Oral health, food avoidance, and dietary quality in a multi-ethnic population of older rural adults

Older and minority rural adults experience oral health disparities relative to other populations. This paper presents data from a population-based survey of oral health among adults 60 years and older living in a multi-ethnic community. A random sample of 635 stratified by gender and ethnicity (African American, American Indian, white) was recruited from two rural counties (screening rate 99%, response rate 74%). Respondents completed in-home interviews and oral examinations documenting oral health status, food avoidance due to oral health problems, and usual dietary intake. Dietary intake data were used to calculate Health Eating Index—2005 scores (HEI-2005). 43% had < 8 years of education, 32% had incomes < poverty level, and only 10% had dental insurance. Oral health status was poor: 47% were edentulous, 49% had a history of periodontal disease, and 45% rated their oral health as fair or poor. After adjusting for age, gender, ethnicity, poverty, and education, oral health deficits were strongly associated with number of foods avoided. Food avoidance was associated with HEI-2005 total score and HEI components. Those avoiding fewer foods consumed more total fruits, total vegetables, dark green vegetables, and meat and beans. They consumed lower saturated fat and less solid fat, alcohol, and added sugars. Food avoidance explains associations between oral health deficits and dietary intake in this population. Oral health promotion among older adults may be necessary to improve dietary quality, and nutrition education is needed to address the avoidance of key foods among those with impaired oral health.