| کلیدواژههای انگلیسی مقاله |
Oral health status, DMF index, Risk factors, IntroductionOral health is a crucial component of public health [ 1, ] that is directly related to people&apos,s health [ 2, - 3, ]. It affects many personal activities such as eating, talking, social communication and quality of life, to the extent that the World Health Organization has identified oral health as one of the most prevalent and important public health problems [ 4, ], Oral health includes a wide range of oral diseases, one of which happens to be tooth decay [ 5, ]. Tooth decay is a major public health concern [ 6, - 7, ] affecting people of all ages, genders, races and economic and social classes [ 2, ]. According to the World Health Organization, approximately 3.5 billion people, 35.5% of the total population, have permanent tooth decay [ 8, ]. Furthermore, about 30% of people aged 65 to 74, worldwide, do not have any healthy teeth [ 4, ]. The prevalence of tooth decay is also high in Iran. The findings of a national study conducted between 2001 and 2002 in Iran showed that the average tooth decay in 18-year-olds was 3.4 and in 35-45-year-olds it was 11 times higher than that of everyone else [ 4, ].Tooth decay occurs when pathogenic bacteria has covered the tooth surface [ 6, ]. Although reversible in the early stages, it progresses slowly and destroys hard tooth tissue if left untreated [ 9, ]. This can even lead to tooth loss, which in turn causes malfunction and social discomfort to people affected [ 10, ]. Tooth decay is a multifactorial disease [ 7, ], which mostly depends on eating habits such as sugar intake and individual behaviors [ 3, ]. In several studies conducted around the world, various factors have been identified in the prevalence of tooth decay, including, gender [ 11, ], age [ 12, ], level of education brushing [ 4, ], smoking [ 13, ], environmental factors [ 14, ] and economic and social class [ 11, ].The most important indicator used to assess oral health status is the DMF index [ 4, ], which is recommended by the World Health Organization to determine and compare the rate of tooth decay in a population [ 15, ]. This index shows the number of decayed, missing and filled teeth and is used to evaluate and control oral health interventions, design policies, and implement interventional programs. Most epidemiological studies in this regard focus on children [ 6, ], thus adults have received less attention [ 4, ]. Nonetheless, evaluating adults&,rsquo oral health status is essential for planning and performing appropriate interventions for the development of oral health policies. Therefore, this study aimed to evaluate the oral health status in adults residing in Kharameh city of Fars province.Materials and MethodThe present study is a cross-sectional descriptive-analytical study conducted using baseline data from the Kharameh cohort study (Fars province-Iran) yielded from 8911 individuals aged from 40 to 70 years old in 2020. Kharameh population-based cohort study is a part of the Persian Cohort study in Iran, which aims to investigate the risk factors for non-communicable diseases in their subjects. After obtaining consent from individuals, questionnaires were administered by trained health-care staff during face-to-face interviews. All demographic information, disease status, economic and social status and lifestyle and behavioral factors were collected during the interviews, following a clinical examinations and anthropometric measurements performed for all subjects. Other details of cohort studies can be seen in other publications [ 16, ].The information required for this study included demographic information such as age, sex, body mass index, level of education, place of residence, smoking habits, economic and social status and diabetes history. In addition, other required data included the information on oral health, including number of decayed teeth, number of missing teeth, number of filled teeth and number of times that brushing, flossing and mouthwash was employed during the day.Moreover, the socio-economic status of households was calculated using the principle component analysis method. The resulting asset index was subsequently divided into 5 categories (poorest - poorer - medium level - richer - richest). To calculate this index, variables related to people&apos,s owned properties were used. These variables included the type of residential ownership (owned or rented), area of residential (in square meters), number of rooms, ownership of landline telephone, washing machine, dishwasher, Flat-screen TV, refrigerator, vacuum cleaner, personal computer/laptop, access to the Internet at home, access to bathroom and toilet and finally car ownership status and its price. To assess the oral health status of the subjects the DMF index was used. This index was calculated based on the results of examining the condition of the teeth in terms of the number of decayed, filled and missing teeth. Oral and dental examinations were performed by trained dentists on field, using a probe, mirror and cotton rolls, in order to score each participant using the DMF index. Finally, frequency and standard deviation were used to describe quantitative variables, and frequency or frequency percentage was used for qualitative variables. After examining the normality of variables, if normal, t-test was used to examine the difference between mean DMF indices between two groups, and if not normal, Mann-Whitney test was used. Furthermore, to evaluate the difference between the mean DMF indices in more than three groups, ANOVA statistical test was applied for normal data and if not normal, Cross-Wallis test was used. To detect differences in between groups, Bonferroni test has been used. Additionally, in order to identify the factors affecting the increase in DMF index, simple and multiple linear regression was applied. Significance level was considered less than 0.05 for all tests and all analyses were performed using the STATA version 13 software.ResultsThe present study was performed on 8911 individuals aged between 40 to 70 years old from the Persian Kharameh cohort study. 43.3% of the subjects were male and 56.6% were female. 46% of people were in the age group of 40 to 50 years old, 34.4%, 50 to 60 years old and 19.5%, 60 to 70 years old. 65.3% of subjects did not use a toothbrush only 28.2% brushed once a day, 5.8% twice a day, and 2.3% of people brushed three times a day. Further demographic and oral health information of the subjects are shown in Table 1,.VariableLevelN%Age40-5041034651-60307034.461-70173819.5SexMale386643.3Female504556.6EducationIlliterate437249Primary234926.3Secondary100911.3High-school6367.14University5456.12Smoking habitsNo688477.2Yes202722.7ResidenceUrban319535.8Rural571664.1BMIUnder weight2873.22Normal308234.6Over weight382042.88Obese171919.3SESPoorest168218.8Poor175219.6Middle176519.8Richer181620.3Richest189621.3Diabetes HistoryNo766886.05Yes124313.9Mouthwash UseNo882999.08Yes820.92Brushing HabitsOnce/Day251928.2Twice/Day5205.8Three times/Day2092.3None566365.3FlossingNo831493.3Yes5976.7Table 1.Demographic characteristics and oral health information of adults aged 40 to 70 years old living in Kharameh cityBased on the results of this study, the mean and standard deviation (SD) DMF in all subjects was 18.06&,plusmn 8.7 and the mean (SD) number of decayed, missing, and filled teeth was 5.9&,plusmn 5.6, 10.7&,plusmn 7.5, and 2.7&,plusmn 1.3 respectively. The results of independent t test and Mann-Whitney test in evaluating the difference between the mean DMF at the levels of two-state qualitative variables showed that there was a statistically significant difference in the mean DMF between women and men (p&,lt 0.0001), smokers and non-smokers (p&,lt 0.0001), urban and rural populations (p&,lt 0.0001), as well as between subjects who floss and those who do not (p&,lt 0.0001). However, at different levels of mouthwash use, no statistically significant difference was observed in DMF index numbers (Table 2,).VariableLevelDecayedMissingFilledDMFp ValueMean &,plusmn S.D*,Mean &,plusmn S.D*,Mean &,plusmn S.D*,Mean &,plusmn S.D*,Age40-506.1&,plusmn 5.710.3&,plusmn 7.31.4&,plusmn 2.817.9&,plusmn 8.70.351-605.9&,plusmn 5.511.08&,plusmn 7.61.2&,plusmn 2.618.2&,plusmn 8.861-705.6&,plusmn 5.410.8&,plusmn 7.61.4 &,plusmn 2.817.9&,plusmn 8.6SexMale6.8&,plusmn 6.211.1&,plusmn 7.81.1&,plusmn 2.619.2&,plusmn 9.20.0001Female5.3&,plusmn 5.110.3&,plusmn 7.21.4&,plusmn 2.817.1&,plusmn 8.2EducationIlliterate6.4&,plusmn 5.612.2&,plusmn 7.60.5&,plusmn 1.719.2&,plusmn 8.60.0001Primary5.9&,plusmn 5.69.9&,plusmn 7.11.4&,plusmn 2.717.3&,plusmn 8.6Secondary5.7&,plusmn 5.89.4&,plusmn 7.092.1&,plusmn 3.217.3&,plusmn 8.9High-school5.4&,plusmn 5.68.7&,plusmn 6.82.7&,plusmn 3.516.9&,plusmn 8.6University3.2&,plusmn 4.36.31&,plusmn 5.64.3&,plusmn 4.113.6&,plusmn 7.6Smoking habitsNo5.5&,plusmn 5.39.9&,plusmn 7.11.5&,plusmn 2.917.01&,plusmn 8.40.0001Yes7.5&,plusmn 6.413.2&,plusmn 8.030.81&,plusmn 2.221.6&,plusmn 8.8ResidenceUrban5.7&,plusmn 5.710.5&,plusmn 7.082.4&,plusmn 3.618.7&,plusmn 8.30.0001Rural6.1&,plusmn 5.510.8&,plusmn 7.70.72&,plusmn 1.917.6&,plusmn 8.9BMIUnder weight7.8&,plusmn 6.514.5&,plusmn 8.90.4&,plusmn 2.522.7&,plusmn 8.90.0001Normal6.6&,plusmn 5.911.8&,plusmn 7.91.08&,plusmn 2.519.5&,plusmn 8.8Over weight5.5&,plusmn 5.410.02&,plusmn 7.11.5&,plusmn 3.0117.1&,plusmn 8.5Obese5.4&,plusmn 5.29.5&,plusmn 6.71.4&,plusmn 2.716.4&,plusmn 8.2SESPoorest7.07&,plusmn 5.811.8&,plusmn 7.80.2&,plusmn 0.919.4&,plusmn 8.80.0001Poor6.3&,plusmn 5.511.9&,plusmn 7.70.5&,plusmn 1.618.8&,plusmn 8.8Middle6.1&,plusmn 5.610.9&,plusmn 7.50.08&,plusmn 2.0917.9&,plusmn 8.7Richer5.8&,plusmn 5.710.1&,plusmn 7.11.7&,plusmn 2.917.6&,plusmn 8.6Richest4.6&,plusmn 5.38.8&,plusmn 6.83.1&,plusmn 3.816.7&,plusmn 6.3Diabetes HistoryNo5.9&,plusmn 5.610.5&,plusmn 7.51.3&,plusmn 2.717.8&,plusmn 8.70.0001Yes6.3&,plusmn 5.911.5&,plusmn 7.51.3&,plusmn 2.719.2&,plusmn 8.4Mouthwash UseNo5.9&,plusmn 5.610.7&,plusmn 7.111.3&,plusmn 2.718&,plusmn 8.70.13Yes5.9&,plusmn 5.48.5&,plusmn 6.12&,plusmn 3.616.6&,plusmn 8Brushing HabitsOnce/day4.8&,plusmn 58.5&,plusmn 6.52.2&,plusmn 3.315.2&,plusmn 7.90.0001Twice/Day6.4&,plusmn 6.19&,plusmn 6.81.9&,plusmn 3.317.5&,plusmn 8.5Three times/Day5.9&,plusmn 5.79.7&,plusmn 6.92&,plusmn 3.417.6&,plusmn 8.3None6.4&,plusmn 5.811.8&,plusmn 7.70.8&,plusmn 2.319.2&,plusmn 8.8FlossingNo6&,plusmn 5.610.9&,plusmn 7.51.2&,plusmn 2.618.2&,plusmn 8.70.0001Yes5&,plusmn 54.9&,plusmn 6.73.2&,plusmn 3.915.1&,plusmn 7.7*S.D, Standard Deviation Value, T-test and Mann-Whitney for two-state qualitative variables, Anova and Kruskal-Wallis for qualitative variables with more than two-states |