Poor oral health is associated with social vulnerability in critically ill trauma patients.

Abstract

Background: Social factors affect oral health status, and poor oral health has been associated with worse health outcomes. Using the Oral Health Risk Assessment Value Index (OHRAVI), a bedside tool for non-dentists to assess oral health, we investigated the interplay of oral health with social drivers of health and social vulnerability, as measured by the Social Vulnerability Index (SVI), in severely injured patients.

Methods: Our retrospective study included dentulous critically ill trauma patients who were previously assigned an OHRAVI score (range 0-3; unhealthy score >1). Patient demographics, comorbidities, and self-reported social drivers were obtained from health records. SVI was calculated using census-tract data. Bayesian regression analyses were performed to calculate posterior probabilities of an association between risk factors and poor oral health (PP OR >1).

Results: Among 170 patients, 91 (54%) patients had unhealthy OHRAVI scores. Median index OHRAVI score was 1.13 (IQR 0.86-1.43); median SVI was 0.7 (0.5-0.9). Median OHRAVI scores were higher in the high SVI group (SVI >0.7; OHRAVI 1.19) than in the low SVI group (SVI <0.7; OHRAVI 1.06, p=0.026). Social factors associated with poor oral health from Bayesian analysis (PP OR>1) included lack of social support (99%), housing instability (99%), divorced marital status (87%), and non-English primary language (86%). Social vulnerability was also associated with poor oral health (98%).

Conclusions: Poor oral health in critically ill injured patients was associated with lack of social support, housing insecurity, divorced marital status, non-English primary language, and increased social vulnerability. OHRAVI may provide quick, objective bedside assessment to help identify socially vulnerable patients and serve as a marker for the presence of social risk factors that may portend poor outcomes. Oral health may be a modifiable risk factor, and early identification of patients may allow them to benefit from oral hygiene regimens, including treatment with antimicrobial agents.

Level of evidence: Level II/III, prospective/retrospective cohort study with only one negative criterion.