Sub-Optimal Oral Health, Multimorbidity and Access to Dental Care

INTRODUCTION Emerging research on the links between sub-optimal oral health and multimorbidity (MM), or the co-existence of multiple chronic conditions, has raised queries on whether enhancing access to dental care may mitigate the MM burden, especially in older age. Here, we aim to assess the association between sub-optimal oral health and MM and whether access to dental care can mitigate the risk of MM in individuals with sub-optimal oral health. METHODS We conducted a cross-sectional analysis using data from the Canadian Longitudinal Study on Aging (CLSA) (n=44,815, 45-84 years old). Edentulism, self-reported oral health (SROH), and other oral health problems (e.g., toothache, bleeding gums), were each used as indicators of sub-optimal oral health. MM was defined according to the Public Health Agency of Canada as having 2 or more chronic conditions out of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. Variables for access to dental care included the number of dental visits within the last year, dental insurance status, and cost barriers to dental care. We constructed multivariable step-wise logistic regression models and interaction terms with 95% confidence intervals and estimated prevalence ratio (PR) to assess the associations of interest, adjusting for a priori determined sociodemographic and behavioural factors. RESULTS Each of the sub-optimal oral health indicators were significantly associated with MM (edentulism PR=1.48, 95%CI 1.31, 1.68; poor SROH PR=1.81, 95%CI 1.62, 2.01; other oral health problems PR = 1.91, 95%CI 1.78, 2.06). The magnitude of this association was exacerbated in individuals who lacked dental insurance, could not afford dental care, and those who reported fewer dental visits within the last year. CONCLUSION The association between sub-optimal oral health and MM may be exacerbated by the lack of access to dental care. Policies aiming to enhance access to dental care may help mitigate the risk of MM. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Noha Gomaa is supported by funding from the Schulich School of Medicine & Dentistry, Western University and the Lawson Health Research Institute, London, Ontario, Canada. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This research was made possible using data collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the CLSA is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference: LSA 94473 and the Canada Foundation for Innovation, as well as the following provinces, Newfoundland, Nova Scotia, Quebec, Ontario, Manitoba, Alberta, and British Columbia. This research has been conducted using the CLSA first follow-up from the Comprehensive Dataset version 3.2 and Tracking Dataset version 2.3, under Application Number [2203002]. The CLSA is led by Drs. Parminder Raina, Christina Wolfson, and Susan Kirkland. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript