The Connection Between Socioeconomic Inequalities
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Psychiatria Danubina, 2020; Vol. 32, Suppl. 4, pp S576-582 Medicina Academica Mostariensia, 2020; Vol. 8, No. 1-2, pp 178-184 Original paper © Medicinska naklada - Zagreb, Croatia THE CONNECTION BETWEEN SOCIOECONOMIC INEQUALITIES AND THE APPEARANCE OF THE TOOTHLESSNESS IN MOSTAR Bajro Sariü1, Kristina Galiü2,3, Belma Sariü Zolj3, Zdenko Šarac2, Marina ûurlin2 & Ivan Vasilj2 1Regional Medical Centre Mostar, Mostar, Bosnia and Herzegovina 2Medical School Mostar, Mostar, Bosnia and Herzegovina 3University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina received: 11.12.2019 revised: 7.5.2020 accepted: 7.7.2020 SUMMARY Background: To determine the existence of the toothlessness within the patients in the area of Mostar. The aim is to determine the topography of toothlessness within the population of Mostar, according to Kennedy classification. The aim is to connect measures of socioeconomic status with the appearance of the toothlessness. To develop a model that includes a form of toothlessness and the socioeconomic status of the patients in Mostar. Subjects and methods: The study was conducted at the Health Center in Mostar and the Regional Medical Center in Mostar. The research was cross-sectional study. It included 800 patients who regularlyoccurred to the dental ambulance because of the toothlessness and because of the prosthodontics treatment. The measurement was conducted by the dentist based on the anonymous research cardboard at the first examination of the patient. The dentist will determine the topography of the toothlessness according to Kennedy classification and the etiology of the toothlessness. Results: In the total sample of respondents, the toothlessness was significantly higher represented (P<0.001). The manifestation of thetoothlessness was significantly higher among temporary employees and the retirees (P<0.001). In the total sample, toothless- ness affected the sociological status of a higher percentage of the respondents (P<0.001). Conclusion: In our study, in a total sample of respondents, toothlessness was significantly higher represented (90% of respondents). The influence on the sociological status of the patient is most visible in the groups with the lower material status. Key words: toothlessness - socioeconomic status - topography - Mostar * * * * * INTRODUCTION ranged from 2 to 10 of caries on 100 teeth, so that in the 1000 years BC prevalence increased to 24 caries on 100 A partial or complete toothlessness is defined as a teeth (Larsen et al. 1991, Price 1989). There was the disease state in the patient's mouth caused by extraction initiation of the sugar in the daily nutrition that influen- of the one, more or of the all teeth in the one or both ced on an increased rate of the caries prevalence (Dawes jaws (Suvin 1984, 1991). The main consequence of this 1989). Caries appearance is caused by dynamic process, occurrence is the distortion of the external appearance in which occurs the process of demineralization of the of orofacial system, and sometimes of the facial hard dental tissue. The certain products of bacteria symmetry. The orofacial system is the backbone of the affect the process of demineralization, especially Strep- appearance of the patient in the terms of the social tococcus mutans, as well as the ferments of carbo- perception and the recognizability of the patient hydrates. In the beginning of its development, caries (Knezoviü Zlatariü et al. 2001, Trifunoviü et al. 1995). clinicalmanifests in the form of the white spot (macula The most common cause of the loss of the teeth is cariosa) on the lead glaze, which later changes to the dental caries, which if it is not treated on time leads to brown or black and depends on whether the caries the large destruction, not only of the teeth crown, but begins its development on a smooth surface or on the also of the root and the bone itself, and then the only fissures. The World Health Organization (WHO 1995) way out is the tooth removal.The occurrence of the adopted the doctrinal principles about the prevention of caries in the human development had several stages, caries, where the role of fluoride in the prevention of from sporadic to epidemic occurrence (Gvozdenoviü- formation of caries was pointed out.Examples from the Simiü 1994, Aurer Koželj 1996, Cockburn 1995). Based US suggest that the prevalence rate in some regions is on archaeological findings, it was assumed that in the insignificant and that is under the complete control, but Neolithic and Bronze Age the caries occurrence was still in some areas toothlessness is a serious public very low and it occurred under 1% (Day 1965, Hillson health problem. 1996, Keeih 1925). Based on archeological research that So, data among children of immigrants from Mexico was conducted in France, Greece, Denmark and Great indicate that the rate of the prevalence of the caries Britain it was estimated that in the countries of the ranges from 21 to 46%, which is much more than in Europe in the first 4000 years BC the caries prevalence Central America where the rate of the caries ranges 178 Bajro Sariü, Kristina Galiü, Belma Sariü Zolj, Zdenko Šarac, Marina ûurlin & Ivan Vasilj: THE CONNECTION BETWEEN SOCIOECONOMIC INEQUALITIES AND THE APPEARANCE OF THE TOOTHLESSNESS IN MOSTAR Medicina Academica Mostariensia, 2020; Vol. 8, No. 1-2, pp 178-184 between 6% and 9%. The reason of increasing of the in the German population. According to data in Ger- rate of caries prevalence among the certain groups is man research about the oral health, 22.6% of the associated with the lower oral hygiene in one hand and retirees are toothless. In European comparison, there with the lower socioeconomic status (Herbert et al. are higher values in Great Britain and Ireland, where 2008). In the countries of the Eastern Europe despite almost 50% of those over 65 years old does not have the efforts of the health service to reduce the rate of any of their own teeth. Austria and Switzerland with the caries prevalence, the results are achieved very 15% have significantly less toothless retirees. The slowly (Stamenkoviü et al. 2003, Žabaroviü et al. 2008). condition of the oral health of the adult population of The aim of the therapy in the dental prosthetic is to all countries is characterized with the high degree of restore the disturb function and aesthetics after the loss the loss of teeth and with toothlessness. It is noticed of teeth and to prevent and slow down the changes in the high level of addiction between the age and oral the alveolar ridge, by the prosthetic device, fixed and status. Among 90% of all respondents the periodontal mobile, as the way of the therapy (Hellden et al. 1989, disease is presented. In order to improve the condition Slade 1990, Truin et al. 1988). In the former scientific of the oral health among the older population the researches the connection of the certain risk factor concept of preventive measures for the reduction of with the appearance of the poor condition of the caries and periodontal disease appropriate to the life denture and toothlessness is showed. A review of this age as well as appropriate guidelines of the treatment area of the research shows the existence of the wide with the aim of prolonged preservation of the natural range of connection of poorer socioeconomic state teeth is needed (Frisk et al. 2003, Locker et al. 1991, with the unfavorable health outcomes. In addition to WHO 2007, Sisson 2007). age and the gender, as two common factors that can strongly influence on the various biomedical outcomes, The topography of the toothlessness the recent medical literature often focuses on socio- economic inequality as a risk factor or even the cause The topography of the toothlessness is a constant of several conditions or diseases. These results were default in the dental science. described in the dentistry, and they almost systemati- The simplest topographic classification is according cally speak in favor of poorer condition of the denture, to the criterion of the interrupted or shortened dental a greater chance of loss of one or more teeth and con- arch, or according the position of the toothless alveolar sequently higher incidence of toothlessness among the ridge in relation to the remaining teeth. people of the lower socioeconomic status (Minach Kennedy divides the topographic toothlessness in 1991, Jerolomov 2005, Herbert et al. 2008, Stamen- the four classes and the corresponding subclasses; the koviü et al. 2003, Žabaroviü et al. 2008, Hellden et al. criterion is the relation of the toothless spaces according 1989, Slade 1990). In the available medical literature, to remaining teeth. none of those studies were completely focused on the Class I. are the cases when the toothless alveolar connection between the appearance of the toothless- ridge is located on the both sides behind the re- ness and the socioeconomic status. It is possible that maining teeth; there are significant differences in the location and the Class II. are the cases with unilateral alveolar ridge appearance of toothlessness, which are associated with behind the remaining teeth; some of the indicators of the socioeconomic status. The Class III. free space is unilaterally between the re- developed countries in the health care programs devote maining teeth; full attention to the primary and secondary prevention of the oral health (Stamenkoviü et al. 2003). In Canada, Class IV. toothless alveolar ridge is in front of the although there has been a significant reduction of the remaining teeth. prevalence of the caries in the last 15 years, it was estimated that the costs of the treatment of the caries SUBJECTS AND METHODS were about $ 3.1 billion, although these costs were lower by more than twice than they were in 1980. In a study The study was conducted at the Health Center of conducted among the older population in Mexico, 27% Mostar and at the Regional Medical Center in Mostar.