Factors associated with regular dental care in people with spinal cord injury: Results from the FRASCI study
1Coker J, 1Morse L, 2Battaglino R
1Craig Hospital, Englewood, CO, US; 2University of Colorado - Anschutz Medical Campus, Aurora, CO, US
Objective: The Surgeon General's Report on Oral Health noted that oral health is critical to overall health. Studies have found associations between oral health and bacteremia, respiratory disease, diabetes, and heart disease. Poor oral health can lead to pain and trouble eating and sleeping, all of which affect quality of life, and can impact self-image and social functioning. Regular dental care is crucial to maintaining oral health. People with spinal cord injury (SCI) are at increased risk for health conditions that can be affected by poor oral health, as well as poor quality of life. Studies have found that people with SCI have worse oral health than the general population. The purpose of this analysis was to examine factors associated with regular dental care in people with SCI.
Design: We analyzed data from 348 individuals with SCI who were enrolled in the longitudinal Fracture Risk after SCI (FRASCI) study and had their first study visit from April 2009 to September 2014. Inclusion criteria were at least 22 years of age, at least one year post-injury, not ventilator dependent, no tracheostomy, and no other neuromuscular disease. The independent variable of interest was "Do you receive regular dental care twice per year?" Dependent variables included demographics, injury-related variables, secondary conditions, and psychosocial outcomes. Categorical variables were analyzed with chi square tests of independence, while continuous variables were analyzed by independent t test; the final model was determined by a multivariate logistic regression.
Results: Over 60% of the sample received regular dental care. Receiving regular dental care was significantly associated with sex (higher proportion of women than men received regular dental care), marital status (higher proportion of married compared to not married), employment status (higher proportion of working individuals), years of education (more years of education), and insurance type (private insurance). Higher level of injury and needing a caregiver were associated injury-related variables. More urinary tract infections were the only related secondary health condition, and quality of life in the past week (higher scores) was the only related psychosocial outcome. After adjusting for significant variables noted above, the primary predictor of regular dental care was insurance type (private insurance and Medicaid).
Conclusion: A higher proportion of working individuals and married women with regular dental care may be related to insurance coverage. The association of regular dental care with level of injury and urinary tract infections was surprising, but is likely related to those participants receiving regular medical care overall. As regular dental care was also associated with health and quality of life in our sample, future work is needed to determine the association between oral health and systemic health after SCI. Furthermore, because dental pulp has been identified as a source of autologous stem cells with implications for cure research, access to regular dental care also may have implications for future research.
Support: NICHD (R21HD057030 & R21HD057030), National Institute of Arthritis & Musculoskeletal & Skin Diseases (1R01AR059270), NIDILRR (90SIU5015).
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