Oral health among the indigenous Sámi population. A population-based study on periodontal health, dental caries, and oral health-related quality of life

Abstract

<p><i>Background/Aim:</i> The lack of scientific knowledge on oral health in Sámi populations and the regional differences in caries experience among children in Northern Norway has raised the question of whether the high prevalence of oral disease in that geographic area differs by ethnicity. Evidence-based knowledge on oral health conditions in adults in these areas is scarce. The overall objective of the thesis was to assess oral health in an adult population in core Sámi areas in Northern Norway, with a focus on periodontal disease, dental caries, and oral health-related quality of life (OHRQoL), and their associated risk factors, in Sámi and non-Sámi populations. <p><i>Methods:</i> The thesis is based on a cross-sectional study of adults aged 18 to 75 years in core Sámi areas in Northern Norway, the Dental Health in The North Study. Data collection was incorporated into daily clinical procedures at six Public Dental Health Services clinics in 2013-2014; it included both clinical and radiographic examination, and a questionnaire. Periodontal probing depth (PPD) was assessed at six sites per tooth for all teeth, except the third molar, and post-clinical measurement of radiographic bone loss was conducted. A five-grade diagnostic scale was used to register caries severity on approximal, buccal, lingual/palatinal, and occlusal surfaces. OHRQoL was assessed with Oral Health Impact Profile-14 (OHIP-14). <p><i>Results:</i> Altogether, 2235 adults participated in the study, giving a crude response rate of 88.7%. In total, 2078 were included in the study, and of them, 66.5% reported Sámi affiliation and 57% were women. Three ethnic groups were constructed (Sámi, mixed Sámi/Norwegian, and Norwegian), and in most analyses, ethnicity was dichotomized into Sámi and non-Sámi. According to the modified version of the new American Academy of Periodontology and the European Federation of Periodontology classification system of periodontitis, 49.7% of participants had periodontitis, with 20.1% having stage III/IV, i.e. severe periodontitis. No differences in the prevalence of periodontitis between Sámi and non-Sámi participants were found; however a higher proportion of Sámi had PPD ≥6 mm and a higher probability of severe periodontitis. The overall caries experience among adults in core Sámi areas was high, but differed by region of residence. The mean number of decayed (D), missing (M), and filled (F) teeth (T), which make up the DMFT score, was 16.2 (standard deviation [SD]=6.7), with a significant difference between Sámi (15.7, SD=6.7) and non-Sámi (17.0, SD=6.7) (p<0.05). The mean DT was 1.0 (SD=1.7) in the overall study sample, and 1.0 (SD=1.6) among participants with Sámi affiliation. Sámi from the coastal region had a significantly higher mean DT (1.3, SD=1.8) than inland Sámi (0.8, SD=1.5) (p<0.05), but no ethnic differences in the prevalence of caries were observed within these regions. Factors associated with the prevalence of caries were frequent consumption of sugary soft drinks, toothbrushing less than daily, and irregular dental visits. Both Sámi and non-Sámi participants experienced oral health-related problems that impacted their daily lives. Eighty percent experienced problems related to oral conditions, and around 10% experienced problems fairly often or often (frequent problems). The mean OHIP-14 score among Sámi participants was 5.4 (SD=6.0), significantly higher than among non-Sámi (4.4, SD=5.2). Sámi women experienced problems more often than Sámi men, and Sámi from younger age groups reported problems more often than those from older age groups. Other factors associated with experiencing problems fairly often or often were irregular dental visits, number of teeth, periodontitis and caries. <p><i>Conclusion:</i> Periodontitis and caries were common among adults in core Sámi areas in Northern Norway, regardless of ethnicity. Caries was more prevalent in the coastal region than in the inland region, but no ethnic differences in the prevalence of caries within these regions was found. Four of five adults in these areas experienced problems related to oral conditions or oral diseases that impacted their daily life.

<p><i>Čoahkkáigeassu Duogáš dutkamii / Váldomihttu:</i> Almmolaš bátnedearvvašvuođa dieđut čájehit ahte leat báikkálaš erohusat bátnedearvvašvuođas mánáin ja nuorain Davvi-Norggas, muhto eai gávdno dieđut leat go čearddalaš erohusat. Dutkojuvvon máhttu Norgga álbmoga bátnedearvvašvuođas lea hui vánis, ja sápmelaččaid bátnedearvvašvuohta ii leat vuđolaččat dutkojuvvon. Dán dutkamuša váldomihttu lea leamaš kártet bátnedearvvašvuođadiliid, oktan gullevaš sivaiguin, sápmelaččain Davvi Norggas. Mihttu lei iskat bátnebeassandávdda ja karies leavvama rávisolbmuin sámi álbmogis ja álbmogis geat eai leat sápmelaččat, ja maiddai iskat movt bátnedearvvašvuođaguoski eallinárvu lea dáin čearddalaš joavkkuin. <p><i>Metoda:</i> Dutkosis leat geavahan dieđuid Tannhelse i Nord prošeavttas, mas rávisolbmot gaskal 18 ja 75 jagi oassálaste. Guorahallan čađahuvvui guđa almmolaš bátnedearvvašvuođa klinihkas sámegiela hálddašanguovlluin Finnmárkkus 2013-2014is. Bátnedoaktárat/ bátnedivššárat iske ja govvejedje røntgengovaid buot bániin, earret agibániin, ja oasseváldit devde jearaldatskovi. Klinihkalaš iskkadeamis vižže dieđuid juohke báni ektui, gos juohke bánis mihtiduvvui guđa sajis man čieŋal bátneoažžegaska lea ja galle millimehtera dákti lea nohkan. Karies mihtiduvvui approksimala, bukkala, linguala/palatinala, ja okklusala duolbadasain, skálas 1 gitta 5. Bátnedearvvašvuođaguoski eallinárvu lea mihtiduvvon Oral Health Impact Profile-14iin (OHIP-14). <p><i>Bohtosat:</i> Dán dutkamii serve oktiibuot 2235 rávisolbmo, mii lea 88.7 % jerron oasseváldiin. Ledje 2078 olbmo geat čađahedje sihke klinihkalaš iskosa ja devde ollislaččat jearaldatskovi. Dáin ledje 66.5 % sámi čearddalačča ja 57 % nissonolbmo. Oassálastit juohkásedje golmma čearddalaš jovkui (sámi, sihke sámi/norgalaš čearddalašvuohta ja norgalaččat), muhto analiissain bohtet ovdan guoktin joavkun; sámit ja eai-sámit. Dán dutkamis geavahuvvo muddejuvvon veršuvdna ođđa American Academy of Periodontology and the European Federation of Periodontology klassifiseren vuogádagas go árvvoštallá dási bátnebeassandávddas (Dássi I-IV). Obbalaččat duođaštuvvui bátnebeassandávda 49.7 % sin gaskkas geat serve dutkamii, ja daid gaskkas lei 20.1 % duođalaš bátnebeassandávda (dássi III/IV). Čearddalaš erohusat eai gávdnon bátnebeassandávdda leavvamis, muhto eanet sámiin ledje gurat ≥6 mm ja sis lei stuorat várra sámiin leat duođalaš bátnebeassandávda. Dán dutkama logut čájehit ahte rávisolbmot leat vásihan ráigebániid, muhto loguin leat báikkálaš erohusat. Dat obbalaš gaskamearalaš lohku ráigánan (decayed=D), beassan (missing=M), ja devdon (filled=F) bániin (teeth=T); DMFT lohku, lei 16.2 (standard erohus [SE]=6.7), dat lohku lei unnit sápmelaččaid gaskkas (15.7, SD=6.7) go eai-sámiin (17.0, SD=6.7) (p<0.05). Gaskamearalaš lohku ráigánan bániin lei obbalaččat 1.0 (SE=1.7), ja 1.0 (SD=1.6) sámiid gaskkas. Sámiin riddosuohkaniin lei dát lohku stuorat (1.3, SE=1.8) go siseatnan sámiin (0.8, SE=1.5) (p<0.05), muhto eai lean čearddalaš erohusat guovllu siskkobealde. Čuohcci fáktorat ráigebániide ledje jus dávjá juhká sohkarjuhkosiid, jus ii geala bániid beaivválaččat dahje jus hárve fitná bátnedivššohagas divššus. Sihke sámit ja eai-sámit vásihedje ahte bátnedearvvašvuođa váttut čuhce árgabeaivái. Gávccilot proseantta sis geat serve dán dutkamii ledje oktii dahje dávjjit vásihan váttuid (dahje givssiid) bátnedearvvašvuođa ektui, ja sullii 10 % ledje vásihan dan oalle dávjá dahje dávjá. Gaskamearalaš OHIP-14 lohku sámiid gaskkas lei 5.4 (SE=6.0) ja eai-sámiid gaskkas fas 4.4 (SE=5.2) (p<0.05). Sámi nissonat vásihedje bátnedearvvašvuođaguoski váttuid/givssiid dávjjibu go sámi dievddut, ja nuorat fas dávjjibu go vuorraset olbmot. Muđui gávnnahuvvui ahte sii geat hárve ohcalit bátnedivššu, sis geain váilot bánit dahje lea bátnebeassandávda dahje karies, vásihit bátnedearvvašvuođaguoski váttuid dávjjibu go earát. <p><i>Konklušuvdna:</i> Bátnebeassandávda ja karies leat dábálaččat rávisolbmuin sámi guovlluin Finnmárkkus Davvi Norggas, beroškeahttá čearddalašvuođas. Rávisolbmuin riddosuohkaniin leavvá karies eambbo go siseatnan suohkaniin, muhto eai leat čearddalaš erohusat siskkobealde guovlluid. Njealjis viđa olbmos vásihit bátnedearvvašvuođaguoski váttuid mat váikkuhit beaivválaš doaimmaide.