4th National Oral Health Survey Research Articles

Decomposing socioeconomic inequalities in dental caries among Chinese adults: findings from the 4th national oral health survey

ObjectiveThis cross-sectional study aimed to investigate socioeconomic inequalities in dental caries among adults (35 years and older) in China and explore the contributions of various factors to these inequalities.MethodsThis study included 10,983 adults (3,674 aged 35–44 years, 3,769 aged 55–64 years and 3,540 aged 65–74 years) who participated in the 4th National Oral Health Survey (2015–2016) in China. Dental caries status was evaluated by the decayed, missing and filled teeth (DMFT) index. Concentration indices (CIs) were applied to quantify the different degrees of socioeconomic-related inequality in DMFT, decayed teeth with crown or root caries (DT), missing teeth due to caries or other reasons (MT), and filled teeth without any primary or secondary caries (FT) among adults of different age groups. Decomposition analyses were conducted to identify the determinants and their associations with inequalities in DMFT.ResultsThe significant negative CI indicated that DMFT for the total sample were concentrated among socioeconomically disadvantaged adults (CI = − 0.06; 95% confidence interval [CI], − 0.073 to − 0.047). The CIs for DMFT for adults aged 55–64 and 65–74 years were − 0.038 (95% CI, − 0.057 to − 0.018) and − 0.039 (95% CI, − 0.056 to − 0.023), respectively, while the CI for DMFT for adults aged 35–44 years was not statistically significant (CI = − 0.002; 95% CI, − 0.022 to 0.018). The concentration indices of DT were negative and concentrated in disadvantaged populations, while FT showed pro-rich inequalities in all age groups. Decomposition analyses showed that age, education level, toothbrushing frequency, income and type of insurance contributed substantially to socioeconomic inequalities, accounting for 47.9%, 29.9%, 24.5%,19.1%, and 15.3%, respectively.ConclusionDental caries was disproportionately concentrated among socioeconomically disadvantaged adults in China. The results of these decomposition analyses are informative for policy-makers attempting to develop targeted health policy recommendations to reduce dental caries inequalities in China.

Porphyromonas gingivalis-Derived Lipopolysaccharide Promotes Glioma Cell Proliferation and Migration via Activating Akt Signaling Pathways.

Periodontitis is significantly associated with the risk of cancers in the lung and the digestive system. Emerging evidence shows a plausible link between periodontitis and several types of brain diseases. However, the association between periodontal infection and glioma remains unclear. In the cultured GL261 glioma cells, P. gingivalis lipopolysaccharide (LPS) significantly promoted cell proliferation at concentrations ranging from 10 to 1000 ng/mL. It promoted cell migration at a higher concentration (100 and 1000 ng/mL). Additionally, exposure to 100 ng/mL P. gingivalis LPS induced a significant increase in the expression of TNF-α, TGF-β, MMP2, and MMP9, as well as the phosphorylation level of Akt at Ser473. These changes induced by P. gingivalis LPS were significantly antagonized by the Akt inhibitor. Furthermore, a total of 48 patients with brain tumors were enrolled to investigate their periodontal status before receiving tumor management. Poor periodontal status [probing depth (PD) ≥ 6 mm and attachment loss (AL) >5 mm] was found in 42.9% (9/21) of patients with glioma, which was significantly higher than that in patients with benign tumors and the relevant data in the 4th National Oral Health Survey in China. The glioma patients with both AL > 5 mm and PD ≥ 6 mm had a higher ki-67 labeling index than those with AL ≤ 5 mm or PD < 6 mm. These findings support the association between periodontal infection and glioma progression.

Health behaviors and tooth retention among older adults in China: findings from the 4th Chinese national oral health survey

BackgroundThis study aimed to examine the association between oral health behaviors and tooth retention among Chinese older adults.MethodsData were used from the 4th Chinese National Oral Health Survey, a nationally representative sample. The sample included 9054 older adults aged 55 to 74. Control variables and oral health behaviors were measured through a questionnaire interview, and the number of remaining teeth and periodontal health were obtained from an oral health examination. A chi-square test was used for univariate analysis. Multivariate Logistic regression was used to explore the association between health behaviors and the number of remaining teeth.ResultsThe average number of remaining teeth in the sample was 24.4 ± 7.7. There was a higher proportion of older adults living in urban areas with 20 or more teeth than those living in rural areas (83.2% vs. 79.4%, P < 0.001); and a higher proportion of individuals with high education levels with 20 or more teeth compared to those with low education levels (P < 0.001). Logistic regression models showed that older adults who used toothpicks `(OR = 3.37, 95% CI 2.94–3.85), dental floss (OR = 1.93, 95% CI 1.05–3.53), toothpaste (OR = 3.89, 95% CI 3.14–4.83); and never smoked (OR = 1.43 95% CI 1.20–1.70) were more likely to retain 20 or more natural teeth; whereas older adults who had a dental visit were less likely to retain 20 or more natural teeth (OR = 0.45, 95% CI 0.39–052).ConclusionGood oral hygiene practices, never smoking, and regular dental visits focusing on prevention are significantly associated with teeth retention. It is critical to promote a healthy lifestyle and improve prevention-oriented oral health care systems.

Determining the factors associated with oral health-related quality of life in Chinese elders: Findings from the fourth national survey.

The purpose of this study was to assess the associations between the self-reported oral health-related quality of life (OHRQoL) of older Chinese people and their socio-economic status and oral health using data collected in the 4th National Oral Health Survey. After multistage stratified cluster sampling, 4332 adults aged 65-74years participated in the study. After a clinical examination, the participants completed a structured questionnaire. A Mandarin version of the General Oral Health Assessment Index (GOHAI) was included in the questionnaire. Clinical examinations were carried out using the criteria recommended by the World Health Organization. Multivariate analysis was used to evaluate the associations of the clinical and socio-demographic variables with the GOHAI scores of the participants. The weighted mean (SE) GOHAI score was 51.6 (0.0). Female sex and having more than 10 missing teeth, unrestored tooth spaces, more than 10 decayed teeth and a periodontal pocket ≥6mm were negatively associated with the GOHAI score, while having a higher education level and living in the Eastern region of China were positively associated with the GOHAI score. After adjustment for confounders, the OHRQoL of older Chinese individuals was mainly affected by untreated dental caries and the loss of teeth. Older Chinese individuals who were male, had a higher education level, were from the Eastern region, had no unrestored tooth spaces or deep periodontal pockets and had fewer decayed or missing teeth had higher GOHAI scores, indicating better OHRQoL.

Associated Factors of Oral Health-related Quality of Life in Chinese Adolescents Aged 12-15 Years.

Students aged 12 to 15 years were recruited using to a multistage stratified random sampling method. All the subjects received oral examination and completed a questionnaire. Information relating to OHRQoL was collected through a Mandarin version of the child oral impacts on daily performances (Child-OIDP) questionnaire. The relationship between the Child-OIDP scores and independent variables was assessed using a Mann-Whitney U-test, Kruskal-Wallis test and a multivariate Poisson regression. A total of 89,582 subjects were included in the analysis, of whom 76.6% reported oral impacts in the last 6 months. Eating was the most affected daily performance. The results of the regression analysis showed that factors associated with adolescents' OHRQoL included sex, location of residence, region, only child status, parents' level of education, frequency of sugar consumption, self-perception of general/oral health, dental appointments in the past 12 months, oral health knowledge status, age, decayed, missing and filled teeth (DMFT) index and number of teeth with gingival bleeding. Oral impacts were common among Chinese adolescents, although most were not so severe. Eating was the most commonly affected performance. Sex, location of residence, region, only child status, parents' level of education, frequency of sugar consumption, selfperception of general/oral health status, dental appointments in the previous 12 months, oral health knowledge status, age, DMFT index and number of teeth with gingival bleeding were found to be associated with OHRQoL.

The relationship between different types of caries and periodontal disease severity in middle-aged and elderly people: findings from the 4th National Oral Health Survey of China

BackgroundThe relationship between dental caries and periodontal disease is still controversial. The objective of this study was to explore the relationship between different types of caries and periodontal disease severity in middle-aged and elderly people in China.MethodsThe study population consisted of 4407 middle-aged and 4117 elderly subjects. Caries were divided into the following three types: type A, crown caries; type B, lesions involving both the crown and root, representing mixed-type caries; and type C, root caries. These three types together represent the overall caries situation, which we call type ABC. Caries were quantitated by decayed and filled teeth (DFT index). Periodontitis was evaluated by clinical attachment loss.ResultsMiddle-aged people with periodontitis had a significant association with DFT type B (OR: 1.21, 95% CI 1.17–1.25) and type C (OR: 1.40, 95% CI 1.24–1.56). Elderly people with periodontitis had a significant association with DFT type C (OR: 1.28, 95% CI 1.21–1.35).ConclusionsIn China, caries types B/C were positively correlated with periodontitis in the middle-aged group, and only caries type C was positively correlated with periodontitis in the elderly group.

Association of siblings\u2019 presence and oral health-related quality of life among children: a cross-sectional study

BackgroundThe quantity–quality trade-off theory indicates that an increase in siblings might decrease a child’s well-being, but little is known about the impacts of sibling number on children’s oral health-related quality of life (OHRQoL). This study aims to investigate the effects of presence of siblings on children’s OHRQoL, and to further test whether there is an interaction effect between siblings’ presence and locations on children’s OHRQoL.MethodsData were obtained from an oral-health survey of 12-year-old children in Beijing, China, which was a part of the 4th National Oral Health Survey in the Mainland of China (2015–2016). This study included 2158 children data for analysis. OHRQoL was assessed by the child’s Oral Impacts on Daily Performance (OIDP). OIDP prevalence served as an indicator of OHRQoL. Children with and without siblings were recorded as non-single and single children, respectively. Dental variables, including active caries, gingival bleeding, and calculus, were reported. A logistic regression model was applied to investigate the association of siblings’ presence and OIDP prevalence. A synergy index was used to assess the possible interaction effect between siblings’ presence and location on OIDP prevalence.ResultsSixty percent of Chinese children reported suffering OIDP in the previous six months. OIDP prevalence for non-single and single children were 68.3% and 56.9%, respectively. The adjusted odds ratio (OR) of OIDP for non-single children was 1.31 (95% CI: 1.05, 1.63), and the adjusted OR of OIDP for non-single and rural children was 2.03 (95% CI: 1.47, 2.81). The synergy index between siblings’ presence and location on OIDP was 2.18 (85% CI: 1.30, 3.67), which indicates that an excessive risk increase for OIDP was observed among non-single and rural children.ConclusionsChildren with siblings are more likely to report OIDP and have lower OHRQoL, especially those from rural areas. These findings indicate that oral-health interventions should be given priority for non-single and rural children.

Analysis of dental caries and the impact factors of caries in children aged 3-5 years old in Changdu, Xizang.

To investigate caries status and its impact factors in preschool children in plateau and to provide reference for caries prevention in highlands. Examination of caries was performed on 1 597 children aged 3-5 years old in 11 kindergartens in Changdu, Xizang, in accordance with the 4th National Oral Health Survey standards and methods. Their parents were surveyed with the questionnaire regarding oral hygiene habit and consciousness about oral health and related factors. All the data were collected and analyzed. The prevalence of caries among children aged 3-5 years old in Changdu was 52.85%, with dmft index of 2.44. The caries rate and dmft of children aged 3 years old were lower than those of children aged 4 and 5 years old (P<0.05). No significant difference was observed in the caries rate between males and females (P>0.05). Single-factor analysis showed that the frequency of brushing teeth more than twice a day, low frequency of eating sweets, high frequency of drinking butter tea, and regular oral examination can reduce the rate of caries (P<0.05). Multivariate logistic analysis showed that the frequency of eating sweets, drinking butter tea, and oral examination are related impact factors of caries. The prevalence of ca-ries in children aged 3-5 years old in Changdu increases with aging. Good oral hygiene and eating habits and regular oral examination can reduce the rate of caries.

Association and socioeconomic status and caries among Chinese preschool children: A cross-sectional national study

Objectives: To assess the association between child caries status and socioeconomic status (SES) in China. Methods: Data from the 4th National Oral Health Survey of China, which was done in 2015. The sampling process was conducted by a multistage stratified cluster method, comprising of 40,360 children aged 3-5 years. Caries indicators included untreated caries, dental pain and dmft (number of decayed, missing and filled teeth). SES was measured by parental education level and household income. The bivariate association between the participants’ characteristics and dmft was analyzed using non-parametric tests, while the untreated caries and dental pain were analyzed using Pearson’s chi-square tests. Negative binomial regression and Poisson regression models were used to analyze association between SES and oral health by regulating confounders. Results: There were significant associations between SES and all oral health indicators (p<0.05). And the trends of oral health for different SES remained significant. The prevalence of untreated caries, dental pain and dmft of children from the lowest parental education were 1.19, 1.10 and 1.19 times higher than those from the highest parental education. And the prevalence of untreated caries, dental pain and dmft of children from the lowest household income families were 1.12, 1.11 and 1.24 times higher than those from the highest household income families. Conclusions: There were consistently wide socioeconomic inequalities in child oral health in China, posing challenges for designing public health strategies and social policies.

Tooth Retention and Health Behaviors: Findings From the 4th Chinese National Oral Health Survey

This study aimed to investigate the association between tooth retention and health behaviors among Chinese older adults. Data was used from the Chinese 4th National Oral Health Survey, a national representative sample. The sample included 9054 older adults age 55-74. The control variables included age, gender, residence, region, education level, occupation, periodontal health, self-reported oral health, and self-reported general health. Logistic regression models shows that older adults who used tooth picks (OR=3.37, 95% CI: 2.94-3.85), dental floss (OR=1.93, 95%CI: 1.05-3.53), and toothpaste (OR=3.89, 95%CI: 3.14-4.83), and never smoked (OR=1.43 95%CI: 1.20-1.70) were more likely to retain more than 20 natural teeth; while having dental visit had the opposite association (OR = 0.45, 95% CI: 0.39-052). Unexpectedly, this study did not find frequency of toothbrushing was associated with tooth retention. This study suggest that improving oral hygiene and preventive dental care are key for good oral health. .

Socioeconomic Status, Health Behaviors, and Oral Health of Older Adults In China

Many Chinese older adults suffer from oral health diseases and problems due to low oral health literacy, limited dental coverage and lack of dental care services for this segment of the population in China. However, so few studies have been conducted to examine social and behavior factors related to oral health among Chinese older adults. This symposium examines how socioeconomic status (SES) and health behaviors are associated with oral health among Chinese older adults. The first paper used the Nanjing Centenarians Study to examine the association between health behaviors and oral health among Chinese centenarians. The results showed that health behaviors were associated with self-rated oral health and edentulism. Using the Chinese Longitudinal Healthy Longevity Survey, the second one employed an ‘after death’ approach to examine risk factors for orofacial pain symptoms at the end of life among Chinese older adults. The third paper investigated the association between SES and tooth loss among middle-aged and older adults in ten cities of China. SES played a stronger role in tooth retention for non-migrants and migrants with high education vs those migrants with low education. The last paper examined the association between health behaviors and retention of teeth among Chinese older adults using data from the Chinese 4th National Oral health Survey. This symposium provides empirical evidence on the current status of oral health and health behaviors at the national level, and also suggests that is critical to improve oral health education and access to dental care.

The prevalence and severity of periodontal disease in Mainland China: Data from the Fourth National Oral Health Survey (2015–2016)

To evaluate periodontal conditions in adults in mainland China based on data from the 4th National Oral Health Survey. Data of adult subjects (35- to 44-year-old group [N=4409], 55- to 64-year-old group [N=4622], and 65- to 74-year-old group [N=4428]) were analysed. Demographic, socio-economic, personal habit, dental history, and health attitude data were obtained using a questionnaire. Periodontal condition was assessed using the standardized case definitions of the 2018 classification scheme. A multivariate analysis was performed to investigate the relationship between periodontitis severity and age, smoking status, gender, and region using generalized additive models after adjusting for confounders. The frequency of subjects with periodontitis was 52.8%, 69.3%, and 64.6% in the three age groups, respectively. The frequency of subjects with severe periodontitis (stage III or IV) was 10.6%, 37.3%, and 43.5% in the three age groups, respectively. The severity of periodontal disease was positively associated with age. Current and former smokers exhibited significantly greater disease severity than non-smokers after adjustment for confounders. No significant difference of severity was found between males and females. Within the limitations of the study, the prevalence of periodontitis is very high among adults in mainland China. Periodontal status is associated with age and smoking status.

Measuring and decomposing socioeconomic-related inequality in the use of oral health services among Chinese adults.

This study aimed to measure socioeconomic-related inequality and horizontal inequity in the use of oral health services and decompose this inequality among adults of different age groups in China. In total, 10973 adults (3669 aged 35-44years, 3767 aged 55-64years and 3537 aged 65-74years) who participated in the 4th National Oral Health Survey (2015-2016) in China were included. Concentration curves and the Erreygers-corrected concentration index (EI) were employed to measure socioeconomic-related inequality in the use of oral health services. Then, inequity in this utilization was measured by the horizontal inequity index (HI). Furthermore, decomposition analyses were conducted for the three groups to explain the contributions of income level, need factors (ie self-assessed oral health and evaluated oral health status), other factors (ie sex, residential location, educational attainment level and type of basic insurance) and a residual term to overall inequality in oral health service utilization. The significant positive EI and HI values indicated that pro-rich inequality and inequity in oral health service utilization exist among Chinese adults. Income and type of basic medical insurance contributed the most to socioeconomic-related inequality in the use of oral health services among adults aged 55-64 and 65-74years. However, the main driving factors of socioeconomic inequality among adults aged 35-44years in dental care use included income, educational achievement, type of basic medical insurance and residential location. The need variables accounted for a very small proportion of overall socioeconomic-related inequality in oral health service use in all three groups. Oral healthcare service utilization was disproportionately concentrated among better-off Chinese adults. The primary determinants of inequality in dental care use in different age groups provide information for policymakers to create more targeted policies to achieve equity in the oral healthcare system in China.

Assessment of risk factors for early childhood caries at different ages in Shandong, China and reflections on oral health education: a cross-sectional study

BackgroundThe high prevalence of early childhood caries (ECC) is widespread around the world, and oral health education (OHE) plays a vital role in preventing ECC. Numerous studies on ECC risk factor assessment have assisted us in enriching the content of OHE. The objective of this study was to further assess independent risk factors for ECC at different ages to provide evidence and insights for OHE.MethodsChildren aged 3–5 years old (N = 1301) in Shandong Province were enrolled in this cross-sectional study. Data about oral health status and caregivers’ oral health knowledge, attitude, and practice (KAP) were extracted from the 4th National Oral Health Survey of China. The associations between ECC prevalence and various KAP variables were tested with chi-square tests, bivariate analysis and multivariable logistic regression analyses.ResultsThe ECC prevalence in Shandong Province was 64.6%, and the dmft mean was 3.15. The independent variables with an increased risk for ECC were age, feeding method within 6 months of birth, bedtime sugar frequency, experience of toothache over the past year and dental visits (P < 0.05, chi-square tests). Complete breastfeeding within 6 months of birth primarily contributed to the high ECC risk of the 3-year-old group (OR: 3.39, 95% CI: 1.41–8.17), while high frequency bedtime sweet consumption mainly contributed to that of the 5-year-old group (OR: 3.22, 95% CI: 1.03–10.06; logistic regression analysis). Tooth brushing was not associated with ECC in this study, and some positive knowledge and attitude variables were positively correlated with a high risk of ECC.ConclusionThese data provide evidence to suggest that the ECC-related risk factors at different ages are inconsistent, which provides some insights for OHE. We should highlight the effects of feeding methods in the early stages of deciduous dentition and sugar habits in the late stages of deciduous dentition on ECC, as well as encourage preventive dental visit and supplemental training for oral health practices.

Prevalence and associated factors of periodontal conditions among 55- to 74-year-old adults in China: results from the 4th National Oral Health Survey.

The purpose of this study was to assess periodontal health conditions among 55- to 74-year-old Chinese people and to analyze the factors associated with periodontal diseases. In total, 9054 subjects aged 55-74years were enrolled from all 31 provinces using a stratified multistage probability sampling method, autonomous regions and municipalities of the Chinese mainland, the response rate was 86.9%. All subjects underwent clinical examinations on the severest site for every tooth and completed a questionnaire that collected information on their sociodemographic characteristics and oral habits. T tests, chi-square tests and binary logistic regression analysis were performed to analyze the data. The percentage of people without bleeding on probing, probing depth ≥ 4mm and attachment loss > 3mm was 5.0 and 9.3% in the 55- to 64-year-old and the 65- to 74-year-old age group. The prevalence of bleeding on probing was 88.4% among 55 to 64years old and 82.6% among 65 to 74years old. Mean number of teeth with bleeding on probing were 13.87 among 55 to 64years old and 11.25 among 65 to 74years old. The prevalence of probing depth ≥ 4mm and attachment loss > 3mm were 69.3 and 69.9% in people aged 55-64years and were 64.6 and 74.2% in people aged 65-74years. Mean number of teeth with probing depth = 4-5mm and probing depth ≥ 6mm were 4.48 and 0.36 in 55-64 age group and 3.70 and 0.33 in 65-74 age group. And mean number of teeth with attachment loss > 3mm were 5.17 among 55 to 64 years old and 5.63 among 65 to 74 years old. Besides, attachment loss > 3mm was associated with age, gender, smoking, toothbrushing frequency and toothpick use. Periodontitis was not highly prevalent among 55- to 74-year-old Chinese adults. Age, gender, smoking, toothbrushing frequency and toothpick use could be risk factors. Scientific rationale for the study: The periodontal conditions among 55 to 64 and 65 to 74years old Chinese population were not highly serious, but prevalence of bleeding on probing, periodontal pockets and attachment loss should be drawn enough attention by relevant public health administrations. The prevalence of periodontal diseases was evaluated in 55- to 64-year-old and 65- to 74-year-old subjects in a nationally representative Chinese sample population. The prevalence of probing depth ≥ 4mm and AL > 3mm were high; these values were 69.3% and 69.9%, respectively, in the 55-64 age group and 64.6% and 74.2%, respectively, in the 65-74 age group. In addition, case percentage of AL = 4-5mm combined with PD < 6mm were 23.1 and 19.4% among 55- to 64-year-old and 65- to 74-year-old people. And case percentage of AL>5mm combined with PD ≥ 6mm were 11.1% and 12.1% among 55- to 64-year-old and 65- to 74-year-old people, respectively. The present study provides a reference for the epidemiological analysis of periodontal diseases. To reduce widespread inadequate treatment of periodontal diseases, clinical management should be performed in dental practices. Furthermore, oral health recommendations should be made at multiple levels.

Factors associated with oral health service utilization among adults and older adults in China, 2015-2016.

To explore the factors associated with utilization of oral health services among Chinese adults and older adults according to the Andersen Behavior Model. Data from the 4th National Oral Health Survey (2015-2016) in China were used. A total of 7206 people (3669 adults aged 35-44years and 3537 older adults aged 65-74years) were included in our analysis. Oral health service utilization in the past 12months was the outcome variable. Explanatory variables were selected according to the Andersen Behavior Model. Descriptive statistics and bivariate associations (chi-square tests) were analysed, followed by hierarchical Poisson regression models, which were conducted to determine the factors associated with oral health service utilization. In total, 21.4% (95% CI: 19.4%-23.7%) of adults (35-44years old) and 20.7% (95% CI: 18.6%-22.9%) of older adults (65-74years old) utilized oral health services in the past 12months. Nearly 80% of adults (78.7%, 95% CI: 74.0%-82.7%) and more than 90% of older adults (93.7%, 95% CI: 91.0%-95.6%) visited a dentist for treatment. Adults aged 35-44years old who were female (IRR: 1.15, 95% CI: 1.00-1.33, P=.047), had good oral health knowledge and attitudes (IRR: 1.30, 95% CI: 1.06-1.59, P=.011), perceived their oral health status as fair (IRR:1.51, 95% CI:1.24-1.85, P<.001) or poor/very poor (IRR:2.52, 95% CI:2.01-3.18, P<.001) and had a decayed, missing and filled teeth (DMFT) index >0 (IRR: 1.52, 95% CI: 1.11-2.09, P=.009) were more likely to report dental visits in the past 12months. Older adults who utilized oral health services tended to be female (IRR: 1.32, 95% CI: 1.09-1.59, P=.004); to be covered by Urban Resident Basic Medical Insurance (URBMI) (IRR: 1.56, 95% CI: 1.18-2.05, P=.002), Urban Employee Basic Medical Insurance (UEBMI) (IRR: 1.69, 95% CI: 1.32-2.16, P<.001) or government medical insurance (GMI) (IRR: 1.03, 95% CI:1.01-2.16, P=.044); to have a high education level (IRR: 1.37, 95% CI: 1.08-1.74, P=.010); to have an income level in the 2nd tertile (IRR: 1.44, 95% CI: 1.13-1.84, P=.003) or 3rd tertile (IRR:1.52, 95% CI:1.18-1.95, P=.001); and to perceive their oral health status as poor or very poor (IRR: 1.53, 95% CI: 1.21-1.95, P=.001). Sex and self-perceived oral health status were associated with oral health utilization among Chinese population. Additionally, for older adults, education level, household income and insurance coverage were determinants of dental service use. These findings can aid in creating more targeted policies to increase the use of dental services by Chinese adults.

Factors Impacting the Oral Health-related Quality of Life in Chinese Adults: Results from the 4th National Oral Health Survey.

To explore the clinical and socio-demographic factors influencing oral health-related quality of life (OHRQoL) of Chinese adults in the 4th National Oral Health Survey. Multistage stratified cluster sampling and PPS method were used in sampling and 4720 adults aged 35 to 44 years were recruited. The study subjects completed a structured questionnaire in an interview and underwent a clinical examination. The questionnaire was a Putonghua version of the General Oral Health Assessment Index (GOHAI) and was completed by the interviewer on the site of the 4th National Oral Health Survey. Clinical examination was performed using the criteria recommended by the World Health Organization (WHO). The mean GOHAI score of the subjects was 54.42 (SD 6.01). Result of Poisson regression showed that subjects with a higher household income per capita, had lower DMFT, fewer missing teeth, had no unrepaired missing teeth, or not wearing a partial denture had higher GOHAI scores indicating better OHRQoL. The OHRQoL of the adults in China was fair and was mainly influenced by dental caries, integrity of dentition and restoration of lost teeth. With limited resources and dental manpower in China, higher priority should be given to the prevention and treatment of the main cause leading to losing teeth.

Permanent Teeth Caries Status of 12- to 15-year-olds in China: Findings from the 4th National Oral Health Survey.

To investigate the dental caries status of teenagers in China by means of analysing national data from the 4th National Oral Health Survey of China. Data for 12- to 15-year-olds participated in the 4th National Oral Health Survey of China were used for statistical analysis. Children who were recruited in the survey completed a dental examination and filled in a questionnaire. Social demographic factors, oral hygiene behaviours, sugar consumption habits, status of dental service utilisation, and pit-and-fissure sealant history were compared between adolescents with caries experiences and those without. For decayed, missing and filled permanent teeth (DMFT) and each of its components, mean values were statistically tested to see if significance existed between or among different categories of all involved variables. In total, data from 27,821, 30,961, 30,691 and 29,128 Chinese 12-, 13-, 14-, and 15-year-olds respectively, were analysed. Social demographic factors, sugar consumption and dental service utilisation showed statistical significance when compared between those with and without dental caries experience in the 12- and 15-year-old groups. Certain categories of these factors above also had important influence on the mean value of the number of decayed teeth (DT), filled teeth (FT) and DMFT, and they might be potential determinants of dental caries experience of permanent teeth for teenagers. Dental caries in 12- and 15-year-old Chinese adolescents was impacted by certain social demographic and dental behavioural factors, which could provide some implications for policy makers and dental public health professionals when attempting to enhance oral health status for those teenagers in the early stages of permanent dentition.

Dental Caries in Chinese Elderly People: Findings from the 4th National Oral Health Survey.

To investigate the dental caries status and related factors in Chinese elderly people, using data from the 4th National Oral Health Survey of China. In this cross-sectional study, a multistage, cluster strategy was used to recruit 4,431participants (2,222 male and 2,209 female) aged 65 to 74 years from all 31 provinces, autonomous regions and municipalities of the mainland of China. The survey was performed according to the diagnostic standard proposed by the World Health Organization (WHO). Socio-demographic information was collected with a closed questionnaire. The caries prevalence in 65 to 74-year-olds was rather high; the report shows it was 98.0% (DMFT ≥ 1) among elderly people in China. The mean DMFT, DT, MT and FT was 13.33 ± 9.32, 3.33 ± 4.17, 9.50 ± 8.66 and 0.49 ± 1.41, respectively. The filling rate was very low, assessed as 12.8%. The number of DMFT related to gender, residential district type, educational level, level of annual household income, toothbrushing frequency, consumption frequency of desserts, attitudes to oral health and oral health-related knowledge. The prevalence of dental caries in Chinese elderly people is rather high and a lot of decayed teeth still need to be filled and suitable prevention and treatment for this group is urgently needed.

The Prevalence and Associated Factors of Periodontal Disease among 35 to 44-year-old Chinese Adults in the 4th National Oral Health Survey.

To assess the current periodontal status of 35 to 44-year-olds from the Chinese population and to analyse potential influence factors on periodontal disease. The data of subjects were collected from both urban and rural areas of all 31 provinces, autonomous regions and municipalities of the mainland of China, as part of the 4th National Oral Health Survey. All subjects were aged 35 to 44 years old. In total, 4,410 subjects were enrolled in the present study. Each subject was asked to undergo a professional oral examination and to fill in a questionnaire. Periodontal health status was evaluated by probe bleeding, calculus, periodontal pocket depth and clinical attachment loss. The data were analysed using the chi-square test and binary logistic regression analysis. The prevalence of probe bleeding and calculus was 87.4% and 96.7% respectively among the 35 to 44-year-old population. Prevalence of shallow pockets (4 mm ≤ PD < 6 mm) and deep pockets (PD ≥ 6 mm) was 45.8% and 6.9% respectively among 35 to 44-year-old people. In addition, prevalence of clinical attachment loss (CAL > 3 mm) was 33.2%. Gender, educational level, smoking, teeth brushing frequency, dental floss and toothpick use were found relevant to periodontal condition. Periodontal disease was highly prevalent among 35 to 44-year-old Chinese adults. Gender, educational level, smoking, teeth brushing frequency, toothpick and dental floss use could be potential influence factors of periodontal health status.