Dentist-patient relationships and oral health impact in Australian adults

Exploring avoidance of dental care due to dental fear and economic burden -A cross-sectional study in a national sample of younger adults in Norway

AIM

To assess the prevalence of dental avoidance due to dental fear and economic burden and its distribution by utilization of dental care and socio-behavioural characteristics.

METHOD

A sample of 9052 Norwegian adults aged 25-35 years was invited to participate, and 2551 completed electronic questionnaires regarding lifetime prevalence of dental avoidance due to fear and last year prevalence of dental avoidance due to economic burden.

RESULTS

Cancelled- and avoided ordering appointments due to fear amounted to 14.7% and 30.5%, respectively. Avoidance of dental visits due to cost was 37.7%. Frequency of cancelled appointments due to fear was 30% and 16.6% among participants attending dental care several times annually and seldom, respectively. Multiple logistic regression revealed that avoiding dental visits due to cost was less likely among participants with higher household income (OR 0.4, 95% CI 0.3-0.5) and more likely among participants with dental care need (OR 1.8, 95% CI 1.2-2.7). Cancelled and avoided appointments due to fear was most likely among those with need for dental care and lower education. Early unpleasant experience with dental care remained a covariate of avoidance behaviour due to fear.

CONCLUSION

14.7%, 30.5%, and 37.7% confirmed cancelled appointments due to fear, avoided ordering appointments due to fear, and avoided visiting the dentist due to cost. Avoiding dental care due to fear and economic burden was more and less common among participants with respectively, frequent and seldom use of dental care. Dental avoidance behaviours were highest among socially disadvantaged groups, indicating a hole in the welfare state model that needs political consideration.

Psychosocial factors, dentist-patient relationships, and oral health-related quality of life: a structural equation modelling

BACKGROUND

Psychosocial factors and dentist-patient relationships (DPR) have been suggested to be associated with oral health outcomes. This study aimed to test a conceptual model which hypothesised relationships among psychosocial factors, DPR variables, and oral health-related quality of life (OHRQoL) in the 'distal-to-proximal' framework.

METHODS

A total of 12,245 adults aged 18 years or over living in South Australia were randomly sampled for the study. Data were collected from self-complete questionnaires in 2015-2016. The outcome variable of Oral Health Impact Profile was used to measure OHRQoL. Psychosocial domain consisted of psychological well-being, social support, and health self-efficacy. DPR domain included trust in dentists, satisfaction with dental care, and dental fear. The hypothesised model was tested using the two-step approach in structural equation modelling.

RESULTS

Data were analysed from 3767 respondents after the screening/preparing process (adjusted valid response rate 37.4%). In the first step of the analysis, confirmatory factor analyses produced acceptable measurement models for each of the six latent variables (GFI = 0.95, CFI = 0.98, RMSEA = 0.04). The final structural model indicated that better well-being, higher self-efficacy, and more satisfaction were associated with lower oral health impact (β = - 0.12, - 0.07, - 0.14, respectively) whereas fear was positively associated (β = 0.19). Among intermediates, support was positively associated with satisfaction within a small effect size (β = 0.06) as compared to self-efficacy with trust (β = 0.22). The invariance of the final model was also confirmed on participants' SES and dental service characteristics except the variable of 'last dental visit'.

CONCLUSIONS

Psychosocial factors and DPR variables were associated with oral health impact in both direct and indirect paths. The framework of 'distal-to-proximal' actions is empirically supported from psychosocial factors via DPR variables to OHRQoL.

Effect of personality traits on socioeconomic inequalities in health, a population-based study

OBJECTIVES

This study aimed to estimate the effects of positive personality traits (PTs) in income and self-rated dental and general health (SRDH and SRGH) associations in a large South Australian sample.

METHODS

Cross-sectional analyses were conducted using self-reported data collected from 3578 adults (2015-2016). Multivariable regression models assessed the main effects and interactions of the Ten-Item Personality Inventory (TIPI) and income with SRDH and SRGH. Prevalence ratios (PR) of poor health ratings were estimated using Poisson regression.

RESULTS

Among all respondents, high-income individuals with stronger Conscientiousness scores had the lowest prevalence of poor SRGH (0.8%), while those with stronger Extraversion (2.9%) and Agreeableness scores (3.4%) had the lowest prevalence of poor SRDH. Poor SRGH was related to weak Conscientiousness (PR = 6.9, 95% CI [2.3-20.8]) and Emotional Stability scores (PR = 6.0, 95% CI [2.0-18.3]), while poor SRDH was associated with weak Extraversion (PR = 2.3, 95% CI [1.2-4.5]), Agreeableness (PR = 1.8, 95% CI [1.0-3.2]) and Conscientiousness scores (PR = 2.1, 95% CI [1.1-4.0]). Among low-income people, poor health ratings were less prevalent in those with stronger positive PTs scores versus weaker scores. Among low-income respondents, poor SRGH was lower in individuals with stronger versus weaker Conscientiousness scores (10.9% vs 16.2%), and poor SRDH showed lower prevalence in participants with stronger versus weaker Agreeableness scores (18.1% vs 22.6%).

CONCLUSION

Findings showed the association between PTs and the prevalence of poor SRDH and SRGH. Stronger positive PTs modified the self-rated health inequalities associated with low income in a representative sample of the South Australian population.

The dentist-patient relationship and oral health-related quality of life among older adults: A cohort study

OBJECTIVES

To assess the association between aspects of the dentist-patient relationship at age 65 and Oral Impacts on Daily Performances (OIDP) at ages 65 and 70 and to examine whether dental avoidance behaviours play a role in explaining that association.

BACKGROUND

Information about the quality of the dentist-patient relationship is important for dental care provision and healthy ageing.

METHOD

Secondary data analysis of a cohort study of Norwegians born in 1942. The participation rate in 2007 (age 65) and 2012 (age 70) was, respectively, 58.0% (n = 4211) and 54.5% (n = 3733). A total of 70.0% (n = 2947) of the baseline participants responded in 2012. Dentist-patient relationship aspects were assessed in terms of communication with the dentist, satisfaction with dental care, unpleasant experiences and changes of dentist. Generalised Estimating Equations (GEEs) were used to account for repeated measurements.

RESULTS

Prevalence of oral impacts (OIDP) was 29.0% in 2007 and 28.4% in 2012. Participants who received communication on oral hygiene during dental visits had a higher likelihood, whereas participants who reported satisfaction with dental care, no unpleasant experience and did not change dentist had a lower likelihood of reporting oral impacts over these 5 years. Corresponding odds ratios were: 1.2 (95% CI 1.0-1.5), 0.4 (95% CI 0.3-0.5), 0.6 (95% CI 0.5-0.7) and 0.5 (95% CI 0.3-0.6). Associations between dentist-patient relationship aspects and OIDP remained unchanged after adjustment for avoidance behaviours.

CONCLUSION

Training dentists in relationship skills might improve social interaction with patients and the oral health-related quality of life of older people in Norway.

A scoping review to explore patient trust in dentistry: the definition, assessment and dental professionals' perception

Background A trusting dentist-patient relationship is pivotal in providing person-centred care. This scoping review aims to identify how trust is defined, measured and perceived by dental professionals.Methods The Joanna Briggs Institute framework was adopted. A search strategy was developed using MeSH (Medical Subject Headings) terms and key words. Medline/PubMed, Embase, PsycINFO and CINAHL were searched. Data were synthesised using thematic analysis.Findings In total, 16 studies were included that frequently used quantitative research methodology. Only four studies provided definition of trust. Many studies employed either Dental Trust Scale or Dental Beliefs Survey to measure dentist-patient trust, although others developed their own items. Limited research suggested that the dental professionals appreciated communication was paramount to building a trusting relationship with patients.Conclusion No consensus was found on the definition of trust, nor on a preferred assessment tool to measure dentist-patient trust. The limited evidence intimated that dental professionals acknowledged the importance of effective communication in building a trusting alliance with patients. The scarcity of relevant research highlights the need for more robust investigations of trust in dental care.

Dental service sector and patient-reported oral health outcomes: Modification by trust in dentists

Objective

The study aimed to examine the association between patient-reported oral health outcomes and the dental service sector and trust in dentists. The possible interaction effect of trust on this association was also explored.

Methods

Randomly selected adults aged over 18 years living in South Australia were surveyed using self-administered questionnaires. The outcome variables were self-rated dental health and the evaluation outcome of the Oral Health Impact Profile. The dental service sector and the Dentist Trust Scale were included in bivariate and adjusted analyses with sociodemographic covariates.

Results

Data from 4,027 respondents were analyzed. Unadjusted analysis showed that poor dental health and oral health impact were associated with sociodemographic characteristics, including lower income/education, public dental service, and lower trust in dentists (p < 0.01). Adjusted associations were similarly maintained (p < 0.05) but attenuated with the loss of statistical significance, mainly in the trust tertiles. Lower trust in dentists in the private sector had an interaction effect, with a higher prevalence ratio of oral health impact (prevalence ratio = 1.51; 95% confidence interval, 1.06–2.14; p < 0.05).

Conclusion

Patient-reported oral health outcomes were associated with sociodemographic characteristics, the dental service sector, and trust in dentists.

Implications for public health

The inequality of oral health outcomes between dental service sectors needs to be addressed both independently and in association with covariates including socioeconomic disadvantage.

Personality traits and income inequalities in self-rated oral and general health

The association of low income with poor health is widely recognized, but why some low-income individuals do not experience poor health remains unclear. The aim of this study was to determine whether greater positive personality trait scores modify the association between income and oral and general health-related quality of life (OHRQoL and HRQoL) among a representative sample of the South Australian population. Cross-sectional self-rated questionnaire data from a sample of 3645 adults in 2015-2016 were used for secondary analysis. In four factorial ANOVA models, the main effects, interaction, and effect modification of personality traits [measured using the Ten-Item Personality Inventory (TIPI)] on the association between income and OHRQoL [measured using the Oral Health Impact Profile (OHIP-14)] and HRQoL [measured using the European Quality of Life indicator (EQ-5D-3L)] were assessed. In the low-income group, participants with greater TIPI scale scores had lower means for the OHIP-14 and the EQ-5D-3L (better OHRQoL and HRQoL). Greater emotional stability scores modified the association between low income and HRQoL and OHRQoL. Stronger positive personality traits, such as emotional stability, appear to ameliorate the adverse effect of income inequalities in health.

"How obsessive are dentists?"--A personality styles & disorder inventory based prospective, controlled study

OBJECTIVES

The aim of this study was to examine the typical personality traits of dentists and to discuss critically their influence on the necessary characteristics for a good dentist-patient relationship.

METHODS

Two groups were invited via e-mail to participate the study in 2015-2020. One group consisted of German dentists (DENT N = 580). The other group was formed by German speaking psychotherapists from Germany, Austria and Switzerland (DACH N =  1.027). The Personality Styles and Disorder Inventory was used in its short form (PSDI-S) via online survey. The normalization sample (NORM N = 3.392) of the PSDI-S was used to compare the results with a normative sample.

RESULTS

Dentists differed in 10 out of 14 personality styles from the normalization sample (NORM), and in 13 out of 14 personality styles compared with the psychotherapists (DACH). Female dentists differed in 7 out of 14 personality styles to their male colleagues.

CONCLUSIONS

The most significant differences in personality styles were willful (PN), spontaneous (BL), reserved (SZ), ambitious (NA), optimistic (RH) and conscientious (ZW), which seem to be necessary for a good dentist-patient relationship and dental procedures. The expression of personality styles is most likely to influence the choice, delivery and cost as well as patient perception of treatment.

CLINICAL SIGNIFICANCE

Dentist's personality has an important impact on the interpersonal, which influences the dentist-patient relationship and its therapeutic outcome.

Self-perception of orofacial appearance: Brazil-Finland cross-national study

OBJECTIVE

(i) To study the measurement invariance of Orofacial Esthetic Scale (OES) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), (ii) to compare the perception of orofacial appearance (OA) and (iii) to study the frequency of individuals who have sought or received aesthetic dental treatment between Brazil and Finland.

METHODS

This was a cross-sectional observational study with snowball non-probability sample selection. Students and staff from universities in Finland and Brazil were invited to participate. Data were collected online using a demographic questionnaire, OES and PIDAQ. The samples consisted of 3636 Finns (75.0% female; age: 32.0 years) and 1468 Brazilians (72.6% female; age: 33.2 years). The frequency of receiving aesthetic dental treatment was estimated. If configurational invariance was observed, cross-national measurement invariance was verified by multigroup analysis. When measurement invariance was attested, factor scores were compared using Welch's t-test.

RESULTS

OES showed configurational and measurement invariance and no significant difference between the countries. Despite similarity in satisfaction with OA, 71.9% of Brazilians had received aesthetic dental treatment, while 59.4% of Finns had never sought such treatments. PIDAQ did not present configurational invariance between the countries.

CONCLUSION

Although there is no difference in satisfaction with OA, seeking and receiving aesthetic dental treatment is significantly greater for Brazilians. Psychosocial impact of OA is perceived differently in the studied countries.

Psychometric properties of the EQ-5D-3L in South Australia: a multi-method non-preference-based validation study

OBJECTIVE

Although HRQoL tools such as the EQ-5D-3L are significant in determining health status, these measures have not been validated in general populations in Australia. This study aims to psychometrically validate the EQ-5D-3L in a large population sample in Australia for the first time.

METHODS

The EQ-5D-3L was included in the Dental Care and Oral Health study (DCOHS), conducted in a South Australian population sample. The participants were 23-91 years old, and 44.1% were male. The EQ-5D-3L was responded to on a three-point rating scale ("none"/"no", "some" and "extremely"/"unable"/"confined"). We employed the area under the receiver operating characteristic curve (AUROC) to evaluate whether the EQ-5D-3L total score could identify participants with diagnosed diseases and mental health disorders. Psychometric validation of the EQ-5D-3L investigated dimensionality with Exploratory Graph Analysis, model fit, floor/ceiling effects and criterion validity.

RESULTS

The EQ-5D-3L comprised two dimensions, Activities and Symptoms. According to Root Mean Squared Error of Approximation (RMSEA) (<.05) and Comparative Fit Index (CFI) (>.950), the 2-dimensional structure showed excellent model fit with good reliability for the Activities subscale (Ωc = 0.80-95% CI [0.77, 0.83]), and poor reliability for the Symptom subscale (Ωc = 0.56-95% CI [0.53, 0.58]). The EQ-5D-3L showed adequate reliability (Ωc = 0.70-95% CI [0.67, 0.72]). The EQ-5D-3L showed good discrimination for diagnosed diseases (ranging from 64.3% to 86.3%). Floor/ceiling effects were observed across all items. The EQ-5D-3L total score discriminated between respondents who were experiencing health conditions (e.g. cancer, cardiovascular disease, stroke) from healthy individuals.

DISCUSSION

Despite the ceiling effects, the EQ-5D-3L displayed good psychometric properties as an HRQoL measure and discriminated between health states in the general South Australian population. Further research should investigate the psychometric properties of the EQ-5D-5L in South Australia and whether an increased number of response categories can mitigate the observed ceiling effects.

Protocol for a Case Control Study to Evaluate Oral Health as a Biomarker of Child Exposure to Adverse Psychosocial Experiences

Background: The early identification of children who have experienced adversity is critical for the timely delivery of interventions to improve coping and reduce negative consequences. Self-report is the usual practice for identifying children with exposure to adversity. However, physiological characteristics that signal the presence of disease or other exposures may provide a more objective identification strategy. This protocol describes a case–control study that assesses whether exposure to adversity is more common in children with tooth enamel anomalies compared to children without such anomalies. Methods: For 150 mother–child pairs from a pediatric dental clinic in Toronto, Canada, maternal interviews will assess the child’s adverse and resilience-building experiences. Per child, one (exfoliated or extracted) tooth will be assessed for suspected enamel anomalies. If anomalies are present, the child is a case, and if absent, the child is a control. Tooth assessment modalities will include usual practice for dental exams (visual assessment) and modalities with greater sensitivity to identify anomalies. Conclusion: If structural changes in children’s teeth are associated with exposure to adversity, routine dental exams could provide an opportunity to screen children for experiences of adversity. Affected children could be referred for follow-up.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

The association between depression and oral health related quality of life in people who inject drugs

BACKGROUND AND AIMS

Oral health related quality of life (OHRQoL) is known to be reduced in disadvantaged populations, including people who inject drugs. Mental health issues, such as depression are also commonly reported. In this study we examined the association between depression and OHRQoL.

METHODS

Cross-sectional analysis survey data was collected from the Melbourne Injecting Drug User Cohort Study (SuperMIX) of people who inject drugs (N = 982). Three measures derived from the Oral Health Impact Profile (OHIP-14) were used to assess OHRQoL: Prevalence (reporting one or more dental issue "Very often" or "Fairly often" in the previous year), Extent (number of items reported either "Very often" or "Fairly often") and Severity (summary score of all ordinal responses). Regression analyses assessed the association between depression, indexed as scoring above 10 on the Patient Health Questionnaire (PHQ-9), and OHIP-14 measures, adjusted for sociodemographic, drug use and dental service utilisation variables.

RESULTS

Overall, participants had low levels of OHRQoL, indexed through OHIP-14 scores (46% exhibiting prevalence, mean extent of 2.35 and mean severity of 12.72). Depression was associated with increases in all OHIP-14 measures, after adjustment for potential confounders.

CONCLUSIONS

We found a significant association between depression and poor OHRQoL in this sample of people who inject drugs. Further research using a longitudinal frame is needed to determine the direction of this relationship. Interventions to improve oral health of people who inject drugs are urgently needed, and these may benefit mental health outcomes for people who inject drugs.