Dental services and perceived oral health: are patients better off going private?

Oral Health Indicators for Risk of Malnutrition in Elders

OBJECTIVES

Using both clinical parameters and subjective measures of oral health, this study aimed to identify useful oral health indicators for the risk of malnutrition in elders.

DESIGN

Cross-sectional study.

SETTING

Five community centers run by non-government organizations (NGOs).

PARTICIPANTS

195 community dwelling elders (65 or above).

MEASUREMENTS

An interviewer-administered questionnaire was completed to collect information on elders' socio-demographic background and oral health perception and practice. Their number of teeth, number of occluding tooth pairs, dental caries, and periodontal condition were examined. General Oral Health Assessment Index (GOHAI), an instrument for assessing oral health related quality of life (OHQoL), was used as a subjective measure of oral health. The elders' nutritional status was evaluated by using the Mini-Nutritional Assessment (MNA).

RESULTS

The mean (SD) DFT was 3.3 (3.1). Over 60% of elders had periodontal pockets; 33% had fewer than 20 teeth and 6% were edentulous. The mean (SD) of occluding tooth pairs was 7.1 (4.8). The mean (SD) total GOHAI score was 56.4 (8.0); 60% reported negative impact of oral health on their quality of life. The mean (SD) MNA score was 25.0 (2.9); 30% had malnutrition or were at risk. After controlling for socio-demographic factors, none of the clinical indicators (dental caries, periodontal status, number of teeth, and number of occluding tooth pairs) were associated with risk of malnutrition (all p>0.05). Poorer OHQoL indicated a higher chance for malnutrition in both adjusted models (OR of 0.914; 95% CI of 0.850-0.982; p=0.014 and OR of 0.915; 95% CI of 0.852-0.984; p=0.017). Tooth loss and untreated decayed teeth (DT) were significant/marginally significant determinants of poor OHQoL.

CONCLUSION

Elders' tooth loss and unmet treatment need for dental caries were associated with compromised quality of life, which indicated increased likelihood for malnutrition.

Diagnosing the severity of buccal caries lesions in governmental and private orthodontic patients at debonding, using the ICDAS-II and the DIAGNOdent Pen

OBJECTIVES

To clinically evaluate the prevalence of buccal caries and white spot lesions (WSLs) at debonding in governmental and private orthodontic patients, using the International Caries Detection and Assessment System (ICDAS-II) and the DIAGNOdent Pen, and to study the correlation between the two methods.

MATERIALS AND METHODS

A cross-sectional study was carried out on the nonextracted premolars and anterior teeth of 89 orthodontic patients. They were recruited into two groups based on the treatment center they attended: governmental group (G; n=45) and private group (P; n=44). Immediately after debonding, the examination of buccal caries and WSLs on premolars and anterior teeth was carried out using the ICDAS-II and the DIAGNOdent Pen. Cross-tabulation was applied to study the correlation between the ICDAS-II index and the DIAGNOdent Pen by calculating the Spearman correlation coefficient.

RESULTS

The G group showed a significantly higher (P<.0001) prevalence of WSLs and/or buccal caries compared to that of the P group based on evaluation by the two methods. Based on ICDAS-II, 43% of the patients in the P group and 9% in the G group were free from any WSLs. In the G group, 22% of the patients had ≥16 LESIONS, whereas there were none for the P group. The Spearman correlation coefficient between the two methods was .71.

CONCLUSIONS

The prevalence of caries and/or WSLs at debonding was significantly higher in the G group compared to the P group. The clinical index (ICDAS-II) showed a good correlation with the DIAGNOdent Pen.

Caries risk profile using the Cariogram in governmental and private orthodontic patients at de-bonding

OBJECTIVES

To analyze various caries-related factors in orthodontic patients at de-bonding, and to test the null hypothesis that there is no difference in caries risk between governmental and private orthodontic patients immediately after orthodontic treatment.

MATERIALS AND METHODS

A cross-sectional examination was carried out on 89 orthodontic patients aged 13-29 years, mean age 21.5 years. They were divided into two groups based on the center of treatment, governmental group (G) (n  =  45) and private group (P) (n  =  44). The investigation comprised a questionnaire, plaque scoring, caries examination, bitewing radiographs, salivary secretion rate, buffering capacity, and cariogenic microorganisms. Data were entered into the Cariogram PC program to illustrate caries risk profiles.

RESULTS

Findings revealed that "the chance of avoiding new cavities," according to the Cariogram, was high in the P-group and low in the G-group (61% and 28%, respectively) (P < .001). Decayed, missing, and filled surfaces (DMFS), plaque index, mutans streptococcus and lactobacillus counts, and salivary buffer capacity were significantly higher in the G-group compared with the P-group (P < .05). The total number of caries lesions at de-bonding in the G-group was more than two times higher than that in the P-group (150 vs 68) (P < .001).

CONCLUSIONS

The "chance to avoid new cavities" in orthodontic patients at de-bonding was less in the governmental group compared with the private group, as illustrated by the Cariogram. The governmental group also had significantly less favorable values than the private group for most of the caries-related factors.

Fatores associados à necessidade subjetiva de tratamento odontológico em idosos brasileiros

A transição demográfica pela qual o Brasil vem passando nos últimos anos produz como efeito um fenômeno mundialmente conhecido como envelhecimento populacional. Dessa forma, o objetivo deste estudo foi conhecer os fatores relacionados à necessidade de tratamento odontológico percebida por idosos brasileiros. Foi realizado um aprofundamento dos resultados encontrados no levantamento epidemiológico nacional de saúde bucal de 2003. O tamanho total da amostra foi de 5.349 indivíduos. Modelos de regressão de Poisson foram realizadas para identificar as variáveis individuais envolvidas na autopercepção de necessidade de tratamento odontológico. As variáveis associadas à necessidade subjetiva de tratamento odontológico foram diferentes para idosos edêntulos e não edêntulos. Estes achados são importantes para o planejamento da oferta de serviços de saúde bucal para a população, fornecendo uma estimativa sobre os principais problemas que estes indivíduos demandam e quantos necessitariam de atendimento.

Why do adults entitled to free or highly subsidized dental services select fully out-of-pocket-paid care?

OBJECTIVE

To investigate patients' reasons for selecting a dental clinic given their choice of free or highly-subsidized dental services.

METHODS

The study was based on cross-sectional data obtained through phone interviews with adults in Tehran, Iran. The present study included those entitled to free or highly-subsidized dental services (n = 726). The data covered the patients' awareness of subsidized dental services and type of dental clinic for their most recent visit and their reasons for selecting that clinic. Awareness of subsidized dental services was dichotomized as being either aware or unaware of such subsidy. The type of clinic was dichotomized as providing either free or highly-subsidized (FHS) or fully out-of-pocket paid (FOP) services. Free format answers about the subjects' reasons for selecting a particular clinic were later sub-grouped as: convenient access, good technical aspects, good interpersonal aspects, low or reasonable fees, recommendation by a friend, and no reason. Socio-demographic status was based on background. Data analysis included the chi-square test and logistic regression model.

RESULTS

Of the subjects (n = 726), 60% were women and 58% were under 35 years of age. The subjects' mean age was 33.5 years with no difference by gender (P = 0.24) and the majority had public insurance (91%). Of all the subjects, 60% selected FOP. Good interpersonal aspects were the strongest reason for selecting FOP (OR = 4.6), follow by good technical aspects (OR = 2.3). Those subjects who were unaware of their benefit had 4.6 times the odds of selecting FOP.

CONCLUSIONS

Despite the opportunity to use highly-subsidized dental services, good interpersonal and good technical aspects lead patients to select private dentists and to pay fully out of pocket.

Dental service patterns among private and public adult patients in Australia

BACKGROUND

While the majority of dental care in Australia is provided in the private sector those patients who attend for public care remain a public health focus due to their socioeconomic disadvantage. The aims of this study were to compare dental service profiles provided to patients at private and public clinics, controlling for age, sex, reason for visit and income.

METHODS

Data were collected in 2004-06, using a three-stage, stratified clustered sample of Australians aged 15+ years, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire. Analysis was restricted to those who responded to the CATI.

RESULTS

A total of 14,123 adults responded to the CATI (49% response) of whom 5,505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. Multivariate analysis controlling for age, sex, reason for visit and income showed that persons attending public clinics had higher odds [Odds ratio, 95%CI] of extraction (1.69, 1.26-2.28), but lower odds of receiving oral prophylaxis (0.50, 0.38-0.66) and crown/bridge services (0.34, 0.13-0.91) compared to the reference category of private clinics.

CONCLUSION

Socio-economically disadvantaged persons who face barriers to accessing dental care in the private sector suffer further oral health disadvantage from a pattern of services received at public clinics that has more emphasis on extraction of teeth and less emphasis on preventive and maintenance care.