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Self-reported and Clinical Oral Health in Users of VA Health Care

^a The Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
^b Department of Health Policy and Health Services Research, Boston University Goldman School of Dental Medicine, Massachusetts
^c Departments of Health Services, Boston University School of Public Health, Massachusetts
^d Departments of Epidemiology and Biostatistics, Boston University School of Public Health, Massachusetts
^e Massachusetts' Veterans Epidemiologic Research and Information Center, VA Boston Healthcare System
^f Harvard School of Dental Medicine, Boston, Massachusetts

Judith A. Jones, CHQOER (152), VAMC, 200 Springs Road, Bedford, MA 01730 E-mail: judjones{at}bu.edu.

Decision Editor: William B. Ershler, MD

Background. This article describes the oral health of users of Veterans Administration (VA) health care using both clinical and self-report measures, and models relationships between these measures and self-perceived oral health.

Methods. We conducted a cross-sectional study of 538 male users of VA outpatient care in the Boston area. Questionnaires assessed self-reported oral health, oral-specific health-related quality of life, health behaviors, and sociodemographic information. Clinical data were collected on oral mucosa status, number of teeth and root tips, dental caries, and periodontal treatment need. We report clinical and self-reported oral health status by age group (era of military service). We regressed models of self-perceived oral health on clinical indices and self-reported measures of the impact of oral health on daily life, adjusting for sociodemographic characteristics and health behavior.

Results. Among those participants aged 65 to 91 years old, 2.8%, 18.7%, and 41.5% rated their oral health as excellent, very good, or good, respectively. Among 50- to 64-year-old men, the corresponding values were 1.4%, 18.5%, and 40.4%, while among those aged 22 to 49 years old, the values were 2.3%, 17%, and 34.1%. Tooth loss was common among users of VA care; 34% of those aged 65–90 years, 28% of those aged 50–64 years, and 8% of those aged 25–49 years had no teeth. Periodontal treatment needs were uniformly high among persons with teeth; mild mucosal change was common, and 10% had root tips. Regression models showed self-perceived oral health was better in persons with more teeth and recent dental treatment, and worse with tooth mobility, coronal decay, and more medical problems. Measures of the impact of oral conditions on daily life added significantly to the amount of explained variance in self-perceived oral health.

Conclusions. Clinical conditions and the impact of oral health on daily life are important determinants of self-perceived oral health.

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