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To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel-Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as "good," "very good" or "excellent" by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI = 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting "good," "very good" or "excellent" oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.

Several studies have shown that oral health problems impact the quality of life of older adults. However, few data are available to describe the oral health status, barriers to care, and patterns of care for adults and older populations living in rural areas. The purpose of this study was to evaluate the perceived need for treatment of oral health problems by adult residents in a rural county in Iowa. The oral health component was part of a larger longitudinal health study of the residents. The sample was stratified into three groups by residence, that is, farm households, rural non-farm households and town households. The sample was subsequently post-stratified by gender and age group into young elderly, 65-74 years old, and old elderly, 75 years and older. Dentition status varied according to age and was related to the perception of treatment needs. Edentulous persons had fewer perceived treatment needs and utilized a dentist less frequently. Place of residence, education, and marital status were not associated with the subjects' perceived problems with eating and chewing. However, persons with difficulty chewing were more likely to have some missing upper teeth, have a perceived need to have denture work, and have smoked for a number of years. The results suggest that this rural population is retaining more teeth and consequently may need and may seek dental services more often than previous more edentulous cohorts.

The authors compared the estimated prosthodontic treatment needs of edentulous older adults when using normative and sociodental approaches. This cross-sectional study involved a non-random sample of 158 edentulous adults, aged 60 to 74 years, who were living independently in metropolitan Chiang Mai, Thailand. Each subject was given an oral examination and was interviewed. The dental questionnaire and the clinical criteria were adapted from the National Diet and Nutritional Survey for People Aged 65 and Older and included the Oral Impacts on Daily Performances sociodental indicator. Of the 158 subjects, we found using a normative assessment that 79.7% had a treatment need for complete dentures; 60.5% of those adults had impact-related treatment needs. Estimated treatment need dropped by about 40% when subjects were assessed using the sociodental approach. We concluded that large reductions in normative need estimates for complete dentures were apparent using a sociodental approach to assess prosthodontic dental treatment needs of older people.

Our knowledge of variables affecting the coping strategies that lead to acceptance of foods in populations wearing complete dentures is limited. Focus groups were conducted with the specific aim of determining factors responsible for successful adaptation to chewing with complete dentures. Each of the five focus groups consisted of eight to 15 participants (mean = 11; mean age = 64 yrs), of mixed gender, with at least five years of denture-wearing experience (mean = 7 years), and with groups varying in their socio-economic and ethnic backgrounds. Participants' statements (n = 324) were sorted for their content, by consensus between the two investigators, into 12 conceptually independent domains (listed in decreasing order of frequency of mention): foods and food textures causing difficulties when eating, foods being avoided, stability and retention of dentures, social constraints, bolus size, general satisfaction with the current dentures, general experience with dentures, sensation of temperature, experience of pain during chewing, experiences with taste, experiences with rinsing the dentures after eating, and time involved with chewing. In addition, further analysis of statements showed that food texture was the most commonly mentioned with foods that were either difficult to chew or avoided. These perceptions significantly affected the choice of food. The results of this qualitative study indicate that food texture is one of the major factors influencing the choice of a coping strategy by denture wearers when trying to overcome difficulties in chewing specific foods. As such, food texture may have a significant effect on patients' success in the process of their functional adaptation.

Stereotypic perceptions of older patients have been documented to influence relationships with older adults. To assess the impact of age and dentate status on dental student treatment decisions and perceptions of patients, we designed a qualitative study utilizing projective tests. Seventy first- and third-year dental students wrote stories about two "cue" statements, one describing a young patient and one an older patient. Each cue varied by dentate status, having either a complete dentition or seven remaining teeth. The stories were evaluated for negativity and for general themes of stereotypic statements. The results indicated that while patient age did not influence the dental care prescribed, a high level of negativity existed toward old patients in general (45%, older patient with teeth; 47%, older patient with seven teeth) and toward a younger patient with few remaining teeth (57.6%). The level of negativity expressed toward the young patient with full dentition (27%) may suggest a patient gender bias among dental students in this sample.