{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:49:28Z","timestamp":1791607768408,"version":"4.3.4"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS\u20102024\u201000347440"],"award-info":[{"award-number":["RS\u20102024\u201000347440"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Oral Rehabilitation"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chewing discomfort related to tooth loss is a common functional problem among older adults, and high out\u2010of\u2010pocket costs for prosthodontic rehabilitation may limit access to treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess whether age\u2010specific trends in self\u2010reported chewing discomfort changed around South Korea's stepwise expansion of National Health Insurance coverage for dental implants relative to a younger comparison group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used nationally representative repeated cross\u2010sectional data from the Korea Community Health Survey (2010\u20132024). A controlled interrupted time series design, using adults aged 60\u201364\u2009years as the comparison group, assessed age\u2010specific trajectories before and after phased implementation (2014 for \u2265\u200975\u2009years; 2015 for 70\u201374\u2009years; 2016 for 65\u201369\u2009years). Chewing discomfort was defined as self\u2010reported discomfort when chewing due to problems with teeth, dentures or gums. Survey\u2010weighted segmented logistic regression models were used to estimate immediate level changes and post\u2010intervention slope changes. A sensitivity analysis used adults aged 55\u201364\u2009years as an alternative comparison group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Chewing discomfort declined in all age groups, including the comparison group. No statistically significant differential immediate level change was observed. A differential post\u2010intervention slope change was consistently observed among adults aged 70\u201374\u2009years. No additional differential slope change was identified among adults aged 65\u201369\u2009years, who had already shown a faster pre\u2010intervention decline. The estimate among adults aged \u2265\u200975\u2009years was no longer statistically significant when adults aged 55\u201364\u2009years were used as the alternative comparison group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings indicate substantial secular improvement and age\u2010specific heterogeneity in policy\u2010timed changes in chewing discomfort, with the most consistent additional decline observed among adults aged 70\u201374\u2009years. However, they do not establish an implant\u2010specific treatment effect and highlight the need for age\u2010sensitive, post\u2010implementation evaluation and refinement of dental coverage based on functional outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/joor.70340","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:22:36Z","timestamp":1791606156000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age\u2010Specific Changes in Chewing Discomfort During the Expansion of National Health Insurance Coverage for Dental Implants: A Controlled Interrupted Time Series Analysis in South Korea, 2010\u20132024"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7406-9675","authenticated-orcid":false,"given":"Eun\u2010ju","family":"Park","sequence":"first","affiliation":[{"name":"Dental Research Institute Seoul National University  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang\u2010Keum","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Dental Hygiene Daejeon Health University  Daejeon South\u00a0Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5964-0032","authenticated-orcid":false,"given":"Yoon Min","family":"Gil","sequence":"additional","affiliation":[{"name":"Dental Research Institute Seoul National University  Seoul South Korea"},{"name":"Department of Dental Education, School of Dentistry Seoul National University  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.1787\/8f9e3f98-en","volume-title":"Health at a Glance 2025: OECD Indicators","author":"OECD","year":"2025"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","DOI":"10.1787\/450ea778-en","volume-title":"Is Care Affordable for Older People?","author":"OECD","year":"2024"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1186\/s12889-019-7762-5","article-title":"Consequences of Chronic Diseases and Other Limitations Associated With Old Age \u2010 A Scoping Review","volume":"19","author":"Maresova P.","year":"2019","journal-title":"BMC Public Health"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"E151","DOI":"10.5888\/pcd13.160174","article-title":"Multimorbidity and Functional Limitations Among Adults 65 or Older, NHANES 2005\u20132012","volume":"13","author":"Jindai K.","year":"2016","journal-title":"Preventing Chronic Disease"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.arr.2011.03.003","article-title":"Aging With Multimorbidity: A Systematic Review of the Literature","volume":"10","author":"Marengoni A.","year":"2011","journal-title":"Ageing Research Reviews"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1111\/hsc.12311","article-title":"Social Isolation, Loneliness and Health in Old Age: A Scoping Review","volume":"25","author":"Courtin E.","year":"2017","journal-title":"Health & Social Care in the Community"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/S0140-6736(05)71146-6","article-title":"Social Determinants of Health Inequalities","volume":"365","author":"Marmot M.","year":"2005","journal-title":"Lancet"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/ger.12016","article-title":"Association Between Functional Tooth Units and Chewing Ability in Older Adults: A Systematic Review","volume":"31","author":"Naka O.","year":"2014","journal-title":"Gerodontology"},{"issue":"1","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/ggi.14783","article-title":"Factors Related to Subjective Evaluation of Difficulty in Chewing Among Community\u2010Dwelling Older Adults","volume":"24","author":"Seto E.","year":"2024","journal-title":"Geriatrics & Gerontology International"},{"issue":"1","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/ger.12617","article-title":"Prevalence of Chewing Difficulty in Older People in Long\u2010Term Care: A Systematic Review and Meta\u2010Analysis","volume":"40","author":"Abreu M. 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