A community-based oral public health approach to promote health equity

Objectives: The objectives are: (1) to explore the interrelationships among diabetes, hypertension, and missing teeth among underserved racial/ethnic minority elders; and (2) to assess whether or not an ordinal logit model that utilizes ordered response categories for missing teeth is more informative and interpretable, as compared to a binary logit model with edentulism as the outcome.

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 northern Manhattan, New York. Oral health examinations were conducted by trained dentists and measurements of hemoglobin A1c and blood pressure were obtained by trained staff in partnering prevention centers for ElderSmile participants who agreed to be screened.

Results: Neither self-reported diabetes nor self-reported hypertension alone was an important predictor of edentulism or more missing teeth in any of the models examined. Nonetheless, 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 three domains--dentistry, medicine, and public health—may prove useful in place-based assessment and delivery of services to older adults. An ordinal logit model that utilizes ordered response categories for missing teeth may be informative and interpretable, as compared to models that utilize only binary responses or are intended for outcomes with normal distributions.