RESEARCH ARTICLE
Oral health among the eld
c
Background many factors including nutrition and enjoyment of food
Singh et al. BMC Oral Health  (2015) 15:46 
DOI 10.1186/s12903-015-0030-xNCDs often cause reduced quantity and quality of saliva,Tobago
Full list of author information is available at the end of the articleThe Latin America and the Caribbean (LAC) population
is ageing at unprecedented rates. The UN Database re-
ports that by 2025 the elderly will increase by 300% in
developing countries, especially in Latin America [1,2].
As life expectancy increases, so too does the desire for
improved quality of life (QoL). QoL is dependent upon
which involves adequate mastication and oral health [1].
Older people have more complex oral health needs.
Oro-facial and dental pain or missing, discoloured and
broken teeth can adversely affect people’s health, confi-
dence and well-being. The resultant facial shape change
which occurs may lead to an unwillingness to carry out
everyday activities [1,3-5]. Many elderly also suffer from
non-communicable diseases (NCDs) that can affect gen-
eral and oral health. The required medications for these
* Correspondence: rohan.maharaj@sta.uwi.edu
2Unit of Public Health and Primary Care, The Faculty of Medical Sciences, The
University of the West Indies, St. Augustine, West Indies, Trinidad andAbstract
Background: To describe the prevalence of missing teeth, use of bridges and dentures and unmet dental needs
among those aged 60 years and above. The associations of these conditions with socio-demographics, type 2 diabetes
mellitus and depression were also studied. The work was carried out in 7 Latin American and Caribbean (LAC) cities in
1999-2000.
Methods: A secondary analysis was conducted on the Survey of Health and Well-Being of Elders (SABE) dataset. The 7
cities were Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. This survey did not
employ any oral examinations. Descriptive statistics, chi-square and regression analysis were used to test for associations.
Results: Data for 10 902 persons were analyzed. Females made up 62% of the population. Across the SABE population,
between 93.7% (Mexico City) to 99.9% (Santiago) reported missing teeth, with an average of 97.5%. Of those with
missing teeth, between 55.1% (Mexico City) and 82.4% (São Paulo) reported having bridges or dentures, with an average
of 70.1% across all SABE cities. The proportion of the SABE population with ‘unmet dental needs’ ranged from 85.8%
(Santiago) to 98.4% (Havana), with an average of 94.5%. Bridgetown, São Paulo and Mexico City demonstrated a
statistically significant association between aging and tooth loss. Generally a greater proportion of females (97.6%)
reported tooth loss compared with males (96.8%), but in only São Paulo and Montevideo was there a statistically
significant association between sex and tooth loss. Generally those with higher education reported less tooth loss,
primary education (97.6% had tooth loss), secondary (96.8%) and tertiary (94.7%). All the SABE cities except Buenos Aires
demonstrated a statistically significant association between tooth loss and education.
Conclusions: The prevalence of missing teeth, use of bridges and dentures and unmet dental needs were high in the
SABE cities in 1999-2000. In general across the SABE cities, the elderly with the most missing teeth were less educated or
less likely to be a professional. They tended to be not working and were receiving a pension. Additionally they were less
likely to report their health as ‘excellent’, were diabetic and were more likely to give responses suggestive of depression.
Keywords: Public health dentistry, Dental health survey, Elderly, Latin America, CaribbeanAmerican and Caribbean
cross-sectional study
Hema Singh1, Rohan G Maharaj2* and Rahul Naidu3© 2015 Singh et al.; licensee BioMed Central. T
Commons Attribution License (http://creativec
reproduction in any medium, provided the or
Dedication waiver (http://creativecommons.or
unless otherwise stated.Open Access
erly in 7 Latin
ities, 1999-2000: ahis is an Open Access article distributed under the terms of the Creative
ommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and
iginal work is properly credited. The Creative Commons Public Domain
g/publicdomain/zero/1.0/) applies to the data made available in this article,
Singh et al. BMC Oral Health  (2015) 15:46 Page 2 of 14thereby increasing the risk for tooth decay and other
oral diseases [6]. Additionally, ill-fitting dentures affect
patients’ QoL by making certain foods difficult to chew.
Finally, oral cancer is also common in this age group and
may develop after years of tobacco and alcohol abuse [7].
Whilst oral health care services are available in devel-
oped countries, utilisation is low among the elderly [8].
In low income countries where access to health care is
poor especially in rural areas, elderly people experience
high levels of oral health problems. In addition to socio-
economic factors, issues of limited availability and access
to oral care make the elderly more vulnerable to devel-
oping oral diseases. The problem is further compounded
in developing countries with diets rich in refined carbo-
hydrates, and little allocation of health budgets to the
prevention of oral diseases. Dental health resources cost
developed countries 5-10% of health care expenditure
per year [7] and oral disease is the fourth most expensive
disease to treat [7]. Research in Latin America reveal
that 60-70% of Mexicans over age 65 years have few or
no teeth and gum disease and untreated caries are highly
prevalent [7]. In South Brazil, poorer QoL are associated
with depression and difficulty to chew food [9]. Aging
populations therefore pose a significant challenge to
healthcare systems. Appropriate oral health policies and
strategies are needed to address these challenges.
This paper employed a secondary analysis of the Survey
on Health, Well-Being, and Aging in Latin America and
the Caribbean (SABE) dataset [10] to achieve the follow-
ing objectives:
1. To describe the prevalence of oral health issues in
the elderly population in 7 Latin American and
Caribbean cities in 1999-2000.
2. To investigate associations between demographic
variables, oral health and NCDs in this population.
Although dated, the information can provide a back-
ground of past oral health in preparation for future pol-
icies, strategies and research.
Method
The Survey on Health, Well-Being, and Aging in Latin
America and the Caribbean (SABE) [10] was a cross-
sectional study conducted between October 1999 and
December 2000. It set out to examine health (including
oral health) conditions and limitations of persons aged
60 years and above, and living in private households.
The surveys were undertaken in seven cities: Buenos Aires
(Argentina), Bridgetown (Barbados), São Paulo (Brazil),
Santiago (Chile), Havana (Cuba), Mexico City (Mexico)
and Montevideo (Uruguay). SABE was funded by the Pan
American Health Organisation (PAHO/WHO) [10]. The
data base is to be used only for statistical reporting andanalysis and is publicly available from: http://www.icpsr.
umich.edu/icpsrweb/NACDA/studies/3546?archive=NAC
DA&q=SABE.
Demographic variables such as age, sex, race, education,
birthplace, religion, ethnicity, marital status, and income
were collected along with cognitive, health (including
dental), functional and nutritional status, and use and ac-
cessibility of services. Dental health was measured by self-
reporting rather than oral examination [11].
Sampling target populations
The sampling target population from the SABE dataset
were the sixty years (60) and older population living at
home in urban areas of the respective cities [10].
Sample design
Eligible participants were selected through a multistage
clustered sample with stratification of the units. The
sample was chosen in three selection stages of primary,
secondary and tertiary sampling units; with two stages
employed in Barbados and Brazil [10].
Questionnaire
The SABE questionnaire was designed to produce infor-
mation and to compare unique ageing processes in the
LAC cities with other populations [10]. The modules ex-
tracted and included in this current paper are demo-
graphics, work history and income, self-reported overall
health, oral health, diabetes and depression.
SABE and Oral Health
The dentition aspects investigated in SABE are -
➢ The prevalence of oral disease in the elderly,
ascertained from the question: Are you missing any
teeth?
➢ Access to dental care: Do you have any bridges/
dentures/false teeth?
➢ Unmet Dental Needs: In the SABE, the Geriatric
Oral Health Assessment Index (GOHAI) scale was
used to quantify the ’Unmet needs for oral health
services’ of older adults [12,13]. If a participant had a
score of 57 or less out of 60, they were regarded as
having an ‘unmet dental need’.
Other information collected included self-reported
overall assessment of health where responses ranged
from ‘Excellent’ and ‘Very Good’ to ‘Bad’. Also collected
was information on depression, the Yesavage Geriatric
Depression Scale (GDS) Short form was used [14].
Ethical issues
Ethical approval was granted for the conduct of the sur-
vey by the Pan American Health Organization Ethical
Table 1 Age and dentition for the SABE population
Row % Are you missing any teeth? Do you have bridges/dentures? Unmet dental needs?
N (%) N (%) N (%)
Age groups Yes No p value Yes No p value Yes No p value
Bridgetown N = 1474 N = 1417 N = 1477
60 yrs and > 291 (96.4) 11 (3.6) 0.038 177 (61.9) 109 (38.1) 0.104 285 (94.1) 18 (5.9)
61 - 65 yrs. 310 (97.8) 7 (2.2) 171 (56.4) 132 (44.6) 307 (96.2) 12 (3.8) 0.182
66 - 70 yrs. 298 (99.3) 2 (0.7) 180 (62.5) 108 (37.5) 276 (93.9) 18 (6.1)
71 - 75 yrs. 248 (99.2) 2 (0.8) 161 (66.0) 83 (34.0) 230 (92.0) 20 (8.0)
76 - 80 yrs. 175 (99.4) 1 (0.6) 95 (56.2) 74 (43.8) 163 (92.6) 13(7.4)
81 yrs. and up 133 (98.5) 2 (1.5) 69 (54.3) 58 (45.7) 131 (97.0) 4 (3.0)
Buenos Aires N = 1027 N = 998 N = 1028
60 yrs and > 46 (95.8) 2 (4.2) 0.441 30 (66.7) 15 (33.3) 0.164 47 (97.8) 1 (2.1) 0.423
61 - 65 yrs. 241 (98.0) 5 (2.0) 178 (73.6) 64 (26.4) 237 (96.3) 9 (3.7)
66 - 70 yrs. 252 (98.4) 4 (1.6) 185 (73.4) 67 (26.6 ) 243 (94.9) 13 (5.1)
71 - 75 yrs. 233 (97.1) 7 (2.9) 176 (76.5) 54 (23.5) 235 (97.9) 5 (2.1)
76 - 80 yrs. 134 (98.5) 2 (1.5) 97 (74.0) 34 (26.0) 134 (97.8) 3 (2.2)
81 yrs. and up 101 (100) 0 (0.0) 79 (80.6) 19 (19.4) 96 (95.0) 5 (5.0)
São Paulo N = 2143 N = 2129 N = 2143
60 yrs and > 76 (100) 0 (0.0) 0.045 66 (86.8) 10 (13.2) 0.022 73 (96.1) 3 (3.9) 0.747
61 - 65 yrs. 429 (98.8) 5 (1.2) 331 (77.2) 98 (22.8) 413 (95.2) 21 (4.8)
66 - 70 yrs. 366 (99.2) 3 (0.8) 308 (84.2) 58 (15.8) 356 (96.5) 13 (3.5)
71 - 75 yrs. 379 (98.7) 5 (1.3) 311 (82.3) 67 (17.7) 373 (97.1) 11 (2.9)
76 - 80 yrs. 421 (100) 0 (0.0) 352 (83.6) 69 (16.4) 404 (96.0) 17 (4.0)
81 yrs. and up 459 (100) 0 (0.0) 358 (78.0) 101 (22.0) 438 (95.6) 21 (4.6)
Santiago N = 1299 N = 1281 N = 1301
60 yrs and > 63 (100) 0 (0.0) 0.365 41 (67.2) 20 (32.8) 0.017 55 (87.3) 8 (12.7) 0.108
61 - 65 yrs. 278 (100) 0 (0.0) 180 (65.7) 94 (34.3) 244 (87.1) 36 (12.9)
66 - 70 yrs. 327 (100) 0 (0.0) 202 (72.5) 121 (27.5) 290 (88.7) 37 (11.3)
71 - 75 yrs. 247 (100) 0 (0.0) 178 (72.7) 67 (27.3) 216 (87.4) 31 (12.6)
76 - 80 yrs. 182 (100) 0 (0.0) 133 (73.9) 47 (26.1) 153 (84.1) 29 (15.9)
81 yrs. and up 201 (99.5) 1 (0.5) 147 (74.2) 51 (25.8) 162 (80.2) 40 (19.8)
Havana N = 1905 N = 1877 N = 1905
60 yrs and > 112 (99.1) 1 (0.9) 0.838 69 (61.6) 43 (38.4) 0.007 113 (100) 0 (0.0) 0.452
61 - 65 yrs. 438 (98.0) 9 (2.0) 293 (66.9) 145 (33.1) 440 (98.4) 7 (1.6)
66 - 70 yrs. 389 (98.7) 5 (1.3) 285 (73.3) 104 (26.7) 384 (97.5) 10 (2.5)
71 - 75 yrs. 326 (99.1) 3 (0.9) 226 (69.3) 100 (30.7) 321 (97.6) 8 (2.4)
76 - 80 yrs. 251 (98.4) 4 (1.6) 192 (76.5) 59 (23.5) 252 (98.8) 3 (1.2)
81 yrs. and up 361 (98.4) 6 (1.6) 270 (74.8) 91 (25.2) 329 (97.8) 8 (2.2)
Mexico City N = 1873 N = 1717 N = 1876
60 yrs and > 628 (89.0) 78 (11.0) 0.000 339 (54.1) 288(45.9) 0.620 662 (93.5) 46 (6.5) 0.255
61 - 65 yrs. 337 (90.8) 34 (9.2) 171 (51.0) 164 (49.0) 352 (94.9) 19 (5.1)
66 - 70 yrs. 280 (93.6) 19 (6.4) 155 (55.6) 124 (44.4) 282 (94.3) 17 (5.7)
71 - 75 yrs. 201 (95.7) 9 (4.3) 109 (54.5) 91 (45.5) 190 (94.5) 20 (9.5)
76 - 80 yrs. 150 (95.5) 7 (4.5) 89 (59.7) 60 (41.3) 150 (95.5) 7 (4.5)
Singh et al. BMC Oral Health  (2015) 15:46 Page 3 of 14
Review Committee and the appropriate institutional
review board in each city.
Analysis
Descriptive statistics was used to compare proportions
of affected elderly between the various cities and chi-
square analysis was done to investigate whether any
associations exist between demographic and disease
variables and dentition in the elderly. Regression analysis
for the ‘Unmet needs’ oral health variable against the
demographic and disease variables was conducted to de-
termine possible predictors of ‘Unmet dental health
needs’ in the various cities. Statistical Package for the
Social Sciences (SPSS) v. 12 was used. Statistical signifi-
cance was set at p < 0.05.
Results
The overall sample size of the SABE population was
10,902, females comprised 62%. The response rate
ranged from 62.5% in Buenos Aires to 95.3% in Havana
[10]. Across the SABE population, between 93.7%
(Mexico City) to 99.9% (Santiago) reported missing
teeth, with an average for all countries of 97.5%. See
Tables 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10.
Table 1 Age and dentition for the SABE population (Continued)
81 yrs. and up 127 (97.7) 3 (2.3) 71 (55.9) 56 (45.1) 120 (94.5) 7 (5.5)
Montevideo N = 1450 N = 1365 N = 1450
60 yrs and > 64 (91.4) 6 (9.6) 0.166 52 (79.7) 13 (21.3) 0.078 66 (94.3) 4 (5.7) 0.259
61 - 65 yrs. 291 (92.7) 23 (7.2) 209 (72.8) 78 (27.2) 301 (95.9) 13 (4.1)
66 - 70 yrs. 366 (94.8) 20 (5.2) 289 (79.2) 76 (20.8) 376 (97.4) 10 (2.6)
71 - 75 yrs. 282 (96.2) 11 (3.8) 214 (76.4) 66 (23.6) 277 (94.5) 16 (5.5)
76 - 80 yrs. 220 (96.5) 8 (3.5) 163 (75.1) 54 (24.9) 217 (95.2) 11 (4.8)
81 yrs. and up 153 (96.2) 6 (3.8) 129 (84.9) 23 (15.1) 156 (98.1) 3 (1.9)
Table 2 Gender and dentition for the SABE population
Row N % Are you missing any teeth? Do you have bridges/dentures? Unmet dental needs?
Singh et al. BMC Oral Health  (2015) 15:46 Page 4 of 14N (%) N (%)
Sex Yes No p value Yes
Bridgetown N = 1474 N = 1417
Male 887 (97.9) 13 (2.1) 0.349 515 (61.9)
Female 562( 98.6) 12 (1.4) 338 (59.1)
Buenos Aires N = 1027 N = 998
Male 370 (97.9) 12 (2.1) 0.765 268 (73.2)
Female 637 (98.2) 8 (1.8) 477 (75.5)
São Paulo N = 2143 N = 2129
Male 872 (99.0) 9 (1.0) 0.039 634 (72.7)
Female 1258 (99.7) 4 (0.3) 1092 (86.9Santiago N = 1299 N = 1281
Male 445 (99.8) 1 (0.2) 0.167 236 (53.8)
Female 853 (100) 0 (0.0) 645 (76.7)
Havana N = 1905 N = 1877
Male 700 (98.9) 8 (1.1) 0.343 454 (64.9)
Female 1177 (98.3) 20 (1.7) 881 (74.9)
Mexico City N = 1873 N = 1717
Male 465 (91.7) 42 (8.3) 0.789 216 (46.8)
Female 1258 (92.1) 108 (7.9) 718 (57.2)
Montevideo N = 1450 N = 1365
Male 490 (92.5) 40 (7.5) 0.001 318 (65.4)
Female 886 (96.3) 34 (3.7) 737 (83.8)N (%)
No p value Yes No p value
N = 1477
356 (38.1) 0.299 843 (93.5) 59 (6.5) 0.104
208 (41.9) 549 (95.5) 26 (4.5)
N = 1028
98 (26.8) 0.143 368 (97.4) 10 (2.6) 0.255
155 (25.5) 624 (96.0) 26 (4.0)
N = 2143
238 (27.3) 0.000 846 (96.0) 35 (4.0) 0.937
165 (13.1) 1211 (96.0) 51 (4.0)N = 1301
203 (46.2) 0.000 376 (84.3) 70 (15.7) 0.180
197 (23.3) 744 (87.0) 111 (13.0)
N = 1905
246 (35.1) 0.000 698 (98.6) 10 (1.4) 0.239
296 (25.1) 1171 (97.8) 26 (2.2)
N = 1876
246 (53.2) 0.000 481 (94.9) 26 (5.1) 0.172
537 (42.8) 1275 (93.1) 94 (6.9)
N = 1450
168 (34.6) 0.000 514 (97.0) 16 (3.0) 0.175
142 (16.2) 879 (95.4) 41 (4.5)
io
av
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)
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7)
Singh et al. BMC Oral Health  (2015) 15:46 Page 5 of 14Table 3 Education level and dentition for the SABE populat
Row N (%) Are you missing any teeth? N (%) Do you h
Education level Yes No p value Yes
Bridgetown N = 1456 N = 1399
Primary 1119 (98.7) 15 (1.3) 0.049 665 (60.9
Secondary 217 (96.4) 8 (1.6) 126 (59.4
Higher/oth 96 (99.0) 1 (1.0) 50 (52.6)
Buenos Aires N = 989 N = 960
Primary 690 (98.4) 11 (1.6) 0.209 505 (74.5
Secondary 184 (97.4) 5 (2.6) 136 (73.5
Higher/oth 95 (96.0) 4 (4.0) 78 (80.4)
São Paulo N = 1600 N = 1586
Primary 1347 (99.6) 6 (0.4) 0.001 1140 (84.Socio-demographics (Age, education, marital status,
occupational status) and prevalence of missing teeth
Across the SABE cities 2.5% of the population aged
60 years and above reported no missing teeth. A notable
exception was the 60-65 years age groups in Mexico City
and Montevideo where 8-11% reported having complete
dentition. Bridgetown, São Paulo and Mexico City demon-
strated a statistically significant association between aging
and tooth loss. In all cities except Havana (M:F = 1.01:1), a
greater proportion of females (97.6%) reported tooth loss
compared with males (96.8%). In only São Paulo and
Montevideo was there a statistically significant association
between sex and tooth loss.
Generally those with higher education reported less
tooth loss, among those with primary education, 97.6%
reported tooth loss, secondary (96.8%) and tertiary
(94.7%). All the SABE cities except Buenos Aires
Secondary 70 (97.2) 2 (2.8) 59 (84.3)
Higher/oth 170 (97.1) 5 (2.9) 140 (82.4)
Santiago N = 1138 N = 1126
Primary 90 (100) 0 (0.0) * 62 (68.9)
Secondary 143 (100) 0 (0.0) 96 (67.6)
Higher/oth 905 (100) 0 (0.0) 618 (69.1)
Havana N = 1901 N = 1873
Yes 1793 (98.7) 23 (1.3) 0.001 1270 (70.8)
No 80 (94.1) 5 (5.9) 63 (78.8)
Mexico City N = 1553 N = 1415
Primary 1014 (92.1) 87 (7.9) 0.020 531 (52.5)
Secondary 115 (95.0) 6 (5.0) 77 (67.0)
Higher/oth 291 (87.9) 40(22.1) 210 (72.7)
Montevideo N = 1382 N = 1300
Primary 859 (96.5) 31 (3.5) 0.000 656 (76.7)
Secondary 221 (94.8) 12 (5.2) 177 (81.6)
Higher/oth 231 (89.2) 28(11.8) 172 (75.4)
*Santiago has 100% missing teeth for this variable unable to determine an associat
Havana has no education level variable, so “Did you attend school - yes/no” was usn
e bridges/dentures? N (%) Unmet dental needs? N (%)
No p value Yes No p value
N = 1459
427 (39.1) 0.281 1071 (94.2) 66 (5.8) 0.843
86 (41.6) 214 (95.1) 11 (4.9)
45 (47.4) 91 (93.8) 6 (6.2)
N = 990
173 (25.6) 0.301 677 (96.6) 24 (3.4) 0.838
49 (26.5) 182 (95.8) 8 (4.2)
19 (19.6) 96 (97.0) 3 (3.0)
N = 1600
206 (15.3) 0.729 1293 (95.6) 60 (4.4) 0.622demonstrated a statistically significant association be-
tween tooth loss and education.
Greater proportions of manual and unskilled (92.5%),
service workers and office employees (92.3%) reported
having missing teeth compared with professionals (88.8%).
São Paulo, Havana, Mexico City and Montevideo all dem-
onstrated a statistically significant association between
tooth loss and past employment. Across all SABE cities,
among those with missing teeth, there were higher pro-
portions currently not working (97.9%) than currently
working (96.1%). Whilst among those with no missing
teeth, there were more persons working (3.9%) than not
(2.1%). This achieved statistical significance in Mexico
City and Montevideo. Across the entire SABE population,
among those with missing teeth, greater proportions were
receiving a pension (97.5%) than not (95.2%); and among
those with no missing teeth, greater proportions were not
11 (15.7) 69 (95.8) 3 (4.2)
30 (17.6) 170 (96.1) 5 (3.9)
N = 1139
28 (31.1) 0.936 77 (85.6) 13 (14.4) 0.877
46 (32.4) 125 (87.4) 18 (12.6)
276 (31.9) 778 (85.9) 128 (14.1)
N = 1901
523 (29.2) 0.126 1782 (98.1) 34 (1.9) 0.751
17 (21.2) 83 (97.6) 2 (2.4)
N = 1554
480 (47.5) 0.000 1033 (93.7) 69 (6.3) 0.276
38 (33.0) 115 (95.0) 6 (5.0)
79 (27.3) 303 (91.5) 28 (8.5)
N = 1382
199 (23.3) 0.239 858 32 (3.6) 0.886
40 (19.4) 224 9 (3.9)
56 (24.5) 248 11 (4.2)
ion.
ed.
Table 4 Marital status and dentition for the SABE population
Row % Are you missing any teeth? Do you have bridges/dentures? Unmet dental needs? N (%)
Marital status Yes No p value Yes No p value Yes No p value
Bridgetown N = 1459 N = 1402 N = 1462
Unmarried 292 (98.7) 4 (1.3) 0.373 186 (63.9) 105 (36.1) 0.368 284 (94.4) 17 (5.6)
Married 499 (97.7) 12 (2.3) 292 (59.8) 196 (40.2) 488 (95.1) 25 (4.9)
Widow/er 407 (99.3) 3 (0.7) 232 (58.1) 167 (41.9) 382 (93.2) 28 (6.8) 0.164
Separated 151 (98.1) 3 (1.9) 94 (63.9) 53 (36.1) 149 (96.1) 6 (3.9)
Divorced 81 (97.6) 2 (2.4) 42 (54.5) 35 (45.5) 74 (89.2) 9 (10.8)
Buenos Aires N = 1025 N = 996 N = 1026
Unmarried 54 (94.7) 3 (5.3) * 46 (82.1) 10 (17.9) 0.212 56 (98.2) 1 (1.8)
Married 432 (97.7) 10 (2.3) 315 (72.7) 118 (27.3) 426 (96.4) 16 (3.6)
Widow/er 42 (98.6) 6 (1.4) 313 (76.3) 97 (23.7) 413 (96.5) 15 (3.5) 0.886
Separated 88 (98.9) 1 (1.1) 60 (69.0) 27 (31.0) 85 (95.5) 4 (4.5)
Divorced 10 (100) 0 (0.0) 9 (90.0) 1 (10.0) 10 (100) 0 (0.0)
São Paulo N = 2142 N = 2128 N = 2142
Unmarried 103 (100) 0 (0.0) * 80 (77.7) 23 (22.7) 0.139 95 (92.2) 8 (7.8)
Married 1112 (99.2) 9 (0.8) 899 (80.9) 12 (19.1) 1082 (95.5) 39 (3.5)
Widow/er 757 (99.6) 3 (0.4) 626 (82.7) 131 (17.3) 728 (95.8) 32 (4.2) 0.035
Separated 135 (99.3) 1 (0.7) 101 (74.8) 34 (25.2) 132 (97.1) 4 (2.9)
Divorced 22 (100) 0 (0.0) 20 (90.9) 2 (19.1) 19 (86.4) 3 (13.6)
Santiago N = 1284 N = 1266 N = 1286
Unmarried 94 (98.9) 1 (1.1) * 56 (61.5) 35 (39.5) 0.013 85 (89.5) 10 (10.5)
Married 560 (100) 0 (0.0) 362 (65.3) 192 (34.7) 495 (88.4) 65 (11.6)
Widow/er 458 (100) 0 (0.0) 334 (73.7) 119 (26.3) 379 (82.4) 81 (17.6) 0.015
Separated 166 (100) 0 (0.0) 113 (69.3) 50 (31.7) 147 (88.6) 19 (11.4)
Divorced 5 (100) 0 (0.0) 5 (100) 0 (0.0) 3 (60.0) 2 (40.0)
Havana N = 1902 N = 1874 N = 1902
Unmarried 61 (93.8) 4 (6.2) * 31 (50.8) 30 (49.2) 0.001 64 (98.5) 1 (1.5)
Married 700 (98.5) 11 (1.5) 484 (69.1) 216 (30.9) 702 (98.7) 9 (1.3)
Widow/er 658 (98.9) 7 (1.1) 494 (75.1) 164 (24.9) 648 (97.4) 17 (2.6) 0.534
Separated 247 (99.6) 1 (0.4) 179 (72.5) 68 (27.5) 243 (98.0) 5 (2.0)
Divorced 208 (97.7) 5 (2.3) 145 (69.7) 63 (30.3) 209 (98.1) 4 (1.9)
Mexico City N = 1868 N = 1712 N = 1871
Unmarried 89 (94.7) 5 (5.3) 0.002 52 (58.4) 37 (41.6) 0.063 92 2 (2.1)
Married 978 (91.1) 95 (8.9) 515 (52.9) 458 (47.1) 1010 64 (6.0
Widow/er 457 (94.0) 29 (6.0) 259 (56.6) 199 (44.4) 452 36 (7.4) 0.291
Separated 170 (92.9) 13 (7.1) 86 (51.2) 82 (48.8) 169 14 (7.7)
Divorced 24 (75.0) 8 (5.0) 19 (79.2) 5 (20.8) 29 3 (9.4)
Montevideo N = 1444 N = 1360 N = 1444
Unmarried 49 (94.2) 3 (5.8) 0.288 28 (57.1) 21 (42.9) 0.000 49 (94.2) 3 (5.8)
Married 659 (93.7) 44 (6.2) 495 (75.8) 158 (24.2) 673 (95.7) 30 (4.3) 0.456
Widow/er 511 (96.4) 19 (3.6) 416 (82.1) 91 (17.9) 515 (97.2) 15 (2.8)
Separated 82 (96.5) 3 (3.5) 55 (67.9) 26 (32.1) 80 (94.1) 5 (5.9)
Divorced 70 (94.6) 4 (5.4) 57 (81.4) 13 (18.6) 70 (94.6) 4 (5.4)
*Buenos Aires, São Paulo, Santiago and Havana has many cells with N < 5 for this variable therefore unable to determine an association.
Singh et al. BMC Oral Health  (2015) 15:46 Page 6 of 14
tio
h
Bridgetown N = 1404 N = 1348
.3)
.1)
.4)
)
.8)
.0)
Singh et al. BMC Oral Health  (2015) 15:46 Page 7 of 14Professionals 108 (54.3) 91 (45.7) 0.079 108 (54
Office workers 371 (59.1) 257 (41.9) 371 (59
Manual/unskill 325 (62.4) 196 (31.6) 325 (62
Buenos Aires N = 925 N = 898
Professionals 129 (97.7) 3 (2.3) 0.810 99 (78.0
Office workers 248 (98.4) 4 (1.6) 187 (74
Manual/unskill 533 (98.5) 8 (1.5) 375 (72Table 5 Past occupation and dentition for the SABE popula
Row % Are you missing any teeth? Do you
Past occupation Yes No p value Yesreceiving a pension (4.8%) than those who were receiving
a pension (2.5%). This achieved statistical significance in
Bridgetown.
Throughout the SABE cities, all the categories of mari-
tal status report tooth loss range from 75% - 100%. With
an average of 98.1%, Havana and Mexico City demon-
strated a significant statistical association between tooth
loss and marital status.
Health conditions (depression and diabetes), self-reported
overall health and prevalence of missing teeth
For all SABE cities except Montevideo, among those
with missing teeth there were greater levels of depres-
sion (average 11.2%) compared with those not missing
São Paulo N = 2000 N = 1986
Professionals 141 (97.2) 4 (2.8) 0.003 125 (88.7)
Office workers 535 (99.3) 4 (0.7) 409 (76.6)
Manual/unskill 1311 (99.6) 5 (0.4) 1075 (82.)
Santiago N = 1053 N = 1038
Professionals 77 (100) 0 (0.0) * 58 (77.3)
Office workers 207 (100) 0 (0.0) 136 (67.3)
Manual/unskill 769 (100) 0 (0.0) 514 (67.5)
Havana N = 1584 N = 1561
Professionals 266 (96.4) 10 (3.6) 0.003 180 (67.7)
Office workers 568 (99.3) 4 (0.7) 405 (71.3)
Manual/unskill 727 (98.8) 9 (1.2) 515 (70.8)
Mexico City N = 1532 N = 1410
Professionals 113 (86.9) 17 (13.1) 0.035 85 (75.2)
Office workers 477 (93.7) 32 (6.3) 262 (55.3)
Manual/unskill 823 (92.2) 70 (7.8) 404 (49.1)
Montevideo N = 1310 N = 1233
Professionals 183 (89.3) 22 (10.7) 0.000 140 (78.2)
Office workers 304 (96.5) 11 (3.5) 248 (81.8)
Manual/unskill 756 (95.7) 34 (4.3) 555 (73.9)
*Santiago has 100% missing teeth for this variable therefore no cell for a p value.n
ave bridges/dentures? Unmet dental needs? N (%)
No p value Yes No p value
N = 1407
91 (45.7) 0.129 197 (93.8) 13 (6.2) 0.166
257 (40.9) 622 (95.4) 30 (4.6)
196 (37.6) 506 (92.8) 39 (7.2)
N = 883
28 (22.0) 0.345 84 (93.3) 6 (6.7) 0.288
63 25.2) 243 (96.3) 9 (3.6)
146 (28.0) 525 (97.0) 16 (3.0)teeth (average 6.5%). This achieved statistical signifi-
cance in Mexico City.
For all SABE cities except São Paulo and Montevideo,
among those with missing teeth there were greater levels
of diabetes (average = 16.5%) compared with those not
missing teeth (average = 12.3%). This did not achieve
statistical significance in any of the SABE cities.
Among those with missing teeth, 0.3% (Mexico City)
to 6% (Montevideo) reported ‘Excellent’ health, with an
average of 3.5% across 6 cities (excluding Havana which
had different descriptors on the Likert scale). Among
those with no missing teeth, between 0% (Montevideo)
and 23.1% (São Paulo) reported ‘Excellent’ health, with
an average of 9.3%. The association between ‘self-re-
ported’ overall health and missing teeth achieved
N = 2000
16 (11.3) 0.002 139 (95.9) 6 (4.1) 0.985
125 (23.4) 517 (95.9) 22 (4.1)
236 (18) 1260 (95.7) 56 (4.3)
N = 1055
17 (22.7) 0.211 67 (87.0) 10 (13.0) 0.700
66 (32.7) 178 (85.2) 31 (14.8)
247 (32.5) 672 (87.4) 97 (12.6)
N = 1584
86 (32.3) 0.538 274 (99.3) 2 (0.7) 0.160
163 (28.7) 558 (97.6) 14 (2.4)
212 (29.2) 725 (98.5) 11 (1.5)
N = 1533
28 (24.8) 0.000 119 (91.5) 11 (8.5) 0.323
212 (44.7) 469 (92.1) 40 (7.9)
419 (50.9) 840 (94.0) 54 (6.0)
N = 1310
39 (21.8) 0.019 196 (4.4) 9 (95.5) 0.470
55 (18.2) 306 (2.9) 9 (97.1)
196 (26.1) 755 (4.4) 35 (95.5)
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Singh et al. BMC Oral Health  (2015) 15:46 Page 8 of 14Table 6 Working status and dentition for the SABE populat
Row % Are you missing any teeth? Do you h
Working status Yes No p value Yes
Bridgetown N = 1409 N = 1353
Yes 247 (97.2) 7 (2.8) 0.191 138 (56.6
No 137 (98.4) 18 (1.6) 671 (60.5
Buenos Aires N = 929 N = 902
Yes 246 (97.6) 6 (2.4) 0.258 186 (75.3
No 668 (98.7) 9 (1.3) 479 (73.1
São Paulo N = 2004 N = 1990
Yes 432 (98.9) 5 (1.1) 0.145 344 (79.8
No 1559 (99.5) 8 (0.5) 1268 (81.
Santiago
Yes 313 (100) 0.0 * 191 (61.8
No 873 (100) 0.0 604 (70.2
Havana N = 1905 N = 1807
Yes 346 (98.3) 6 (1.7) 0.685 236 (68.2
No 1531 (98.6) 22 (1.4) 1099 (71.
Mexico City N = 1569 N = 1443
Yes 573 (88.7) 73 (11.3) 0.000 284 (49.6statistical significance for São Paulo, Mexico City and
Montevideo.
Socio-demographics and reporting bridges or dentures
Of those with missing teeth, between 55.1% (Mexico
City) and 82.4% (São Paulo) reported having bridges or
dentures, with an average of 70.1%.
São Paulo, Santiago and Havana all demonstrated a
statistically significant association between aging and
reporting the use of dentures or bridges. On average
more females (73.4%) have bridges and dentures than
males (62.7%), except in Bridgetown where it is the re-
verse. São Paulo, Santiago, Havana, Mexico City and
Montevideo all demonstrated a statistically significant
association between sex and reporting the use of den-
tures or bridges. The proportions of those with bridges/
dentures was distributed on average equally among
those with lower (70.1%) versus those with higher educa-
tional achievement (72.1%) across all SABE cities except
in Mexico City. Here there was a statistically significant
association between educational achievement and
reporting the use of bridges or dentures.
Santiago, Havana and Montevideo all demonstrated a
statistically significant association between marital status
and reporting the use of dentures or bridges.
No 873 (94.6) 50 (5.4) 486 (55.9)
Montevideo N = 1327 N = 1250
Yes 227 (91.9) 20 (8.1) 0.015 170 (75.2)
No 1023 (95.6) 47 (4.4) 785 (76.7)n
e bridges/dentures? Unmet dental needs? N (%)
No p value Yes No p value
N = 1412
106 (43.4) 0.255 243 (95.7) 11 (4.3) 0.267
438 (39.5) 1087 (93.9) 71 (6.1)
N = 929
61 (24.7) 0.508 239 (94.8) 13 (5.2) 0.138
176 (26.9) 656 (96.9) 21 (3.1)
N = 2004
87 (20.2) 0.476 422 (96.6) 15 (3.4) 0.371
291 (18.7) 1498 (95.6) 69 (4.4)
N = 1188
118 (39.2) 0.007 274 (87.3) 40 (12.7) 0.659
257 (29.8) 754 (86.1) 120 (13.7)
N = 1905
110 (31.8) 0.185 346 (98.3) 6 (1.7) 0.777
432 (29.2) 1523 (98.1) 30 (1.9)
N = 1571
289 (51.4) 0.019 603 43 (6.7) 0.904Generally larger proportions of professionals (74.2%)
reported bridges or dentures compared with office or
manual and unskilled workers (68.9%). In São Paulo,
Mexico City and Montevideo there was a statistically
significant association between occupation and reporting
the use of bridges or dentures. Among those reporting
using bridges or dentures there were no consistent pat-
tern of current employment, except in Santiago and
Mexico City. In these 2 cities there was a statistically sig-
nificant association with greater proportions of those
wearing dentures ‘not currently working’.
In 4 of the SABE cities among those reporting having
bridges or dentures there were higher proportions re-
ceiving pensions. Only in Mexico City was there a statis-
tically significant association.
Health conditions and reporting bridges or dentures
In the SABE cities among those with missing teeth and
reported wearing bridges or dentures 12.3% were ascer-
tained to be depressed compared with 15.7% among
those not wearing bridges or dentures. In Bridgetown
and Mexico City this association achieved statistical
significance.
Among the elderly with missing teeth and reporting
use of bridges and dentures the proportion with diabetes
383 (44.1) 862 63 (6.8)
N = 1327
56 (24.8) 0.645 238 9 (3.6) 0.661
239 (23.3) 1034 46 (4.3)
ve
Yes 668 (98.2) 12 (1.8) 0.710 186 (75.3)
D/K 12 (92.3) 1 (7.7) 11 (91.7)
Singh et al. BMC Oral Health  (2015) 15:46 Page 9 of 14Havana N = 1448 N = 1427
Yes No 1427 (98.5) 21 (1.5) * 1015 (71.1)
Mexico City N = 1852 N = 1696
Yes 406 (93.1) 30 (6.9) 0.286 252 (62.5)
No 1296 (91.5) 120 (8.5) 667 (51.6)No 326 (97.9) 7 (2.1) 479 (73.1)
São Paulo N = 2135 N = 2121
Yes 1689 (99.4) 10 (0.6) 0.812 1373 (81.3)
No 433 (99.3) 3 (0.7) 348 (80.6)
Santiago N = 1297 N = 1279
Yes 1284 (100) 0 (0.0) 0.000 868 (68.5)Table 7 Pension and dentition for the SABE population
Row % Are you missing any teeth? Do you ha
Pension? Yes No p value Yes
Bridgetown n = 1454 N = 1397
Yes 995 (99.0) 10 (1.0) 0.003 581 (60.1)
No 435 (96.9) 14 (3.1) 261 (60.6)
Buenos Aires N = 1014 N = 902was 17.9%, compared with those without bridges and
dentures, diabetes was present in 20.7%. In Havana and
Mexico City there was a statistically significant associ-
ation among those wearing bridges and dentures and the
presence of diabetes.
Self-reported overall health
Among the SABE cities there was a consistent pattern of
self-reported overall health and whether the respondents
used bridges or dentures. In Santiago, Havana and
Mexico City this achieved a statistically significant
association.
Socio-demographics and unmet oral health needs
The proportion of the SABE population with ‘unmet
dental needs’ ranged from 85.8% (Santiago) to 98.4%
(Havana), with an average of 94.5%. There were no
statistically significant associations between unmet den-
tal needs and age, sex, past occupation, education
achievement, working status, or pension status. There
were no statistically significant associations between
marital status and unmet dental needs except in São
Paulo and Santiago.
Montevideo N = 1445 N = 1361
Yes 1108 (95.4) 54 (4.6) 0.155 859 (78.1)
No 264 (93.3) 19 (6.7) 192 (73.6)
*Havana has 100% elderly persons receiving pension therefore no cell for a p valuebridges/dentures? Unmet dental needs? N (%)
No p value Yes No p value
N = 1457
385 (39.9) 0.884 944 (93.7) 63 (6.3) 0.229
170 (30.4) 429 (95.3) 21 (4.7)
N = 1014
61 (24.7) 0.508 657 (96.5) 24 (3.5) 0.949
126 (26.9) 321 (96.4) 12 (3.6)
N = 2135
316 (18.7) 0.727 1631 (96.0) 68 (4.0) 0.905
84 (19.4) 418 (95.9) 18 (4.1)
N = 1299
399 (61.5) 0.085 1107 (86.1) 179 (13.9) 0.879
1 98.3) 11 (84.6) 2 (15.4)
N = 1444
412 (28.9) * 1421 (98.1) 27 (1.9) *
N = 1854
151 (37.5) 0.000 408 (93.6) 28 (6.4) 0.955
626 (48.4) 1328 (93.7) 90 (6.3)Health conditions and unmet dental needs
There were no statistically significant associations be-
tween unmet dental needs and depression or self-
reported health in any of the SABE cities. Similarly,
there were no statistically significant associations be-
tween unmet dental needs and diabetes except for
Bridgetown where more of those without diabetes have
unmet dental needs. Regression analysis was conducted
for each SABE city to determine which independent var-
iables predicted having an ‘Unmet dental need’. There
were no such independent variables identified except in
Bridgetown where the ‘absence of diabetes’ predicted
having an Unmet dental need. See Table 11.
Discussion
There has been a wealth of information arising from the
SABE dataset, [10,12] but this paper is the first to
describe the oral health of the population. Across the
SABE population, in 1999-2000, 97.5% reported missing
teeth, and of those with missing teeth, an average of
70.1% reported having bridges or dentures. Further,
94.5% were determined to have ‘unmet dental needs’, ex-
pressing difficulties with chewing, oral pain, speech and
appearance, among other issues. Further analysis re-
vealed associations with the presence of missing teeth
N = 1445
241 (21.9) 0.117 1122 (96.6) 40 (3.4) 0.143
69 (26.4) 268 (94.7) 15 (5.3)
.
ve
Yes 221 (97.8) 5 (2.2) 150 (67.9)
Singh et al. BMC Oral Health  (2015) 15:46 Page 10 of 14Mexico City N = 1873 N = 1717
No 1377 (91.1) 135 (8.9) 0.003 784 (57.2)Table 8 Depression and Dentition for the SABE population
Row % Are you missing any teeth? N (%) Do you ha
Depression Yes No p value Yes
Bridgetown N = 1474 N = 1445
No 1403 (98.3) 24 (1.7) 0.816 834 (60.4)
Yes 46 (97.9) 1 (2.1) 31 (47.7)
Buenos Aires N = 1027 N = 1013
No 916 (97.9) 20 (2.1) 0.159 673 (74.0)
Yes 91 (100) 0 (0.0) 76 (73.9)
São Paulo N = 2143 N = 2129
No 1860 (99.4) 12 (0.6) 0.590 1503 (80.8)
Yes 270 (99.6) 1 (0.4) 223 (82.6)
Santiago N = 1299 N = 1281
No 1004 (99.1) 1 (0.1) 0.588 687 (69.5)
Yes 294 (100) 0 (0.0) 195(66.2)
Havana N = 1905 N = 1877
No 1656 (98.6) 23 (1.4) 0.323 1185 (71.6)and educational achievement or past employment across
many, but not all the SABE cities.
Social determinants of missing teeth
Education and Past occupation
Generally in this study those with higher education and
those self-reporting their occupation as professionals re-
ported less tooth loss. Those with a primary and second-
ary education had more tooth loss versus those with a
tertiary education. All the SABE cities except Buenos
Aires demonstrated a statistically significant association
between tooth loss and education. Similarly, the manual
and unskilled, service workers and office employees gen-
erally reported having more missing teeth compared
with professionals. São Paulo, Havana, Mexico City and
Montevideo all demonstrated a statistically significant
association between tooth loss and past employment.
This association with education is consistent with re-
ports from the United States (US). In the National
Health and Nutrition Examination Survey (NHANES)
study, 23% of those with 0-8 years of education reported
pain in biting or chewing compared with 10% of those
with 13 or more years of education [15].
Yes 346 (95.8) 15 (4.2) 150 (43.4)
Montevideo N = 1450 N = 1365
No 1229 (95.1) 64 (4.9) 0.445 949 (77.9)
Yes 147 (93.6) 10 (6.4) 106 (72.1)bridges/dentures? N (%) Unmet dental needs N (%)
No p value Yes No p value
N = 1508
546 (39.6) 0.041 1358 (94.6) 81 (5.6) 0.571
34 (52.3) 64 (92.8) 5 (7.2)
N = 1043
236 (26.0) 0.833 903 (96.4) 34 (3.6) 0.352
28 (26.9) 104 (98.1) 2 (1.9)
N = 2143
356 (19.2) 0.495 1797 (96.0) 75 (4.0) 0.967
47 (17.4) 260 (95.9) 11 (4.1)
N = 1301
301 (30.5) 0.281 859 (85.3) 148 (14.7) 0.130
99 (33.8) 261 (88.8) 33 (11.2)
N = 1905
471 (28.4) 0.256 1649 (98.2) 30 (1.8) 0.368
71 (32.1) 220 (97.3) 6 (2.7)
N = 1817
587 (42.8) 0.000 1414 (93.3) 101 (6.7) 0.327Other surveys of dental disease in the Americas
Successive surveys of seniors over the age of 65 years in
the US has shown that overall, the prevalence of tooth
loss in seniors has decreased from the 1970 until the
2000s [16]. A more recent paper from 2005-8 reported
that in this population 19.9% had untreated dental caries
and almost 23% of were edentulous [17]. The data from
this paper cannot be compared with these results how-
ever as different oral parameters were measured. In
Latin America, a 2012 report of Decayed, Missing, Filled
Teeth (DMFT) index showed a mean DMFT of 21.57 in
the 65–74 years group [18]. Factors related to tooth loss
in the 65–74 year-old group were education level
<12 years (OR 2.54) and personal income (OR 1.66).
This current paper has similar findings with respect to
education. Two other South American countries have
carried out national surveys including an oral examin-
ation in adults: Colombia [19] with a DMFT of 19.6 in
the “older than 55” group and Brazil with a mean DMFT
of 27.8 for the 65–74-year-old group in 2003 and a
DMFT of 27.5 for the 65–74 years adults in 2010 [20].
However both these report DMFT, which cannot be
compared directly with these results. Nevertheless they
suggest, as does this paper, high levels of caries preva-
lence in the elderly.
196 (56.6) 342 (94.7) 19 (5.3)
N = 1450
269 (22.1) 0.112 1238 (95.7) 55 (4.3) 0.070
41 (27.9) 155 (98.7) 2 (1.3)
ve
Singh et al. BMC Oral Health  (2015) 15:46 Page 11 of 14Table 9 Diabetes and Dentition for the SABE population
Row % Are you missing any teeth? Do you ha
Diabetes Yes No p value Yes
Bridgetown N = 1469 N = 1412
Yes 315 (99.10 3 (0.9) 0.237 191 (62.4)
No 1129 (98.1) 22 (1.9) 661 (59.8)
Buenos Aires N = 1023 N = 985
Yes 128 (98.5) 2 (1.5) 0.713 494 (75.0)
No 875 (98.0) 18 (2.0) 240 (73.6)
São Paulo N = 2126 N = 2112
Yes 377 (99.2) 3 (0.6) 0.840 304 (80.6)
No 1736 (99.4) 10 (0.4) 1412 (81.4)
Santiago N = 1283 N = 1265
Yes 173 (100) 0 (0.0) 0.693 126 (72.8)
No 1109 (99.9) 1 (0.1) 745 (68.2)
Havana N = 1903 N = 1876
Yes 288 (99.3) 2 (0.7) 0.254 226 (78.5)
No 1588 (98.5) 25 (1.5) 1109 (69.8)
Mexico City N = 1862 N = 1708Depression and dentition
Depression has been well linked to dentition [21]. In
Santiago, this association was found for the 35-44 age
group but not the 65-74 year olds [18]. Similarly, in this
current paper, no association was found except in
Mexico City where those with missing teeth had twice
the rate of depression than those with no missing teeth
(8.9% vs. 4.2%, p < 0.003). In general, there were more
depressed among those not wearing dentures (15.7%)
than among those wearing dentures (12.3%).
This provides interesting areas for debate, including
whether many of those elderly with missing teeth are
generally less accepting of their loss and have higher
rates of depression; and whether those without bridges
and dentures, either had no access to care or cannot
afford the services and have the resultant increased de-
pression rates. These are areas for future study.
Diabetes and oral health
Recent research have widened our understanding of the
relationship between oral health and diabetes [22,23].
For example, periodontal disease has been shown to be
is a strong predictor of mortality from ischemic heart
disease (IHD) and diabetic nephropathy among Pima
Yes 347 (93.5) 24 (6.5) 0.224 171 (49.7)
No 1366 (91.6) 125 (8.4) 760 (55.7)
Montevideo N = 1445 N = 1360
Yes 175 (93.1) 13 (6.9) 0.232 134 (77.0)
No 1196 (95.1) 61 (4.9) 919 (77.5)bridges/dentures? Unmet dental needs? N (%)
No p value Yes No p value
N = 1472
115 (37.6) 0.401 291 (90.9) 29 (9.1)
445 (40.2) 1096 (95.1) 56 (4.9) 0.004
N = 1024
165 (25.0) 0.649 125 (96.2) 5 (3.8) 0.827
86 (26.4) 863 (96.5) 31 (3.5)
N = 2143
73 (19.4) 0.060 370 (97.4) 10 (2.6) 0.210
323 (18.6) 1670 (95.6) 76 (4.4)
N = 1285
47 (27.2) 0.224 153 (88.4) 20 (11.6) 0.333
347 (31.8) 953 (85.7) 159 (14.3)
N = 1899
62 (21.5) 0.003 280 (96.6) 10 (3.4) 0.315
479 (30.2) 1587 (98.4) 126 (1.6)
N = 1864Indians with type 2 diabetes (T2DM) [24]. Also individ-
uals with poorly controlled diabetes mellitus had a sig-
nificantly higher prevalence of severe periodontitis than
those without diabetes [25]. Tooth loss is considered the
end point for untreated periodontal disease. The preva-
lence of periodontal disease is increasing in most aging
societies suggesting it is a public health problem [26].
One study from Germany reported that the association
between T2DM and tooth loss was statistically signifi-
cant only for females [27]. In this current paper we stud-
ied the relationship between the presence of diabetes
and oral health. We could demonstrate no relationship
between those with diabetes and those reporting missing
teeth. In 5 of the 7 SABE cities we could not demon-
strate a relationship between diabetes and those report-
ing the use of bridges or dentures, the two exceptions
being Havana and Mexico City. In both these cities
those with diabetes made up about 17% of the users of
bridges and dentures.
Pension systems in SABE cities and relationship with
oral health
Across the entire SABE population, among those with
missing teeth, greater proportions were receiving a
173 (50.3) 0.045 346 (93.0) 26 (7.0) 0.628
604 (44.3) 1398 (93.7) 94 (6.3)
N = 1445
40 (23.0) 0.888 182 (96.8) 6 (3.2) 0.569
267 (22.5) 1206 (95.9) 51 (4.1)
Table 10 Self-reported overall health and dentition for the SABE population
Row % Are you missing any teeth? Do you have bridges/dentures? Unmet dental needs? N (%)
Self reported health Yes No p value Yes No p value Yes No p value
Bridgetown N = 1474 N = 1445 N = 1508
Excellent 56 (98.2) 1 (1.8) 0.218 33 (60.0) 22 (40.0) 0.391 57 (98.3) 1 (1.7) 0.368
Very good 163 (98.8) 2 (1.2) 89 (56.0) 70 (44.0) 164 (94.8) 9 (5.2)
Good 501 (97.3) 14 (2.7) 289 (57.5) 214 (42.5) 496 (94.3) 30 (5.7)
Fair 648 (98.8) 8 (1.2) 405 (62.3) 245 (37.7) 626 (93.4) 44 (6.6)
Bad 81 (100) 0 (0.0) 49 (62.8) 29 (37.2) 79 (97.5) 2 (2.5)
Buenos Aires N = 995 N = 982 N = 1042
Excellent 44 (97.8) 1 (2.2) 0.301 30 (71.4) 12 (28.6) 0.800 43 (93.5) 3 (6.5) 0.271
Very good 148 (100) 0 (0.0) 104 (73.2) 38 (26.8) 144 (97.3) 4 (2.7)
Good 447 (97.6) 11 (2.4) 334 (74.4) 115 (25.6) 447 (96.3) 17 (3.7)
Fair 284 (97.3) 8 (2.7) 220 (73.8) 78 (26.2) 294 (97.7) 7 (2.3)
Bad 52 (100) 0 (0.0) 35 (68.6) 16 (31.4) 50 (96.2) 2 (3.8)
São Paulo N = 2143 N = 2129 N = 2143
Excellent 90 (96.8) 3 (3.2) 0.001 79 (87.8) 11 (12.2) 0.171 90 (96.8) 3 (3.2) 0.927
Very good 128 (97.7) 3 (2.3) 107 (83.6) 21 (16.4) 125 (95.4) 6 (4.6)
Good 730 (99.6) 3 (0.4) 596 (81.8) 133 (18.2) 702 (95.8) 31 (4.2)
Fair 983 (99.7) 3 (0.3) 792 (80.6) 191 (19.4) 946 (95.9) 40 (4.1)
Bad 199 (99.5) 1 (0.5) 152 (76.4) 47 (23.6) 194 (97.0) 6 (3.0)
Santiago N = 1299 N = 1281 N =1301
Excellent 27 (100) 0 (0.0) 0.661 14 (51.9) 13 (48.1) 0.038 22 (81.5) 5 (18.5) 0.885
Very good 53 (100) 0 (0.0) 38 (77.6) 11 (22.3) 46 (86.8) 7 (13.2)
Good 380 (99.7) 1 (0.3) 239 (64.6) 131 (35.4) 332 (87.1) 49 (12.9)
Fair 559 (100) 0 (0.0) 397 (71.4) 159 (28.6) 483 (86.1) 78 (13.9)
Bad 279 (100) 0 (0.00 103 (69.2) 86 (30.8) 237 (84.9) 42 (15.1)
Havana N = 1905 N = 1877 N = 1905
Proxy 170 (96.6) 6 (3.4) 0.293 109 (64.1) 61 (32.9) 0.009 174 (98.9) 2 (1.1) 0.090
Excellent 33 (100) 0 (0.0) 19 (57.6) 14 (42.4) 32 (97.0) 1 (3.0)
Very good 57 (100) 0 (0.0) 41 (71.9) 16 (28.1) 57 (100) 0 (0.0)
Good 547 (98.7) 7 (1.3) 388 (70.9) 159 (29.1) 548 (98.9) 6 (1.1)
Fair 850 (98.6) 12 (1.4) 634 (74.6) 216 (25.4) 844 (97.9) 18 (2.1)
Bad 220 (98.7) 3 (1.3) 144 (65.5) 76 (34.5) 214 (96.0) 9 (4.0)
Mexico City N =1868 N =1713 N = 1871
Excellent 42 (89.4) 5 (10.6) 0.000 33 (78.6) 9 (21.4) 0.002 43 (91.7) 4 (8.3) 0.728
Very good 67 (83.8) 13 (16.2) 43 (64.2) 24 (35.8) 77 (96.2) 3 (3.8)
Good 395 (89.2) 48 (10.8) 228 (57.7) 167 (42.3) 415 993.7) 28 (6.3)
Fair 900 (92.7) 71 (7.3) 466 (52.0) 431 (48.0) 907 (93.1) 67 (6.9)
Bad 314 (96.0) 13 (4.0) 163 (52.2) 149 (47.8) 309 (94.5) 18 (5.5)
Montevideo N = 1450 N = 1365 N = 1450
Excellent 84 (84.8) 15 (15.2) 0.000 71 (84.5) 12 (15.5) 0.068 96 3 (3.0) 0.626
Very good 143 (89.9) 16 (10.1) 105 (75.5) 36 (24.5) 152 7 (4.4)
Good 663 (96.10 26 (3.9) 495 (78.6) 135 (21.4) 631 28 (4.2)
Fair 426 (97.3) 12 (2.7) 324 (76.6) 99 (23.4) 420 18 (4.1)
Bad 90 (94.7) 5 (5.3) 60 (68.2) 28 (31.8) 94 1 (1.1)
Singh et al. BMC Oral Health  (2015) 15:46 Page 12 of 14
pe
Singh et al. BMC Oral Health  (2015) 15:46 Page 13 of 14pension than not. The question for future study is
whether those with less missing teeth are more educated
and more healthy and therefore continue to work. Fur-
ther, are they less likely to be receiving a pension, more
engaged in life, and are subsequently less depressed?
The findings of this paper appears to suggest that this is
the case. The pension systems across the SABE cities are
varied but generally universal with pensions available
between age 60-65 years [28].
Limitations
There are several limitations to this study, for example,
data used in the SABE study is self-reported and not
actual clinical examinations. This makes the comparison
of this 1999-2000 data impossible with the 3 reported
Table 11 Results of logistic regression to determine the inde
in the SABE population for Bridgetown
Bridgetown B S.E.
Age .204 .247
Sex -.399 .255
Marital status .195 .302
Education level -.068 .316
Past occupation .230 .352
Current working status -.237 .369
Pension .250 .279
Depression .270 .478
Diabetes .583 .254
Self-reported overall health -12.307 .729
Constant -15.598 .563surveys of the DMFT index from Latin America. The
SABE surveys were conducted in urban cities, whilst the
more recent Latin American surveys report using na-
tionally representative samples. This data was also col-
lected fourteen years ago. Therefore, one can question
how comparable or generalizable is it today. Neverthe-
less, the information does provide a baseline for other
LAC cities and countries which have not conducted
any subsequent surveys.
Additionally, the SABE study used self-perceived oral
health which reflects people’s subjective and objective
assessments of their oral health, and is highly associated
with perceptions of treatment need and subsequent de-
mand for dental services [11]. Future studies in these
populations should use an oral examination to confirm
participants’ perceptions.
What’s next
This paper provides baselines which future studies can
re-assess for change. These include the very high levelsof missing teeth among all age intervals of those over
60 years, the high levels of unmet dental needs and the
relatively high proportion of those requiring dental pros-
theses. The very high levels of ‘unmet dental needs’
across all the SABE cities is telling and future studies
should evaluate how well this construct remains elevated
as new dental interventions are introduced. There are
also opportunities for extensive comparison of DMFT
data across more LAC countries, with a focus on the
elderly. As we saw above these are now available for 3
Latin American countries. This can assist in evaluating
the different dental care models in LAC. Notably, the
free health system of Havana did not particularly stand
out as exemplary. Throughout the LAC there has been
an epidemic of NCDs with diabetes being at the fore-
.803 1 -.297 .797
.318 1 -.667 1.207
5.267 1 .085 1.081
284.816 1 -13.736 -10.877
767.698 1 -16.701 -14.494ndent variables associated with Unmet Oral health needs
Wald df 95% CI
Lower Upper
.680 1 -.281 .689
2.452 1 -.899 .100
.418 1 -.397 .788
.047 1 -.688 .552
.427 1 -.460 .920
.412 1 -.961 .487front. The evidence suggests that better periodontal care
assists in better diabetes control [23]. In this study we
could not demonstrate a link between diabetes and miss-
ing teeth. Future research in the LAC should investigate
the cost-effectiveness of improving dental services to as-
sist in combating the diabetes epidemic.
Conclusions
The results of this secondary analysis illustrates that in
1999-2000, there was a high prevalence of missing teeth,
bridge and dentures use and poorly met dental needs
among the elderly in the 7 SABE cities of Latin America
and the Caribbean.
In general across the SABE cities, the larger propor-
tion of elderly reporting missing teeth were less edu-
cated or less likely to be a professional. They were also
currently not working and were receiving a pension.
Finally they were less likely to report their health as
‘excellent’, were diabetic and were more likely to give
responses suggestive of depression.
[http://dx.doi.org/10.1155/2012/810170]
19. Ministerio de Salud de Colombia. II Estudio de Salud Bucal-ENSAB III y II
Estudio nacional de factores de riesgo de enfermedades cronicas-ENFREC II.
Bogotá-Colombia, 1999. (Oral Health Study II - III and II ENSAB national
study of risk factors for chronic diseases - ENFREC II . Bogota, Colombia ,
1999.) [http://www.visitaodontologica.co/ARCHIVOS/ARCHIVOS-NORMAS/
Salud%20Publica_P_y_P/II_ESTUDIO_NACIONAL_SALUD_BUCAL.pdf]
20. Ministério da Saúde Brasil Departamento de Atenção Básica, Coordenação
Geral de Saúde Bucal. Projeto SB Brasil 2010. Pesquisa nacional de Saúde
Singh et al. BMC Oral Health  (2015) 15:46 Page 14 of 14Abbreviations
DMFT: Decayed, Missing, Filled Teeth index; GDS: Geriatric Depression Scale;
GOHAI: Geriatric Oral Health Assessment Index; IHD: Ischemic heart disease;
LAC: Latin American and Caribbean; MPH: Master of Public Health;
NHANES: National Health and Nutrition Examination Survey; NCD: Non-
communicable disease; OR: Odds Ratio; PAHO: Pan American Health
Organisation (PAHO); QoL: Quality of life; SABE: Survey of Health and Well-
Being of Elders; SPSS: Statistical Package for the Social Sciences; T2DM: Type
2 diabetes; US: United States; WHO: World Health Organization.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
All authors contributed to the paper. This paper was created from the MPH
research report of the first author. Both RGM and RN supervised the student
and contributed to the final report. All authors have read and approved the
final manuscript.
Acknowledgements
This paper acknowledges with appreciation the work of the SABE researchers
who designed and implemented the original study. The paper received no
external funding.
Author details
1The University of the West Indies, St. Augustine, Trinidad and Tobago. 2Unit
of Public Health and Primary Care, The Faculty of Medical Sciences, The
University of the West Indies, St. Augustine, West Indies, Trinidad and
Tobago. 3Community Dentistry, The Faculty of Medical Sciences, The
University of the West Indies, St. Augustine, Trinidad and Tobago.
Received: 19 August 2014 Accepted: 24 March 2015
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