INTRODUCTION

Oral health is greatly affected by various kinds of oral infections, such as dental caries, periodontal diseases, lesions in HIV/AIDS, mucosal and salivary gland diseases, orofacial pain and clefts, and, occasionally, oral cancer ¹. Tooth loss weakens mastication and causes poor diet, nutrition, and eating behavior leading to high mortality rates ². Also, poor oral health and periodontal diseases are predisposing factors for pneumonia, chronic obstructive pulmonary diseases, and has adverse- effects on diabetes patients ³. These oral diseases have a great impact on masticatory functions, nutritional intake, speech, swallowing, standard of living, and socialization ¹. The US Surgeon General called dental caries a "silent epidemic", and it is the root cause of loss of teeth in children and can result in severe health outcomes, and even mortality ¹.

The predisposing factors causing oral infections include older age, poor nutrition, tobacco and/or alcohol use, immunodeficiencies, poor dental hygiene, unfavorable social conditions, and diabetes ⁴. It is found that untreated periodontal disease contributes to tooth loss among adults and is known to compromise mastication, esthetics, self-esteem, and standard of living ⁵. There are various complications associated with untreated tooth decay such as pain, poor appearance, dysfunction, irregular school attendance, and low concentration on daily life achievements ⁶. In the United States, untreated dental caries is observed in 53 million people in the permanent dentition, and 25% of adults aged 65 years or older have lost their natural teeth due to untreated oral conditions ⁷.

According to the World Health Organization (WHO), fluoride toothpaste is the most popular and accepted source of fluoride use worldwide, and it is most effective to decline the prevalence of dental caries ⁸. Duijster et al. ⁹ showed that children from families that do not practice regular tooth brushing are more prone to experience dental caries ⁹. In Norway, data from a cohort study has confirmed that brushing teeth of children with a fluoride toothpaste twice in a day reduces the chances of development of cavities from 2 to 5 years of age ¹⁰.

For years, the recommended age of first visit to the dentist for children was around twelve months of age, but, recently, it has changed to a time span between 6 months of age and the development of the first tooth ¹¹. The reasons for this recommendation are to prevent Early Childhood Caries (ECC) and to discover and assess the progression of any dental pathology ¹¹. In addition, early visits to a dentist would educate caregivers about the importance of practicing healthy oral habits, teach them about fluoride use, teething management, and the co-relation between diet and oral health ¹¹.

The occurrence of oral diseases is more prevalent among marginalized population groups, such as people with less education, living in poor conditions, and negligent oral habits. In the United States, 35-44 years aged Hispanic Whites are twice more likely to have untreated tooth decay than non-Hispanic Whites, mainly due to lower access of minorities to dental care and low socio-economic status ¹². In addition, the prevalence of dental caries is most commonly observed in individuals with poor dietary habits, high consumption of sugar, and limited access to oral healthcare ⁸. In 2018, oral cavity cancers rank among the top 15 most common cancers worldwide with a total of 354,864 incident cases ¹³.

MATERIALS AND METHODS

RESULTS

Table 1 presents a detailed description of demographic variables. Regarding gender, a total of 9,254 participated and most respondents were females (50.8%). For educational level 20+ adults, 5,569 respondents' answers were recorded and were categorized as less than 9th grade (5.2%), 9-11th grade (6.9%), High school graduate (14.3), Some college or AA degree (19.2%), College graduate or above (14.4%), Refused (.0%) and Don't know (.1%).

DISCUSSION

Periodontal health is defined as a state of being free from inflammation associated with gingivitis or periodontitis clinically ¹⁴. This study was an analysis of secondary data collected from NHANES 2017- 2018. This study found a significant difference in the rate of health of teeth and gums between those who visited the dentist in the last 6 months and those who did not visit the dentist in the last 6 months. The findings of this study showed that 1,006 residents rated their health of teeth and gums as excellent, having last seen a dentist in 6 months or less. According to the findings of this study, the health of teeth and gums significantly deteriorated for those who did not visit the dentist in more than 2 years. The findings of this research question were similar to studies discussed in the literature review. The literature shows that dental caries in children can be prevented if they visit a dentist before or soon after the eruption of their first tooth ¹¹. At the same time, literature also suggests that children with high family income and lower mean of caries experience were more likely to visit the dentist ¹⁵.

This study did not find a significant difference in the rate of health of teeth and gums between those receiving drops or tablets and those not receiving drops or tablets among children aged 3-15 years in the US. The findings of this study suggest that 71 children who received fluoride drops or tablets rated the health of their teeth and gums as excellent, and 651 children who did not receive fluoride drops or tablets also rated the health of their teeth and gums as excellent. The findings of this research question were different from the reviewed literature. The literature suggests that higher fluoride concentration in drinking water in the US is associated with lower dental caries ¹⁶. Also, the literature highlights that children who do not consume tap water that contains fluoride were more likely to experience dental caries in their lifetime ¹⁶.

This study found no significant difference in the rate of health of teeth and gums according to gender among participants aged 1 and older. The results of this study showed that 869 females rated the health of teeth and gums as excellent, and 818 males rated the health of teeth and gums as excellent. Also, 1,114 females rated the health of their teeth as very good as compared to 1,020 males. In this study, the number of participating females tended to rate the health of their teeth and gums higher than males. However, there was no significant difference between gender and the rate of health of their teeth and gums. The literature shows mixed results, some literature suggests that females having lower levels of protective IgA as compared to males, pregnancies, and being more prone to harbor S. mutants can lead them to develop dental caries ¹⁷. The growing literature suggests that both men and women are equally aware of oral hygiene, and both have equal chances of developing dental caries ¹⁸.

This study found no significant difference in the rate of health of teeth and gums according to educational level among participants aged 20 years and above. The findings suggest that participants who have some college or AA degree have reported better health of their teeth and gums as compared to participants who are less educated than them. But the numbers are not very significant to conclude an association between educational level and health of teeth and gums. The findings of this research question are different from the reviewed literature. The literature suggests that in a study conducted by Kuter & Uzel in 2020, the results showed that a mother's educational level is directly related to children's tooth brushing but not related to the number of cavities in a child's mouth ¹⁹.

In conclusion, this study demonstrated that there were significant differences among one of four hypotheses. There was a significant difference in the rate of health of teeth and gums between those who visited the dentist in the last 6 months and those who did not visit the dentist in the last 6 months. This study concludes that individuals who have visited the dentist in 6 months or less have rated their health of teeth and gums as excellent as compared to those who did not visit the dentist in the last 6 months. Overall, the results of the study suggest further and advanced research regarding factors affecting oral health in the US residents.

Although the results of the secondary data analysis presented in this manuscript found no statistically significant differences in the health of teeth and gums in association with intake of fluoride drops or tablets, gender, and educational level, it is important to test these differences across diverse groups, as significant differences may be present by ethnicity.

The results of this study underscored the importance of consistent visits to the dentist as a protective factor for periodontal health. Educational interventions need to be promoted to emphasize the value of regular check-ups according to oral health guidelines. Further studies should be conducted to identify inequities associated with periodontal health among various cultural and ethnic groups in the US and to design interventions to effectively deal with the identified areas of concern.

The current study supplements information available on the oral health status of children and adults in the American continent. The most common risk factors causing periodontal disease in Latin America are poor oral hygiene and low socioeconomic status. Limited access to oral health care, especially in rural and low socioeconomic status areas contribute to high prevalence of periodontal diseases in Latin America ²⁰. The two main preventive approaches used in Latin America are at a) individual level and b) the population/community level. The prevention of dental diseases is important in terms of public health and should not be concentrated on dentists alone but must include interdisciplinary groups working together ²¹. The prevention of periodontal diseases in Latin America has been focused on oral hygiene instructions for reducing plaque by means of motivational techniques, increasing patient's awareness about the disease, patient empowerment, and providing adequate oral hygiene instructions and knowledge ²¹.