and the presence of diabetes.

Self-reported overall health

Among the SABE cities there was a consistent pattern of self-reported overall health and whether the respondents used bridges or dentures. In Santiago, Havana and Mexico City this achieved a statistically significant association.

Socio-demographics and unmet oral health needs

The proportion of the SABE population with ‘unmet dental needs’ ranged from 85.8% (Santiago) to 98.4% (Havana), with an average of 94.5%. There were no statistically significant associations between unmet dental needs and age, sex, past occupation, education achievement, working status, or pension status. There were no statistically significant associations between marital status and unmet dental needs except in São Paulo and Santiago.

Health conditions and unmet dental needs

There were no statistically significant associations between unmet dental needs and depression or self-reported health in any of the SABE cities. Similarly, there were no statistically significant associations between unmet dental needs and diabetes except for Bridgetown where more of those without diabetes have unmet dental needs. Regression analysis was conducted for each SABE city to determine which independent variables predicted having an ‘Unmet dental need’. There were no such independent variables identified except in Bridgetown where the ‘absence of diabetes’ predicted having an Unmet dental need. See Table 11.
Table 11

Results of logistic regression to determine the independent variables associated with Unmet Oral health needs in the SABE population for Bridgetown

Bridgetown

B

S.E.

Wald

df

95% CI

     

Lower

Upper

Age

.204

.247

.680

1

-.281

.689

Sex

-.399

.255

2.452

1

-.899

.100

Marital status

.195

.302

.418

1

-.397

.788

Education level

-.068

.316

.047

1

-.688

.552

Past occupation

.230

.352

.427

1

-.460

.920

Current working status

-.237

.369

.412

1

-.961

.487

Pension

.250

.279

.803

1

-.297

.797

Depression

.270

.478

.318

1

-.667

1.207

Diabetes

.583

.254

5.267

1

.085

1.081

Self-reported overall health

-12.307

.729

284.816

1

-13.736

-10.877

Constant

-15.598

.563

767.698

1

-16.701

-14.494

Discussion

There has been a wealth of information arising from the SABE dataset, [10,12] but this paper is the first to describe the oral health of the population. Across the SABE population, in 1999-2000, 97.5% reported missing teeth, and of those with missing teeth, an average of 70.1% reported having bridges or dentures. Further, 94.5% were determined to have ‘unmet dental needs’, expressing difficulties with chewing, oral pain, speech and appearance, among other issues. Further analysis revealed associations with the presence of missing teeth and educational achievement or past employment across many, but not all the SABE cities.

Social determinants of missing teeth

Education and Past occupation

Generally in this study those with higher education and those self-reporting their occupation as professionals reported less tooth loss. Those with a primary and secondary education had more tooth loss versus those with a tertiary education. All the SABE cities except Buenos Aires demonstrated a statistically significant association between tooth loss and education. Similarly, the manual and unskilled, service workers and office employees generally reported having more missing teeth compared with professionals. São Paulo, Havana, Mexico City and Montevideo all demonstrated a statistically significant association between tooth loss and past employment. This association with education is consistent with reports from the United States (US). In the National Health and Nutrition Examination Survey (NHANES) study, 23% of those with 0-8 years of education reported pain in biting or chewing compared with 10% of those with 13 or more years of education [15].

Other surveys of dental disease in the Americas

Successive surveys of seniors over the age of 65 years in the US has shown that overall, the prevalence of tooth loss in seniors has decreased from the 1970 until the 2000s [16]. A more recent paper from 2005-8 reported that in this population 19.9% had untreated dental caries and almost 23% of were edentulous [17]. The data from this paper cannot be compared with these results however as different oral parameters were measured. In Latin America, a 2012 report of Decayed, Missing, Filled Teeth (DMFT) index showed a mean DMFT of 21.57 in the 65–74 years group [18]. Factors related to tooth loss in the 65–74 year-old group were education level <12 years (OR 2.54) and personal income (OR 1.66). This current paper has similar findings with respect to education. Two other South American countries have carried out national surveys including an oral examination in adults: Colombia [19] with a DMFT of 19.6 in the “older than 55” group and Brazil with a mean DMFT of 27.8 for the 65–74-year-old group in 2003 and a DMFT of 27.5 for the 65–74 years adults in 2010 [20]. However both these report DMFT, which cannot be compared directly with these results. Nevertheless they suggest, as does this paper, high levels of caries prevalence in the elderly.

Depression and dentition

Depression has been well linked to dentition [21]. In Santiago, this association was found for the 35-44 age group but not the 65-74 year olds [18]. Similarly, in this current paper, no association was found except in Mexico City where those with missing teeth had twice the rate of depression than those with no missing teeth (8.9% vs. 4.2%, p < 0.003). In general, there were more depressed among those not wearing dentures (15.7%) than among those wearing dentures (12.3%).

This provides interesting areas for debate, including whether many of those elderly with missing teeth are generally less accepting of their loss and have higher rates of depression; and whether those without bridges and dentures, either had no access to care or cannot afford the services and have the resultant increased depression rates. These are areas for future study.

Diabetes and oral health

Recent research have widened our understanding of the relationship between oral health and diabetes [22,23]. For example, periodontal disease has been shown to be is a strong predictor of mortality from ischemic heart disease (IHD) and diabetic nephropathy among Pima Indians with type 2 diabetes (T2DM) [24]. Also individuals with poorly controlled diabetes mellitus had a significantly higher prevalence of severe periodontitis than those without diabetes [25]. Tooth loss is considered the end point for untreated periodontal disease. The prevalence of periodontal disease is increasing in most aging societies suggesting it is a public health problem [26]. One study from Germany reported that the association between T2DM and tooth loss was statistically significant only for females [27]. In this current paper we studied the relationship between the presence of diabetes and oral health. We could demonstrate no relationship between those with diabetes and those reporting missing teeth. In 5 of the 7 SABE cities we could not demonstrate a relationship between diabetes and those reporting the use of bridges or dentures, the two exceptions being Havana and Mexico City. In both these cities those with diabetes made up about 17% of the users of bridges and dentures.

Pension systems in SABE cities and relationship with oral health

Across the entire SABE population, among those with missing teeth, greater proportions were receiving a pension than not. The question for future study is whether those with less missing teeth are more educated and more healthy and therefore continue to work. Further, are they less likely to be receiving a pension, more engaged in life, and are subsequently less depressed? The findings of this paper appears to suggest that this is the case. The pension systems across the SABE cities are varied but generally universal with pensions available between age 60-65 years [28].

Limitations

There are several limitations to this study, for example, data used in the SABE study is self-reported and not actual clinical examinations. This makes the comparison of this 1999-2000 data impossible with the 3 reported surveys of the DMFT index from Latin America. The SABE surveys were conducted in urban cities, whilst the more recent Latin American surveys report using nationally representative samples. This data was also collected fourteen years ago. Therefore, one can question how comparable or generalizable is it today. Nevertheless, the information does provide a baseline for other LAC cities and countries which have not conducted any subsequent surveys.

Additionally, the SABE study used self-perceived oral health which reflects people’s subjective and objective assessments of their oral health, and is highly associated with perceptions of treatment need and subsequent demand for dental services [11]. Future studies in these populations should use an oral examination to confirm participants’ perceptions.

What’s next

This paper provides baselines which future studies can re-assess for change. These include the very high levels of missing teeth among all age intervals of those over 60 years, the high levels of unmet dental needs and the relatively high proportion of those requiring dental prostheses. The very high levels of ‘unmet dental needs’ across all the SABE cities is telling and future studies should evaluate how well this construct remains elevated as new dental interventions are introduced. There are also opportunities for extensive comparison of DMFT data across more LAC countries, with a focus on the elderly. As we saw above these are now available for 3 Latin American countries. This can assist in evaluating the different dental care models in LAC. Notably, the free health system of Havana did not particularly stand out as exemplary. Throughout the LAC there has been an epidemic of NCDs with diabetes being at the forefront. The evidence suggests that better periodontal care assists in better diabetes control [23]. In this study we could not demonstrate a link between diabetes and missing teeth. Future research in the LAC should investigate the cost-effectiveness of improving dental services to assist in combating the diabetes epidemic.

Conclusions

The results of this secondary analysis illustrates that in 1999-2000, there was a high prevalence of missing teeth, bridge and dentures use and poorly met dental needs among the elderly in the 7 SABE cities of Latin America and the Caribbean.

In general across the SABE cities, the larger proportion of elderly reporting missing teeth were less educated or less likely to be a professional. They were also currently not working and were receiving a pension. Finally they were less likely to report their health as ‘excellent’, were diabetic and were more likely to give responses suggestive of depression.

Abbreviations

DMFT: 

Decayed, Missing, Filled Teeth index

GDS: 

Geriatric Depression Scale

GOHAI: 

Geriatric Oral Health Assessment Index

IHD: 

Ischemic heart disease

LAC: 

Latin American and Caribbean

MPH: 

Master of Public Health

NHANES: 

National Health and Nutrition Examination Survey

NCD: 

Non-communicable disease

OR: 

Odds Ratio

PAHO: 

Pan American Health Organisation (PAHO)

QoL: 

Quality of life

SABE: 

Survey of Health and Well-Being of Elders

SPSS: 

Statistical Package for the Social Sciences

T2DM: 

Type 2 diabetes

US: 

United States

WHO: 

World Health Organization

Declarations

Acknowledgements

This paper acknowledges with appreciation the work of the SABE researchers who designed and implemented the original study. The paper received no external funding.

Authors’ Affiliations

(1)
The University of the West Indies
(2)
Unit of Public Health and Primary Care, The Faculty of Medical Sciences, The University of the West Indies
(3)
Community Dentistry, The Faculty of Medical Sciences, The University of the West Indies

References

  1. 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. WHO/NMH/NPH/ORH/03.2. [http://www.who.int/bulletin/volumes/83/9/infocus0905/en/index.html]
  2. Jackson R, Strauss R, Howe N. Latin America’s Ageing Challenge: Demographics and Retirement Policy in Brazil, Chile, and Mexico. Global Aging Initiative Center For Strategic And International Studies. 2009. [http://csis.org/files/media/csis/pubs/090324_gai_english.pdf]
  3. Brennan DS, Spencer AJ, Roberts-Thomson KF. Tooth loss, chewing ability and quality of life. Qual Life Res. 2008;17(2):227–35.View ArticlePubMedGoogle Scholar
  4. Johansson V, Axtelius B, Söderfeldt B, Sampogna F, Paulander J, Sondell K. Multivariate analyses of patient financial systems and oral health-related quality of life. Community Dent Oral Epidemiol. 2010;38(5):436–44.View ArticlePubMedGoogle Scholar
  5. Saintrain MV, de Souza EH. Impact of tooth loss on the quality of life. Gerodontology. 2012;29(2):632–6.View ArticleGoogle Scholar
  6. World Health Organization. Oral health in aging societies. Integration of oral health nd general health. Geneva: WHO; 2006.Google Scholar
  7. Braine T. More oral health care needed for ageing populations. Bull World Health Organ. 2005;83(9):641–720.Google Scholar
  8. Petersen PE, Kandelman D, Arpin S, Ogawa H. Global oral health of older people–call for public health action. Community Dent Health. 2010;27(4 Suppl 2):257–67.PubMedGoogle Scholar
  9. Hugo FN, Hilgert JB, de Sousa ML, Cury JA. Oral status and its association with general quality of life in older independent-living south-Brazilians. Community Dent Oral Epidemiol. 2009;37(3):231–40.View ArticlePubMedGoogle Scholar
  10. Pelaez M, Palloni A, Albala C, Alfonso JC, Ham-Chande R, Hennis A, et al. SABE - Survey on Health, Well-Being, and Aging in Latin America and the Caribbean. 2000. National Archive of Computerized Data on Aging. [http://www.icpsr.umich.edu/icpsrweb/NACDA/studies/3546?archive=NACDA&q=SABE]
  11. Schützhold S, Holtfreter B, Schiffer U, Hoffman T, Kocher T, Micheelis W. Clinical factors and self-perceived oral health. Eur J Oral Sci. 2014;122:134–41.View ArticlePubMedGoogle Scholar
  12. Palloni A, Mceniry M, Wong R, Pelaez M. The Elderly in Latin America and the Caribbean. Revista Galega de Economía. 2005;14(1–2):1–33.Google Scholar
  13. Atchison KA, Dolan TA. Development on the Geriatric Oral Health Assessment Index. J Dent Educ. 1990;54(11):680–6.PubMedGoogle Scholar
  14. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression rating scale: a preliminary report. J Psych Res. 1983;17:27.Google Scholar
  15. Vargas CM, Kramarow EA, Yellowitz JA. The oral health of older Americans. Centers for Disease Control and Prevention. 2001. [http://www.cdc.gov/nchs/data/ahcd/agingtrends/03oral.pdf]
  16. NIH. Tooth Loss in Seniors (Age 65 and Over). [http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/ToothLoss/ToothLossSeniors65andOlder.htm]
  17. Dye BA, Li X, Beltrán-Aguilar ED. Selected Oral Health Indicators in the United States, 2005–2008. [http://www.cdc.gov/nchs/data/databriefs/db96.pdf]
  18. Urzua C, Mendoza UC, Arteaga O, Rodríguez G, Cabello R, Faleiros S, et al. Dental Caries Prevalence and Tooth Loss in Chilean Adult Population: First National Dental Examination Survey. International Journal of Dentistry. [http://dx.doi.org/10.1155/2012/810170]
  19. Ministerio de Salud de Colombia. II Estudio de Salud Bucal-ENSAB III y II Estudio nacional de factores de riesgo de enfermedades cronicas-ENFREC II. Bogotá-Colombia, 1999. (Oral Health Study II - III and II ENSAB national study of risk factors for chronic diseases - ENFREC II . Bogota, Colombia , 1999.) [http://www.visitaodontologica.co/ARCHIVOS/ARCHIVOS-NORMAS/Salud%20Publica_P_y_P/II_ESTUDIO_NACIONAL_SALUD_BUCAL.pdf]
  20. Ministério da Saúde Brasil Departamento de Atenção Básica, Coordenação Geral de Saúde Bucal. Projeto SB Brasil 2010. Pesquisa nacional de Saúde Bucal-Resultados Principais. Brasilia 2012. (National Survey of Oral Health - Main Results. Brasilia. 2012. [http://bvsms.saude.gov.br/bvs/publicacoes/pesquisa_nacional_saude_bucal.pdf]
  21. Science Daily. International & American Associations for Dental Research. Tooth loss linked to depression, anxiety. [www.sciencedaily.com/releases/2014/03/140320111903.htm]
  22. Čuković-Bajić I, Verzak Ž, Car N, Car A. Tooth loss among Diabetic patients. Diabetologica Croatica. 2004;33:23–7.Google Scholar
  23. Teeuw WJ, Gerdes VE, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):421–7.View ArticlePubMedPubMed CentralGoogle Scholar
  24. Saremi A, Nelson RG, Tulloch-Reid M, Hanson RL, Sievers ML, Taylor GW, et al. Periodontal disease and mortality in type 2 diabetes. Diabetes Care. 2005;28(1):27–32.View ArticlePubMedGoogle Scholar
  25. Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol. 2002;30(3):182–92.View ArticlePubMedGoogle Scholar
  26. Hughes F. Periodontitis – The new caries. Br Dent J. 2014;217:387.View ArticlePubMedGoogle Scholar
  27. Kaur G, Holtfreter B, Rathmann WG, Schwahn C, Wallaschofski H, Schipf S, et al. Association between type 1 and type 2 diabetes with periodontal disease and tooth loss. J Clin Periodontol. 2009;36(9):765–74.View ArticlePubMedGoogle Scholar
  28. Crabbe C. A Quarter Century of Pension Reform in Latin America and the Caribbean. Washington D.C., IDB, 2005. Available from: [http://publications.iadb.org/handle/11319/314?locale-attribute=en]

Copyright

© Singh et al.; licensee BioMed Central. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement