Abstract
Objectives
This analysis describes the dental self-care behaviors used by a multi-ethnic sample of older adults, and it delineates the associations of self-care behaviors with personal characteristics and oral health problems.
Methods
A cross-sectional comprehensive oral health survey conducted with a random, multi-ethnic (African American, American Indian, white) sample of 635 community-dwelling rural adults aged 60 years and older was completed in two rural southern counties.
Results
Rural older adults engage in a variety of self-care behaviors, including the use of Over-the-Counter (OTC) Medicine (12.1%), OTC Dental Products (84.3%), Salt (51.0%), Prayer (6.1%), and Complementary Therapies (18.2%). Some gender and ethnic class differences are apparent, with greater use by women of OTC Medicine and Salt, and greater use by African Americans and American Indians of OTC Medicine and OTC Dental Products. Use of dental self-care behaviors appears to be driven by need. Those reporting oral pain, bleeding gums, and dry mouth have a greater odds of engaging in most of the dental self-care behaviors, including use of complementary therapies.
Conclusions
The major factor leading to the use of self-care behaviors is need. Although oral pain does increase the use of self-care behaviors, so do bleeding gums and dry mouth. Research and practice should address self-care behaviors used for oral health problems in addition to pain. Investigators should expand analysis of dental self-care behavior and the relationship of self-care behavior to the use of professional services. Further research also should explore the use of complementary therapies in dental self-care.
Keywords: Self-care, health self-management, complementary therapies, aging, gerontology, rural health, minority health
Introduction
Access to health care, particularly dental care, is limited in rural communities (1,2). Compared to urban and suburban communities, rural communities have relatively few dentists. Few rural adults have dental insurance. Rural older adults often have low incomes. The limited access to professional dental care among rural older adults is magnified in the South, where many older adults are members of minority groups (3–5).
Self-care is one means by which older adults can actively engage in managing their oral health without access to professional care (6,7). Self-care is the component of health self-management that includes behaviors undertaken to enhance health, prevent disease, limit illness, or restore health (8). Health self-management can also include informal support, formal services, and professional care (9). Self-care behaviors may be individually initiated or carried out in collaboration with health professionals. They derive from the individual’s knowledge and skills. Gilbert and colleagues (7) explored dental self-care behaviors among problem-oriented dental attenders and regular dental attenders. They report that dental self-care behaviors include changes in diet and regular mouthwash use to prevent oral health problems (toothache pain, bleeding gums, tooth loss), and the use of over-the-counter pain relievers, over-the-counter topical medication, and homemade remedies to treat toothache and bleeding gums. Gilbert and colleagues (7) conclude that dental self-care can complement or substitute for professional dental care, but more knowledge is needed about the relationship of self-care behaviors and decisions to use professional care.
Dental problems experienced by older adults may influence the self-care behaviors that they select. Tooth pain is one dental problem for which the use of self-care behaviors has been examined (6,7,10). Older adults experience dental problems in addition to tooth pain that may influence the use of self-care behaviors. These include bleeding gums, dry mouth, ill-fitting dentures, stained teeth, and bad breath.
Cohen and colleagues (6) used a focus group design to elicit therapies used for toothache among low-income and minority adults. They found that these adults use over-the-counter medicines, over-the-counter dental products, and prescription medicines. The self-care behaviors included a wide variety of home and complementary therapies.
Use of complementary therapies can be a component of health self-care (11,12). Complementary therapies are known to be used widely among older adults (13); however, few studies have examined the use of complementary therapies for oral health in the general population or specifically among older adults. For example, although the 2002 National Health Interview Survey included a module on the use of complementary therapies, and numerous articles have been published with these data, none of these papers considers complementary therapies used for oral health.
This analysis uses data from a comprehensive oral health survey conducted with a large, random, multi-ethnic sample of rural adults aged 60 years and older to describe dental self-care behaviors. The self-care behaviors include complementary therapies as well as over-the-counter medicines and dental products. Additionally, the associations of self-care behaviors with participants’ personal characteristics and oral health problems are delineated.
Methods
Overview of Study
The Rural Nutrition and Oral Health (RUN-OH) Study is a cross-sectional survey of the condition of oral health among rural older adults and the association of oral health with nutrition. Data collection for RUN-OH was conducted in two south central North Carolina counties. These rural counties were selected because they have large minority populations, including African Americans and American Indians.
Sample Design
Eligible participants included community-dwelling English-speaking older adults aged 60 years and older. Participants were located using a random dwelling selection and screening procedure based on a multistage cluster sampling design in which the primary sampling units (clusters) were stratified and selected with probability proportionate to their sizes. This procedure was designed and implemented by the investigators in consultation with the University of Illinois Survey Research Laboratory.
Within 80 randomly-selected, mapped clusters, 5,545, dwelling units were identified. Thirty-nine of these dwelling units were not screened, 4,647 were screened but did not include an eligible participant, and 859 included an eligible participant. The screening rate was 99.3%. Interviewers attempted to recruit participants who met the inclusion criteria in each randomly selected dwelling in a cluster. Once an eligible resident was identified, the interviewer asked to speak with that individual. If the individual was not at home, the interviewer made an appointment to return. The interviewer made at least three additional attempts to contact the selected individual at times which other residents indicated the individual would normally be at home. All randomly selected dwellings were maintained in the sample until their dispositions were finalized.
The eligible resident in 635 of the 859 dwelling units completed the interview, while 224 refused to complete the interview, for a response rate of 73.9%. The University of Illinois Survey Research Laboratory provided weights for each participant based on the size of the cluster from which he/she was selected, and his/her probability of selection within each dwelling unit.
Data Collection
Data collection was completed between January 2006, and March 2008. Personal interviews were completed in participant homes or in another location of the participant’s choosing, such as a senior center. Interviews took from 1.5 to 2.5 hours to complete. African American, American Indian, and white interviewers conducted the interviews; three of the five interviewers were residents of the two counties, and all received training that addressed the protection of human subjects and cultural sensitivity, as well as data collection procedures. The questionnaire included sections addressing personal characteristics, current oral health problems, and self-care behaviors used in the past year. Items on self-care included a variety of over-the-counter and home remedies. Participants were also given an opportunity to describe any additional self-care practices they might use. Participants were given an incentive valued at $10.00 at the completion of the interview. Data collection procedures were reviewed by the Wake Forest University School of Medicine Institutional Review Board.
Measures
Measures of self-care behaviors are based on the analysis of Cohen and colleagues (6), and include six major categories: (a) Over-the-Counter (OTC) Medicine; (b) Over-the-Counter (OTC) Dental Products; (c) Prescription Medicine; (d) Salt; (e) Prayer; and (f) Complementary Therapies (see Table 3). Complementary therapies refer to a diverse set of self-care behaviors not prescribed or directed by a health care professional and used to prevent or to treat oral health problems. In addition to the six major categories, subcategories of OTC Dental Products and Complementary Therapies are also considered that had substantial use and reflect Cohen et al.’s (6) list. OTC Dental Products included the subcategories hydrogen peroxide, OTC gels and salves, denture products, special toothpaste, mouthwash, and other products. Complementary Therapies included the subcategories teabags/herbs (and further subcategories herbs or teas, and tobacco), hot/cold (ice), placing aspirin on the affected area, massaging gums, liquor, spices (subcategories of vanilla extract, and others), rinsing mouth with toxic substances (such as rubbing alcohol and chlorine bleach), other home remedies (subcategories of Epsom salts, baking soda, vinegar, mechanical procedures, and others), vitamins and minerals (subcategories of vitamins and minerals), and relaxation techniques.
Table 3.
Bivariate Associations of Personal Characteristics and Oral Health Problems with Self-Care Behaviors used for Oral Health among Rural Older Adults
| Personal Characteristics and Oral Health Problems | OTC Medicine | OTC Dental Products |
Hydrogen Peroxide | Salt | Complementary Therapies | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Odd Ratios | 95% Confidence Intervals |
Odd Ratios | 95% Confidence Intervals |
Odd Ratios | 95% Confidence Intervals |
Odd Ratios | 95% Confidence Intervals |
Odd Ratios | 95% Confidence Intervals |
||||||
| Age | 0.96 | 0.93 | 0.99 | 0.97 | 0.950 | 0.99 | |||||||||
| Female vs Male | 2.49 | 1.47 | 4.21 | 1.72 | 1.26 | 2.36 | |||||||||
| Ethnicity | |||||||||||||||
| African | |||||||||||||||
| American vs white | 2.18 | 1.17 | 4.07 | 3.03 | 1.57 | 5.83 | 2.91 | 1.839 | 4.60 | ||||||
| American | |||||||||||||||
| Indian vs white | 2.31 | 1.31 | 4.05 | 2.30 | 1.37 | 3.87 | 3.12 | 2.064 | 4.73 | 1.98 | 1.37 | 2.86 | |||
| Education | |||||||||||||||
| <HS vs >HS | 2.81 | 1.31 | 6.02 | 1.68 | 1.030 | 2.73 | 1.97 | 1.30 | 2.98 | ||||||
| HS vs >HS | |||||||||||||||
| Poverty | |||||||||||||||
| Number of Teeth | |||||||||||||||
| 0 vs >20 | 0.43 | 0.22 | 0.81 | 0.55 | 0.350 | 0.85 | 1.66 | 1.11 | 2.47 | 0.41 | 0.25 | 0.68 | |||
| 1–10 vs >20 | 0.56 | 0.323 | 0.98 | 0.39 | 0.20 | 0.75 | |||||||||
| 11–20 vs >20 | 2.27 | 1.10 | 4.70 | 2.00 | 1.27 | 3.17 | 0.52 | 0.30 | 0.91 | ||||||
| Oral Pain | 12.63 | 7.18 | 22.23 | 2.96 | 1.12 | 7.87 | 3.20 | 1.927 | 5.32 | 2.05 | 1.21 | 3.47 | 2.51 | 1.45 | 4.33 |
| Bad Breath | 3.15 | 1.90 | 5.22 | 5.82 | 2.31 | 14.71 | 2.39 | 1.592 | 3.59 | 1.70 | 1.07 | 2.70 | |||
| Ill Fitting | |||||||||||||||
| Dentures | 1.51 | 1.03 | 2.22 | ||||||||||||
| Bleeding Gums | 3.35 | 2.04 | 5.52 | 2.23 | 1.19 | 4.19 | 2.69 | 1.807 | 4.01 | 3.57 | 2.34 | 5.45 | 1.80 | 1.15 | 2.83 |
| Dry Mouth | 1.78 | 1.09 | 2.89 | 2.03 | 1.424 | 2.88 | 1.72 | 1.25 | 2.35 | ||||||
| Stained Teeth (dentate only) | 2.93 | 1.64 | 5.23 | 1.55 | 1.015 | 2.35 | 1.80 | 1.21 | 2.67 | ||||||
Measures of individual characteristics included age, sex, ethnicity (African American, American Indian, white), and educational attainment (less than high school, high school, more than high school). Poverty status (below poverty level and above poverty level) is based on total household income and number of persons in the household. Health insurance and dental insurance are dichotomous measures. General oral health status is based on participants’ self-reported number of teeth in the categories none, 1 to 10, 11 to 20, more than 20. Oral health problems are self-reported dichotomies and include oral pain, bad breath, ill fitting dentures, bleeding gums, and stained teeth (for dentate).
Analysis
All analyses were calculated based on the weighted data as provided by the University of Illinois Survey Research Laboratory. Data were summarized using weighted means and standard errors for continuous variables and weighted frequencies and percents for categorical variables. Associations between self-care behaviors and demographic and oral health characteristics were tested using logistic regression. Characteristics include age, gender, ethnicity, education level, poverty, number of teeth, oral pain, bad breath, ill fitting dentures, bleeding gums, dry mouth, and stained teeth (in dentate participants only). Subsequently, multivariable logistic regression models were used to examine the simultaneous associations between self-care behaviors and demographic and oral health characteristics, including age, gender, ethnicity, education level, number of teeth, oral pain, bad breath, ill fitting dentures, bleeding gums, and dry mouth. Because stained teeth is only assessed in dentate participants, a second set of multivariable logistic regression models was fit looking at all previous characteristics plus stained teeth. All analyses were completed using SAS version 9.1 (Cary, NC).
Results
Participant Characteristics
Participants had a mean age of 71.5 years (SE 0.4) (Table 1). Over half the participants were female. The participants included substantial percentages of African Americans (21.4%), American Indians (30.7%), and whites (47.8%). Most of the participants had less than a high school education (55.7%), with one in five having more than a high school education. Most participants had health insurance (93.5%), with few having dental insurance (10.1%). Almost one-third of the participants had incomes below the poverty level.
Table 1.
Participant Personal and Oral Health Problems for the Weighted Study Sample
| Participant Characteristics | N | % |
|---|---|---|
| Total N | 635 | 100.0 |
| Age [Mean ± SE]: 71.5 ± 0.4 | ||
| Female | 343.8 | 54.1 |
| Ethnicity | ||
| African American | 135.9 | 21.4 |
| American Indian | 195.3 | 30.7 |
| White | 303.8 | 47.8 |
| Education | ||
| Less than High School | 353.7 | 55.7 |
| High School | 155.8 | 24.5 |
| More than High School | 125.5 | 19.8 |
| Has Health Insurance | 593.5 | 93.5 |
| Has Dental Insurance | 64.1 | 10.1 |
| Poverty | ||
| Below Poverty Level | 204.0 | 32.1 |
| Above Poverty Level | 431.0 | 67.9 |
| Number of Teeth | ||
| None | 221.7 | 34.9 |
| 1 to 10 | 105.2 | 16.6 |
| 11 to 20 | 130.6 | 20.6 |
| 21 to 32 | 177.6 | 28.0 |
| Oral Health Problems | ||
| Oral Pain | 69.4 | 10.9 |
| Bad Breath | 126.2 | 20.0 |
| Ill Fitting Dentures | 135.2 | 21.4 |
| Bleeding Gums | 135.4 | 21.5 |
| Dry Mouth | 308.8 | 48.6 |
| Stained Teeth (among dentate) | 178.5 | 43.4 |
Substantial percentages of the participants had oral health problems. Over one-third had no teeth, and 16.6% had from one to ten teeth. More than one in ten had oral pain. More than one in five participants had dentures that did not fit, bleeding gums, or bad breath. Almost half of the participants had dry mouth. Of the dentate participants, 43.4% had stained teeth.
Self-Care Behaviors
The older adults engaged in a variety of self-care behaviors (Table 2). The most prevalent behaviors involved the use of OTC Dental Products (84.0%), particularly mouthwash (77.9%), hydrogen peroxide (28.2%), and denture products (21.6%). OTC gels and salves were used by 10.6% of the older adults. OTC Medicine was used by 12.2%. Few older adults used Prescription Medicine (0.9%).
Table 2.
Self-Care Behaviors used for Oral Health among Rural Older Adults
| Self-Care Behaviors | N | % |
|---|---|---|
| OTC Medicine* | 77.4 | 12.2 |
| OTC Dental Products* | 533.4 | 84.0 |
| Hydrogen peroxide | 179.1 | 28.2 |
| OTC gels and salves | 67.6 | 10.6 |
| Denture products | 137.3 | 21.6 |
| Special toothpaste | 8.7 | 1.4 |
| Mouthwash | 494.4 | 77.9 |
| Other | 0.4 | 0.1 |
| Prescription Medicine* | 5.7 | 0.9 |
| Salt* | 323.2 | 50.9 |
| Prayer* | 38.4 | 6.0 |
| Complementary Therapies | 115.9 | 18.2 |
| Teabags/herbs* | 12.3 | 1.9 |
| Herbs or teas | 9.5 | 1.5 |
| Tobacco | 3.3 | 0.5 |
| Hot/cold (ice)* | 34.8 | 5.5 |
| Placing aspirin on the affected area* | 20.8 | 3.3 |
| Massaging gums* | 0.3 | 0.04 |
| Liquor* | 2.9 | 0.5 |
| Spices* | 6.3 | 1.0 |
| Vanilla extract | 5.2 | 0.8 |
| Other | 2.7 | 0.4 |
| Rinsing mouth with toxic substances* | 28.9 | 4.5 |
| Other home remedies | 33.4 | 5.3 |
| Epsom salts | 2.8 | 0.4 |
| Baking soda | 24.7 | 3.9 |
| Vinegar | 2.7 | 0.4 |
| Mechanical | 1.1 | 0.2 |
| Other | 4.6 | 0.7 |
| Vitamins and minerals | 7.6 | 1.2 |
| Vitamins | 7.6 | 1.2 |
| Minerals | 2.0 | 0.3 |
| Relaxation techniques | 5.1 | 0.8 |
Behaviors delineated Cohen et al. 2007.
Salt was used by over half of the older adults. Complementary Therapies were used by almost one in five participants. Use of Complementary Therapies included a diverse set of behaviors, with no single behavior being used by more than about 5% of the older adults. The most widely used Complementary Therapies were the use of hot/cold (5.5%), rinsing the mouth with toxic substances (4.5%), and placing aspirin on an affected area (3.3%). For the general category, other home remedies, 3.9% used baking soda.
Personal and Oral Health Problems Associated with Self-Care Behaviors
In addition to the major self-care behavior categories (OTC Medicine, OTC Dental Products, Salt, and Complementary Therapies), Hydrogen peroxide is include in further analyses because it had sufficient variability in its use (more than 25% but less than 75%).
Age and gender have some association with these self-care behaviors, with younger age slightly reducing the odds of using OTC Medicine and Hydrogen Peroxide, while women have a greater odds than men for using OTC Medicine and Salt (Table 3). Ethnicity is consistently related to the use of self-care behaviors such that minorities have a greater odds than whites of using most self-care behaviors. African American older adults have over twice the odds of using OTC Medicine, OTC Dental Products, and Hydrogen Peroxide than do white older adults. American Indian older adults have over twice the odds of using OTC Medicine, OTC Dental Products, Hydrogen Peroxide, and Salt than do white older adults. Older adults do not differ by ethnicity in the use of Complementary Therapies.
Education is also consistently associated with the self-care behaviors. Those with less than a high school education have a greater odds of using OTC Medicine, Hydrogen Peroxide and Salt than do those with more than a high school education. Those with a high school education do not differ in the self-care behaviors from those with more than a high school education. Poverty status is not related to use of any of the self-care behaviors.
The associations of number of teeth with self-care behaviors indicated three strong patterns. Those with fewer teeth (0 or 1 to 10 versus more than 20) had lower odds of using Hydrogen Peroxide. Those with fewer teeth (0 or 11 to 20 versus more than 20) had greater odds of using Salt. Those with fewer teeth had lower odds of using Complementary Therapies. Those with no teeth versus those with more than 20 teeth had a greatly lower odds of using OTC Medicine. Those with some teeth (11 to 20) had over twice the odds compared to those with more than 20 teeth of using OTC Dental Products.
Oral health problems had the most consistent patterns of association with self-care behaviors. Those with any oral health problem, except Ill Fitting Dentures, had a greater odds of using almost all of the self-care behaviors. Those with Oral Pain, Bad Breath, Bleeding Gums, Dry Mouth, and Stained Teeth had a greater odds of using OTC Medicine, Hydrogen Peroxide, and Salt. Additionally, those with Ill Fitting Dentures had a greater odds of using Salt. Those with Oral Pain, Bad Breath, and Bleeding Gums had a greater odds of using OTC Dental Products. Those with Oral Pain, Bad Breath, and Bleeding Gums had a greater odds of using Complementary Therapies.
Multivariate Analysis
Although the multivariate models reduce the number of statistically significant associations of personal characteristics and oral health problems with the categories of self-care behaviors for all participants and dentate participants, most of the general patterns present in the bivariate analyses remain (Table 4). Age is no longer significantly associated with any of the self-care behaviors. Being female increases the odds of using OTC medicines for all participants, and of using Salt for all participants and dentate participants. Ethnicity remains consistently related to the use of OTC Dental Products and Hydrogen Peroxide, with both all and dentate African American and American Indian older adults having two to three times the odds of using these self-care behaviors than white older adults. Dentate American Indian older adults have twice the odds of using Salt compared to white older adults. Controlling for the other variables, older adults do not differ in the use of OTC Medicine or in the use of Complementary Therapies by ethnicity. Education has little association with the use of the self-care behaviors.
Table 4.
Multivariate Logistic Models of Personal Characteristics and Oral Health Problems with Self-Care Behaviors used for Oral Health among Rural Older Adults
| Personal Characteristics and Oral Health Problems | All Participants | Dentate Participants | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| OTC Medicine |
OTC Dental Products |
Hydrogen Peroxide | Salt | Comp. Therapies |
OTC Medicine |
OTC Dental Products |
Hydrogen Peroxide |
Salt | Comp. Therapies |
|
| Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
Odds Ratio (95% CI) |
|
| Age | ||||||||||
| Female vs Male | 2.06 (1.14, 3.75) | 1.64 (1.16, 2.31) | 1.60 (1.01, 2.54) | |||||||
| Ethnicity (vs white) | ||||||||||
| African American | 2.35 (1.31, 4.20) | 3.17 (1.97, 5.10) | 2.31 (1.01, 5.25) | 3.47 (1.95, 6.18) | ||||||
| American Indian | 2.76 (1.38, 5.51) | 3.09 (1.86, 5.12) | 2.58 (1.01, 6.60) | 3.33 (1.82, 6.09) | 2.02 (1.18, 3.44) | |||||
| Education (vs >HS) | ||||||||||
| <HS | 2.86 (1.19,6.90) | 0.44 (0.22, 0.89) | ||||||||
| HS | ||||||||||
| Number of Teeth (vs >20) | ||||||||||
| 0 | 0.40 (0.23, 0.71) | 0.31 (0.17, 0.58) | -- | -- | -- | -- | -- | |||
| 1–10 | 0.52 (0.28, 0.96) | 0.33 (0.16, 0.67) | 0.29 (0.14,0.61) | |||||||
| 11–20 | 1.96 (1.18, 3.26) | 0.37 (0.20, 0.68) | 2.02 (1.18,3.46) | 0.36 (0.19,0.68) | ||||||
| Oral Pain | 6.77 (3.47,13.21) | 1.96 (1.03, 3.71) | 6.79 (3.18,14.46) | |||||||
| Bad Breath | 4.35 (1.66,11.42) | 1.78 (1.04, 3.04) | ||||||||
| Ill Fitting Dentures | 1.78 (1.01, 3.14) | |||||||||
| Bleeding Gums | 1.96 (1.05, 3.66) | 1.88 (1.18, 3.01) | 2.70 (1.69, 4.30) | 2.02 (1.19, 3.45) | 3.73 (1.88, 7.39) | 2.31 (1.16, 4.58) | ||||
| Dry Mouth | 1.59 (1.06, 2.40) | 0.42 (0.24, 0.74) | ||||||||
| Stained Teeth (dentate only) | -- | -- | -- | -- | -- | |||||
The three strong patterns of association between number of teeth with self-care behaviors largely remain in the multivariate analysis. Among all participants, those with fewer teeth (0 or 1 to 10 versus more than 20) had lower odds of using Hydrogen Peroxide. Among all participants and dentate participants, those with fewer teeth (11 to 20 versus more than 20) had greater odds of using Salt. Among all participants and dentate participants, those with fewer teeth had lower odds of using Complementary Therapies.
Many of the associations of oral health problems with the self-care behaviors remained in the multivariate analysis. The odds of using OTC Medicine was greatly increased among all participants and dentate participants with oral pain; the odds of OTC Medicine was greater among all participants with bleeding gums. The use of OTC Dental Products was greater among all participants with bad breath. The odds of using of Hydrogen Peroxide was greater among all participants with bleeding gems and dry mouth. Among all participants and dentate participants, the odds of using Salt was greater among those with bleeding gums. The odds of using Complementary Therapies was greater among all participants with oral pain, bad breath, and bleeding gums. Among dentate participants, the odds of using Complementary Therapies was greater among those with bleeding gums, but less among those with dry mouth. Ill-fitting dentures and stained teeth were not related to any of the self-care behaviors in the multivariate analyses.
Discussion
Older adults use a wide variety of self-care behaviors. Many of these are OTC Dental Products and OTC Medicine. These are adjuncts to professional care that may be recommended by a professional care provider. Salt, the most widely used specific, non-OTC product, may be a home remedy, but its use is also often recommended by a professional care provider. While a long list of potential self-care behaviors was elicited from focus groups by Cohen and colleagues (6), when asked about actual use, most older adults do not use them.
Research on medical self-care has focused largely on persons with chronic conditions, such as osteoarthritis and diabetes (14–17). Research in dental self-care has focused largely on how individuals address tooth pain (6,7,10). This analysis shows that use of self-care is associated with several different oral health conditions in addition to tooth pain. Oral pain (which is the actual measure used in this analysis rather than tooth pain) is an important condition that evokes all of the major self-care behaviors included in this analysis. However, only 11% of the older adults in this study reported having oral pain, and the number of older adults using many of the self-care behaviors far exceeds the number who report experiencing oral pain. Bleeding gums also evokes the use of all the major self-care behavior categories included in this analysis, whereas dry mouth evokes all of the major self-care behavior categories other than complementary therapies, and stained teeth evokes the self-care behaviors of OTC Medicine, Hydrogen Peroxide and Salt. To understand the process by which older adults and all adults implement self-care behaviors for oral health, and the interaction of those self-care behaviors with oral health for all adults, researchers must consider conditions in addition to pain.
This research has focused on older adults who generally have multiple health problems with which they must deal. It is likely that these older adults are using multiple self-care behaviors for conditions in addition to oral health problems. Analyses of dental self-care behaviors need to be considered in light of the other self-care behaviors in which older adults are engaged.
Some gender, ethnic, and class differences are apparent in the use of dental self-care behaviors. Greater use of OTC products for self-care by women and minority group members is consistent with other research (18,19). However, more important than gender or ethnicity, use of dental self-care behaviors is driven largely by need. Those with oral pain, bleeding gums, and dry mouth are much more likely to engage in most of the dental self-care behaviors, including the use of complementary therapies. The reasons for lower use of hydrogen peroxide and complementary therapies by those with fewer teeth is not clear.
The use of complementary therapies can be an important component of self-care behaviors. A substantial body of research has begun to delineate the epidemiology of complementary therapies in the US (e.g., 20), and specifically among older adults (13). Virtually no research has documented the actual types of complementary therapies that are being used for oral health or the prevalence of these complementary therapies. Discounting self-care behaviors such as salt and hydrogen peroxide, which may be prescribed by professional care providers, almost one-fifth of the rural older adults in this study used some form of complementary therapy. These older adults use a wide variety of complementary therapies, although no one complementary therapy is widely used. Some of these complementary therapies, like the use of temperature, baking soda, vinegar, vitamins or minerals, may be innocuous. The use of other complementary therapies, such as placing aspirin on affected areas and rinsing the mouth with toxic products (rubbing alcohol, chlorine bleach), are dangerous. Greater research is needed on the use of complementary therapies in dental self-care. Dental care providers need to discuss the use of complementary therapies with their patients.
The results of this analysis must be interpreted in light of specific limitations. The research on which this analysis is based used a cross-sectional survey design. Therefore, it is not possible to document causal relationships, and the results are subject to the recall bias of the participants. The research was conducted in two rural southern counties, and this may limit the generalization of results to adults in other regions. The survey questionnaire included a limited number of self-care behavior items. However, the research included a large, random, ethnically diverse sample. The survey questionnaire allowed for participants to volunteer self-care behaviors beyond the specified items.
This research shows that most rural adults engage in a variety of dental self-care behaviors, including the use of OTC products and complementary therapies. Minority group members engage in some self-care behaviors, particularly the use of OTC Dental Products, more than whites. However, the major factor leading to the use of self-care behaviors is need. Although oral pain does increase the use of self-care behaviors, so do bleeding gums and dry mouth. Investigators need to expand analysis of dental self-care behaviors and the relationship of self-care behaviors to the use of professional services. Further research is also needed to explore the use of complementary medicine in dental self-care.
Acknowledgments
This research was funded by the National Institute for Dental and Craniofacial Research, grant R01 DE017092.
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