Predictors of dental care utilization among working poor Canadians

Factors associated with dental care utilization among Iranian adult populations based on Anderson model

BACKGROUND

The utilization of dental care is affected by different factors. Despite the importance of dental care, there are significant disparities in its utilization among various population groups. The aim of this study was to identify the main factors of dental care utilization and the influences of the Health Transformation Plan (HTP) in Iran based on the Anderson model.

METHODS AND MATERIALS

This cross-sectional house-by-house study was conducted during Aug-Nov 2022 among 704 adult people in two cities under the coverage of the HTP and two cities out-side the plan using a multi-stage sampling method. Dental visit in the last year was considered as the utilization of the dental services. Independent Factors included the contextual, individual enabling, individual predisposing and individual need factors based on the Andersen model. Personal health behaviors were also assessed. Statistical analysis was conducted using Chi-square tests, simple and multivariable logistic regression models (α < 0.05).

RESULTS

The 63.1% of the participants covered by the HTP and 57.7% of the population outside the plan sought dental care in the past year. In the final model individuals in the 35-44 age group (OR = 1.5, 95% CI = 1.02-2.2), males (OR = 1.7, 95% CI = 1.2-2.5), single individuals (OR = 1.4, 95% CI = 1.01-2) and those with the perception of need for dental treatment (OR = 2.1, 95% CI = 1.3-3.4) had higher chance of dental visit. Better perceived oral health status was associated with lower chance of visiting the dentist (OR = 0.9, 95% CI = 0.8-0.9). Being covered by the HTP was not significantly in association with the chance of dental visit in the last year (p value = 0.19, OR = 0.78, 95%CI = 0.55-1.12).

CONCLUSION

The predisposing factors including age, gender, marital status, and perceived oral health status and perceptions of dental need were the main factors in association with the dental utilization behavior among adults and the coverage by the HTP did not have significant effect on it.

Dental caries status and treatment need among pregnant women attending antenatal clinics in Dar-Es-Salaam region, Tanzania

BACKGROUND

Literature shows that pregnant women are more susceptible to dental caries due to several reasons, including changes in salivary flow, reduced pH in the oral cavity, and sugary dietary cravings. The unmet need for care is of special concern, as the failure to obtain treatment can affect the health status of the mother and her unborn child.

OBJECTIVES

To determine dental caries status and treatment needs among pregnant women attending antenatal clinics in the Dar-es-Salaam region.

MATERIALS AND METHODS

A descriptive cross-sectional hospital-based study was conducted among 461 pregnant women aged 14-47 years. Informed consent was obtained from participants during data collection. Dental caries status and treatment need were diagnosed according to the WHO criteria. The Data collected was cleaned and analyzed using SPSS version 23.0 software for generating frequency distribution tables, chi-square tests, and logistic regression analysis. The Confidence Interval was 95% (p < 0.05).

RESULTS

The overall prevalence of dental caries was 69%, with a mean DMFT score of 2.86 (± 3.39). Untreated dental decay was observed in 60.5% of study participants, which needed more restorative treatment (fillings & RCT) than a tooth extraction. Caries experiences differed significantly among the pregnant women in various gravidity. In logistic regression, dental caries experience was significantly higher among multigravida respondents (p-values = 0.04) (OR: 1.840, CI 1.021-3.319).

CONCLUSION

This study demonstrated a high level of dental caries experience and the presence of treatment needs. Multiple pregnancies were a major factor that contributed to high levels of dental caries.

Prevalence of dental visits in older Japanese adults receiving public assistance

OBJECTIVES

Exemption from paying dental care costs among recipients of public assistance contributes to universal health care coverage. Although this system might reduce the financial barriers to dental care among patients, there are still several other barriers for public assistance recipients. Therefore, this study examined whether receiving public assistance was associated with a higher prevalence of dental visits for any reason, treatment and prevention.

METHODS

Data were obtained from 16 366 respondents from the 2019 wave of a nationwide cohort study on older adults in Japan. Poisson regression analyses with robust error variance were used to examine the associations between receiving public assistance and dental visits, adjusting for number of teeth, dental pain, periodontal conditions, age, sex, number of family members, education, equivalent household income, working status, instrumental activities of daily living, medical conditions, depressive symptoms, instrumental support and geographical variations.

RESULTS

More than half of the non-recipients of public assistance visited a dentist for some reason in the past 6 months. Meanwhile, only 37% of the recipients visited a dentist. In addition, almost half of the non-recipients had treatment visits, while only 34% of the recipients visited. Furthermore, 46% of the non-recipients had dental visits for prevention, while 32% of the recipients had preventive visits. In the fully adjusted models, compared to non-recipients, public assistance recipients were 24% (Prevalence Ratio [PR]: 0.76, 95% Confidence Intervals [CI]: 0.64, 0.90), 23% (PR: 0.77, 95% CI: 0.65, 0.92) and 21% (PR: 0.79, 95% CI: 0.65, 0.95) less likely to have dental visits for any reason, treatment, and prevention, respectively.

CONCLUSIONS

Although recipients were exempted from dental treatment fees, receiving public assistance was associated with a lower prevalence of dental visits for any reason, treatment and prevention. Future studies should identify the barriers to accessing dental care among public assistance recipients to improve dental visits.

Dental Health Utilization in Palau: Feasibility of an Oral Cancer Screening Program

Background

Cancer is the second leading cause of death in the Western Pacific region. The prevalent tradition of chewing betel nut in Palau, an island nation in this region, is a risk factor in the development of oral cancer. Oral cancer is the fifth most common cancer in Palau, and the prognosis can be improved with early detection facilitated by visual inspection of the oral cavity by dentists. The purpose of this study is to assess the feasibility of oral cancer screening using existing dental health infrastructure in Palau.

Methods

A mixed methods approach was used to explore topics related to the use of dental care resources in Palau. Primary outcome measures were collected using an electronic survey with closed- and open-ended questions addressing dental health utilization as well as barriers and facilitators to accessing dental care. Secondary measures assessed knowledge, attitudes, and beliefs about betel nut use and oral cancer. Open-ended survey questions were analyzed and coded to develop themes based in grounded theory.

Results

Two hundred twenty-three surveys were completed. The mean age was 42.7 years, 80% identified as female, and most (94.3%) report having seen a dentist in Palau. Dental care is seen as important (mean score 82.3/100), and 57.9% reported it was easy to access a dentist. Themes regarding facilitators include multilevel resources and transportation. Themes regarding barriers include cost and availability of dentists/appointments. Approximately half of the respondents were current users of betel nut.

Conclusion

Our results suggest facilitators are in place to promote seeking and obtaining dental care; however, existing infrastructure may not support an oral cancer screening program. These data provide important areas to address that can improve access and support the implementation of oral cancer screening through existing dental care in the future.

Utilization of dental care among adult populations: a scoping review of applied models

BACKGROUND

The timely and appropriate utilization of dental health care is essential to the prevention and accurate treatment of oral diseases. Therefore, it is crucial that managers, health professionals and healthcare providers be fully aware of the predictors encouraging the utilization of dental services and reduce social inequalities. In this scoping review, we aimed to analyze the published articles and reports to find out the factors associated with dental services utilization and the comprehensiveness of the applied models among general adult populations.

MATERIALS AND METHODS

This scoping study was based on the 5-steps of Arksey and O'Malley framework. Keywords were selected under two main concepts: determinants of dental care utilization and the concept of the applied models. Searches were conducted in some electronic databses including PubMed, Google Scholar and Scopus with variations, and a combination of the keywords under the two main afore-mentioned concepts. All the relevant articles reporting the utilization of dental care and its potential predictors among adult populations were chosen. No restrictions involving terms of study time, location or methodological aspects of oral health utilization were considered. Using tables and charts mapping, we tried to group the studies based on the year of their publication, geographic distribution, the range of included indices and the type of their measurement. Also, a directed content analysis method was used to investigate the comprehensiveness of the studies in regard to considering the determinant factors at different levels suggested by the Andesen model.

RESULTS

Fifty-two articles were included in the analysis. Thirty-six (69%) had been published between 2016 and 2020. The United States had conducted the most research in this scope. About 30% of studies had mentioned all three domains of demographics, social structure and beliefs, simultaneously. To evaluate the enabling factors, in 84.61% and 59.61% of studies, the income levels and insurance feature were assessed, respectively. 57.69% of the retrieved studies considered the perceived need features and 38.46% referred to the evaluated ones. The dental services utilization, in terms of the last visit during the "past 12 months", was assessed more commonly. Only 11.54% of studies did evaluate the contextual characteristics and about 71.15% of articles were relatively comprehensive.

CONCLUSION

Overall, it seems that in most of the studies, not all of the determinant factors at different levels of the Andersen model have been considered. In order to discover the conceptual linkages and feedback loops of the model, it is essential to conduct more comprehensive research in the future.

Trends in self-reported cost barriers to dental care in Ontario

BACKGROUND

The affordability of dental care continues to receive attention in Canada. Since most dental care is privately financed, the use of dental care is largely influenced by insurance coverage and the ability to pay-out-of pocket.

OBJECTIVES

i) to explore trends in self-reported cost barriers to dental care in Ontario; ii) to assess trends in the socio-demographic characteristics of Ontarians reporting cost barriers to dental care; and iii) to identify the trend in what attributes predicts reporting cost barriers to dental care in Ontario.

METHODS

A secondary data analysis of five cycles (2003, 2005, 2009-10, 2013-14 and 2017-18) of the Canadian Community Health Survey (CCHS) was undertaken. The CCHS is a cross-sectional survey that collects information related to health status, health care utilization, and health determinants for the Canadian population. Univariate and bivariate analyses were conducted to determine the characteristics of Ontarians who reported cost barriers to dental care. Poisson regression was used to calculate unadjusted and adjusted prevalence ratios to determine the predictors of reporting a cost barrier to dental care.

RESULTS

In 2014, 34% of Ontarians avoided visiting a dental professional in the past three years due to cost, up from 22% in 2003. Having no insurance was the strongest predictor for reporting cost barriers to dental care, followed by being 20-39 years of age and having a lower income.

CONCLUSION

Self-reported cost barriers to dental care have generally increased in Ontario but more so for those with no insurance, low income, and aged 20-39 years.

Trends in Access to Oral Health Care among Adults from the N-E Region of Romania

Aims and Objectives: To investigate the trends in access to dental services among adults from the N-E region of Romania and to evaluate the factors that influence access to dental care. Material and Methods: A self-administered questionnaire was used to evaluate the access and utilization of dental care among a sample of adults. We collected data on their demographic characteristics, their type of medical insurance, their monthly income, the type of dental office they visited, their reasons for choosing a certain type of dentist office, and their oral hygiene habits. It was found that their financial status determined by the occupation of the individual, as well as their monthly income, influenced their access to medical services. Data were analyzed using SPSS 20.0. Results: Of a total of 696 participants, 55.6% were female, 83.3% were from urban areas, 42.1% were retired, 62.3% of the subjects utilized dental emergency services, and 67.9% of the subjects self-funded their treatment. The reasons for women not attending dental offices included costs (24.3%) and dental fear (9.8%), while men's reasons were high costs (26.4%) and lack of time (5.9%). Significant differences were recorded between gender and reasons for visiting the dentist (p = 0.018), payment for dental services (p = 0.009), and preferred clinic (p = 0.010). In relation to occupation, there were significant differences for most of the variables evaluated (reasons to visit a dentist, payment for dental services, preferred dental clinic, self-rated oral health, etc.). Conclusions: Gender, occupation, and monthly income levels were found to influence access to dental medicine services of Romanians in the N-E region. Dental services were frequently accessed for emergency reasons. Dental services were found to be paid for by state insurance for those with low monthly incomes and self-funded for those with higher monthly incomes.

Critically engaging vulnerability: Rethinking oral health with vulnerabilized populations

This paper is the third in a series of narrative reviews challenging core concepts in oral health research and practice. Our series started with a framework for Inclusion Oral Health. Our second review explored one component of this framework, looking at how intersectionality adds important complexity to oral public health. This current manuscript drills into a second component of Inclusion Oral Health, exploring how labels can lead to 'othering' thereby misrepresenting populations and (re)producing harms. Specifically, we address a common oral public health label: vulnerable populations. This term is commonly used descriptively: an adjective (vulnerable) is used to modify a noun (population). What this descriptor conceals is the 'how,' 'why,' and 'therefore' that leads to and from vulnerability: How and why is a population made vulnerable; to what are they vulnerable; what makes them 'at risk,' and to what are they 'at risk'? In concealing these questions, we argue our conventional approach unwittingly does harm. Vulnerability is a term that implies a population has inherent characteristics that make them vulnerable; further, it casts populations as discrete, homogenous entities, thereby misrepresenting the complexities that people live. In so doing, this label can eclipse the strengths, agency and power of individuals and populations to care for themselves and each other. Regarding oral public health, the convention of vulnerability averts our research gaze away from social processes that produce vulnerability to instead focus on the downstream product, the vulnerable population. This paper theorizes vulnerability for oral public health, critically engaging its production and reproduction. Drawing from critical public health literature and disability studies, we advance a critique of vulnerability to make explicit hidden assumptions and their harmful outcomes. We propose solutions for research and practice, including co-engagement and co-production with peoples who have been vulnerabilized. In so doing, this paper moves forward the potential for oral public health to advance research and practice that engages complexity in our work with vulnerabilized populations.

Socioeconomic inequalities in the utilization of dental services among adults in Saudi Arabia

Background

This study used the Anderson Behavioral Model to assess the socioeconomic inequalities in dental services utilization among adults in Saudi Arabia, along with other predictors of utilization, to inform future planning of dental care services.

Methods

This cross-sectional study was a secondary analysis using national data from the 2019 Kingdom of Saudi Arabia World Health Survey (KSAWHS). The survey consisted of two interviewer-administered questionnaires: one household and one individual interview. The questions covered predisposing factors (age, gender, marital status, nationality, education, employment), enabling factors (income, household wealth, area-based socioeconomic class, health insurance, eligibility for free governmental health care, transportation and region of residence) and self-reported need for dental treatment. The main outcome was dental utilization in the past year; predisposing, enabling and need factors were independent variables. Hierarchical logistic regression analyses identified significant predictors of dental utilization, applying survey weights to adjust for the complex survey design. Adjusted odds ratios with 95% confidence intervals and p values were reported in the final model.

Results

The final dataset included 8535 adults (response rate = 95.4%). Twenty percent of adults had visited the dentist at least once in the past year (95% CI 18–21%). There were socioeconomic inequalities in dental utilization. High household income (OR 1.43, p = 0.043), second and middle household wealth status (OR 1.51, p = 0.003 and OR 1.57, p = 0.006) and access to free governmental health care (OR 2.05, p = 0.004) were significant predictors in the final regression model along with perceived need for dental treatment (OR 52.09, p < 0.001).

Conclusion

Socioeconomic inequalities in the utilization of dental services exist in Saudi Arabia. The need for treatment was the strongest predictor suggesting predominantly symptomatic attendance. Increasing awareness about the importance of preventive dental visits rather than symptomatic attendance could be an important policy implication to improve oral health and optimize dental care expenditure. Further research should explore the drivers for adults to seek preventive care in the absence of any recognized dental problems.

Food insecurity and oral health care experiences during pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System

BACKGROUND

Food insecurity has emerged as a salient risk factor for poor oral health in adult populations. A separate area of research also details that both poor oral health and food insecurity during pregnancy can have adverse consequences for maternal and infant well-being. The authors examine the connection between food insecurity and women's oral health care experiences during pregnancy.

METHODS

Data from 2016 through 2019 came from the Pregnancy Risk Assessment Monitoring System (N = 21,080). Multivariable logistic regression analyses were used to assess the association between food insecurity and 6 indicators of oral health care experiences during pregnancy.

RESULTS

Food-insecure women reported worse oral health care experiences during pregnancy, including being more likely to need to see a dentist for a problem, going to see a dentist for a problem, not receiving dental prophylaxis, not talking with an oral health care provider about dental health, not knowing it was important to care for teeth, and having unmet oral health care needs.

CONCLUSIONS

Food-insecure women exhibit worse overall oral health outcomes and unmet oral health care needs during pregnancy.

PRACTICAL IMPLICATIONS

Considering the risk that both food insecurity and oral health problems pose for maternal and infant health, interventions that can reduce food insecurity and improve oral health and oral health care access among pregnant women are important steps in promoting greater health equity.

Understanding the context of healthcare utilisation for children under-five with diarrhoea in the DRC: based on Andersen behavioural model

BACKGROUND

Diarrhoea is one of the leading causes of death among children under 5 years old in the Democratic Republic of the Congo (DRC). Despite positive effects on prognosis, there is limited literature about the healthcare-seeking behaviours of children with diarrhoea, especially in the DRC. This study used the Andersen Behavioural Model, a theoretical framework, which was commonly adopted to study healthcare utilisation, to investigate and predict factors associated with the use of healthcare to treat diarrhoea in the DRC.

METHODS

Data collected from 2626 under-five children with diarrhoea in the last 2 weeks from the Multiple Indicators Cluster Survey conducted by the National Institute of Statistics in 2017-2018, in collaboration with the United Nations Children's Fund were used in this study. Both direct and indirect relationships among four latent variables: predisposing traits, enabling resources access, health needs, and health services use were measured using the structural equation modelling to test the Andersen behavioural model. The confirmatory Factor Analysis model was also modified based on the DRC context to explore this further.

RESULTS

The modified model had the goodness of fit index (GFI) of 0.972, comparative fit index (CFI) of 0.953 and RMSEA of 0.043 (95% CI: 0. 040, 0.047). Health needs (especially diarrhoea) had the largest positive direct effect on healthcare utilisation (standardized regression coefficient [β] = 0.135, P < 0.001), followed by "enabling resources" (β = 0.051, P = 0.015). Health needs also emerged as a mediator for the positive effect of predisposing on utilisation (indirect effect, β = 0.014; P = 0.009).

CONCLUSION

Access to improved water and improved sanitation, as well as socioeconomic factors like household wealth, were significantly associated with health-seeking behaviours for diarrhoea treatment in the DRC. Besides, caregivers who own higher levels of educational attainments were more inclined to have positive health services uses during the treatments. Efforts are needed to enhance the oral rehydration therapy coupled with educating caregivers on its appropriate use.

Factors patients consider when accessing oral health care

The aim of this cross-sectional study was to understand patients' perceived importance of clinic- and clinician-related factors and contextual characteristics that shape the importance ratings for factors patients consider when accessing oral health care. This study was conducted at Griffith University Dental Clinic, Gold Coast, Australia. Patients answered a self-administered questionnaire on demographics and perceived need for attendance, which constituted the explanatory variables. In the second part of the questionnaire, patients were asked to rate the importance of 17 items related to the provision and quality of oral health services using a five-point scale. Exploratory factor analysis (EFA) was conducted to determine the dimensionality of the questionnaire. The questionnaire was completed by 298 patients. The importance of some of the clinician-related factors, such as 'concern for patients' and 'access to specialist care', were associated with sex, age and employment status. EFA revealed a two-factor structure, which consisted of items related to clinician characteristics and clinic environment characteristics. Female participants had higher importance scores for clinic environment characteristics (mean (±s.d.) 38.00 ± 4.86 vs 35.45 ± 6.30; P < 0.05) and clinician characteristics (32.39 ± 2.85 vs 31.33 ± 3.39; P < 0.05) than male participants. In conclusion, various clinician- and clinic-related aspects were considered important for the provision and quality of oral health services, with the importance of these factors associated with some contextual characteristics. Application of Andersen's behavioural model of health services use provided a framework that offers important insights into patient beliefs and perceptions towards oral health services and can serve as a baseline for future studies in dental clinics across Australia.

A paradox of need: Gaps in access to dental care among people who use drugs in Canada's publicly funded healthcare system

In Canada, publicly funded healthcare provides no-cost access to a large but not comprehensive suite of services. Dental care is largely funded by private insurance or patients, creating employment- and income-dependent gaps in care access. Difficulties accessing dental care may be amplified among vulnerable populations, including people who use drugs (PWUD), who may experience greater dental need due to side effects of substance use and health comorbidities, as well as barriers to care. Using data collected between 2014 and 2018 from two ongoing prospective cohort studies of PWUD in Vancouver, Canada, the aim of this study was to explore factors associated with dental care access. Among 1,638 participants, 246 participants (15%) reported never or only occasionally accessing adequate dental care. In generalised linear mixed-effects models, results showed significant negative associations between accessing dental care and using opioids (Adjusted Odds Ratios [AOR] = 0.73, 95% Confidence Interval [CI] = 0.58-0.91), methamphetamine (AOR = 0.75, 95% CI = 0.59-0.95) and cannabis (AOR = 0.78, 95% CI = 0.63-0.97), as well experiencing homelessness (AOR = 0.54, 95% CI = 0.42-0.70) and street-based income generation (AOR = 0.75, 95% CI = 0.59-0.94). There were significant positive associations between adequate dental care and accessing opioid agonist treatment (OAT) for opioid dependence (AOR = 1.36, 95% CI = 1.07-1.72) and receiving income assistance (AOR = 1.70, 95% CI = 1.05-2.77). These results highlight specific substance use patterns and structural exposures that may hinder dental care access, as well as how direct and indirect benefits of income assistance and OAT may improve access. These findings provide support for recent calls to expand healthcare coverage and address dental care inequities.

Neighbourhoods and oral health: Agent-based modelling of tooth decay

This research used proof of concept agent-based models to test various theoretical mechanisms by which neighbourhoods may influence tooth decay in adults. Theoretical pathways were constructed using existing literature and tested in two study areas in Sheffield, UK. The models found a pathway between shops and sugar consumption had the most influence on adult tooth decay scores, revealing that similar mechanisms influence this outcome in different populations. This highlighted the importance of the interactions between neighbourhood features and individual level variables in influencing outcomes in tooth decay. Further work is required to improve the accuracy and reliability of the models.

Regular Dental Care Utilization: The Case of Immigrants in Ontario, Canada

Considering the critical role of oral health on people's well-being, access to regular dental care to improve oral health may be a useful medium for improving immigrant integration and settlement in Canada. Using the 2013-14 Canadian Community Health Survey, this study contributes to the literature and policy by examining if there are disparities in regular utilization of dental care among recent immigrants, established immigrants, and the native-born in Ontario, Canada. Adopting Andersen's behavioural model of health services use as a conceptual framework, we introduce three sets of variables in our statistical analysis including predisposing, need, and enabling factors. At the bivariate level, recent (OR = 0.42, p < 0.001) and established immigrants (OR = 0.81, p < 0.001) are less likely to use dental care at least once a year than their native-born counterparts. Once accounting for enabling characteristics, however, we observe that the direction of the association becomes positive for established immigrants (OR = 1.15, p < 0.05). The difference between recent immigrants and the native-born is partially attenuated when we control for enabling characteristics but remains statistically significant (OR = 0.73, p < 0.05). Based on these findings, we provide several implications for policymakers and future research.

Unmet dental care need in West of Iran: determinants and inequality

Purpose

The purpose of this study was to assess the self-perceived need, seeking and use of dental care and its main determinants in Kurdistan province, Iran.

Design/methodology/approach

A total of 1,056 adults in Kurdistan province were included in this cross-sectional study. Multistage sampling approach was used to select the samples. Data on sociodemographic characteristics, economic status, self-perceived need, seeking and use of dental care were collected using a self-administrated questionnaire. Multivariate logistic regression model was used to assess factors affecting the use of dental care. In addition, socioeconomic inequality relating to dental care needs and use of dental care were examined using concentration curve and concentration index.

Findings

In this study, unmet dental care need was 62.7%. There was a perceived need for dental care among 13.7% (n = 145) of the participants in the past month, with only 39.3% (n = 57) seeking the care. The most important reasons for unmet dental care need were “Could not afford the cost” and “Insurance did not cover the costs.” Multivariate logistic regression showed that supplementary insurance status and household economic status were identified as main determinants affecting dental care-seeking behavior. The result of concentration index revealed that seeking dental care was more concentrated among the rich, whereas the perceived dental care need is more prevalent among the poor.

Originality/value

This study demonstrated that the prevalence of unmet dental care needs is high in the study setting. Also, financial barrier was identified as the main determinant of unmet dental care needs.

Factors Associated with Dental Service Use Based on the Andersen Model: A Systematic Review

Background: A systematic review synthesizing studies examining the determinants of dental service use drawing on the (extended) Andersen model is lacking. Hence, our purpose was to fill this knowledge gap; Methods: Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies focusing on the determinants of dental service use drawing on the Andersen model were included; Results: In sum, 41 studies have been included (ten studies investigating children/adolescents and 31 studies investigating adults). Among children, particularly higher age (predisposing characteristic), higher income (enabling resource) and more oral health problems (need factor) were associated with increased dental service use. Among adults, findings are, in general, less consistent. However, it should be noted that one half of the studies found an association between increased education (predisposing characteristic) and increased dental service. In general, study quality was rather high. However, it should be noted that most studies did not report how they dealt with missing data; Conclusions: Our systematic review revealed that all components (i.e., predisposing characteristics, enabling resources and need factors) of the Andersen model tend to be associated with dental service use among children, whereas the findings are more mixed among adults. In conclusion, beyond need factors, dental service use also tend to be driven by other factors. This may indicate over—or, more likely—underuse of dental services and could enrich the inequality discussion in dental services research.

Do postponed dental visits for financial reasons reduce quality of life? Evidence from the Survey of Health, Ageing and Retirement in Europe

Background

There is a lack of studies investigating the impact of postponed dental visits due to financial constraints on quality of life.

Aims

The aim of this study was to identify whether these factors are associated longitudinally.

Methods

Data were derived from waves 5 and 6 of the “Survey of Health Ageing and Retirement in Europe” (SHARE). The analysis focused on Germany (n = 7506). The widely used CASP-12 was used to quantify the quality of life. Postponed dental visits for financial reasons in the preceding 12 months (no, yes) were used as the main explanatory variable. Socioeconomic and health-related covariates were included in regression analysis.

Results

Gender stratified regression analysis showed that quality of life decreased with the presence of postponed dental visits due to financial reasons in men. Furthermore, quality of life decreased with the worsening of self-rated health in both men and women. The outcome measure was not associated with age, marital status, income, and chronic diseases in both sexes.

Discussion

Study findings suggest that postponing dental visits due to financial constraints contributes to a decreased quality of life among older men.

Conclusion

Efforts to avoid these circumstances might help to maintain the quality of life in older men.

Demographic and socioeconomic inequalities in oral healthcare utilisation in Malaysia: evidence from a national survey

Background

Throughout the years, oral healthcare utilisation in Malaysia has been low despite various efforts by the Ministry of Health Malaysia for improvement. This study aimed to determine the prevalence of oral healthcare utilisation and identify factors associated with oral healthcare utilisation among adults in Malaysia.

Methods

Secondary data analysis of adults aged 18 years and over from the National Health and Morbidity Survey 2019 was conducted in this study. Characteristics of respondents and those who utilised oral healthcare were described using complex sample descriptive statistics. Logistic regression analysis was performed to examine the association between the dependent and independent variables. Dependent variable was oral healthcare utilisation in the last 12 months. Independent variables were demographic and socioeconomic factors (predisposing, enabling and need characteristics) based on Andersen’s Behavioural Model.

Results

A total of 11,308 respondents, estimated to represent 21.7 million adults aged 18 years and over in Malaysia were included in the analysis. Prevalence of oral healthcare utilisation in the last 12 months was 13.2%. Demographic factors of sex, age, marital status, and socioeconomic factors of education level and occupation as well as health belief such as medical check-up were significantly related to oral healthcare utilisation. Enabling factor of household income quintile had significant association with oral healthcare utilisation. Inequalities were observed; females (OR = 1.57, 95% CI = 1.25, 1.96), younger adults (OR = 1.64, 95% CI = 1.15, 2.33), those who were married (OR = 1.65, 95% CI = 1.23, 2.22), those with higher education (OR = 2.21, 95% CI = 1.23, 3.99), those who had medical check-up in the last 12 months (OR = 1.86, 95% CI = 1.53, 2.25) and those with higher income (OR = 1.43, 95% CI = 1.04, 1.96) were more likely to utilise oral healthcare.

Conclusion

Understanding factors associated with utilisation of oral healthcare could help in formulating effective interventions to improve oral healthcare utilisation. Demographic and socioeconomic factors are strong determinants of oral healthcare utilisation in Malaysia. Appropriate interventions to strengthen the existing programmes aimed to promote regular and timely oral health check-ups are needed to improve oral healthcare utilisation.

Regular use of dental services among university students in southern Brazil

OBJECTIVE

To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel).

METHODS

This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor’s degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models.

RESULTS

The prevalence of regular use of dental services was 45.0% (95%CI 42.7–47.3). University students of high economic class (PR = 1.47; 95%CI 0.91–2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03–1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79–3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03–1.45) showed higher prevalence of regular use of dental services.

CONCLUSION

The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.

Geofencing: Mobile Technology as a Health Promotion Tool to Raise Awareness of a Dental Clinic in Rural North Carolina

PURPOSE

The purpose of the study was to assess the use of geofence technology to raise awareness of a dental clinic in rural North Carolina.

METHODS

The catchment area of the dental clinic was defined by ZIP Codes. A geofence was identified, and cell phones within the perimeter were targeted for oral health message drops to occur over 3 months from April to June 2017. Surveys conducted twice, pre- and postintervention (message drop), evaluated change in community awareness of services available at the dental clinic. A cross-sectional analysis was used to measure the effect of the exposure to the geofence technology in survey respondents.

FINDINGS

The survey included 200 participants (100 pre- and 100 postintervention). There were no significant differences in race or age for pre- and postintervention survey groups. The majority of respondents were American Indians (47.0% pre, 58.6% post) or black (28.8% pre, 25.5% post). There was a statistically significant improvement in awareness of the dental clinic (P = .045) from pre- to postintervention. A significant increase was also observed in the question related to dental visits by the respondent or family member of the respondent (from 6.5% to 15.0%, P = .04). A more modest improvement was found in questions related to the cost of dental care, type of insurance accepted, and services provided.

CONCLUSION

Geofencing has the potential to increase awareness of health care services and ultimately increase the number of patients receiving care.

Factors associated with the performance of primary dental health care in Brazil: A multilevel approach

This study evaluated the factors associated with the performance of Brazilian Oral Health Teams (OHTs).This is multilevel research that used data from 12,386 Brazilian OHTs in 2012. The OHTs performance was estimated in previous research by using Item Response Theory model, which employed 20 questions about dental procedures in Primary Care. The first level covariates were based on OHTs procedures such as: the record of pregnant woman dental appointment, provision of dentistry home care, dental appointments scheduled choices, and OHTs in charge for more than 5000 individuals. Moreover, the use of guidelines was accessed concerning delivering prostheses in primary care, referring to secondary care, referring to suspected oral cancer, and providing care towards patients with special needs. Variables included in level 2 were GINI and Human Development Index. Multilevel linear regression models were constructed, estimating linear regression coefficients, 95% confidence intervals, and P values.OHTs performance was different among the 3,613 municipalities analyzed (P < .001), with 36.7% of the variation in the performance of the OHTs being attributed to the variability between municipalities. The adjusted model showed that higher performance OHTs reported attention to pregnant women, dentistry home care and use of dental care guidelines (P < .001). There were lower performance scores for those OHTs with more restricted scheduling (P < .05), compared to those that reported scheduling appointments at any day and time. The best OHTs and population ratio led to a better performance score (P = .010). At the municipal level, better socioeconomic status was associated with better performance of the OHTs (P < .001).OHTs with higher performance are associated with oral health services organizations and municipalities' socioeconomic status.

The Role of Organizational Factors and Human Resources in the Provision of Dental Prosthesis in Primary Dental Care in Brazil

This study aimed to investigate factors associated with dental prosthesis procedures by oral health teams (OHTs) in the Brazilian primary health care in 2013–2014, who participated in the National Program for Improving Access and Quality of Primary Health Care (PMAQ-AB). This is an analytical cross-sectional study using a questionnaire with dichotomous questions applied in 18,114 OHTs. The dependent variable studied was making any type of prosthesis (removable or fixed). Independent variables involved issues related to human resources and health service management. Data were submitted to simple and multiple binary logistic regression with odds ratio calculation, 95% confidence intervals, and p-values. Most OHTs (57%) do not perform any dental prosthesis. The teams that are more likely to perform dental prostheses have human resources-related characteristics, such as professionals admitted through public examinations (OR 1.25, 95% CI 1.14–1.36) and those involved in permanent education (OR 1.13, 95% CI 1.02–1.26). Moreover, OHTs with a more organized work process and that receive more significant support from municipal management are more likely to perform dental prostheses (p < 0.05). The oral health teams which tended to provide the most dental prostheses to benefit patients were; hired as civil servants, had a municipal career plan, involved all members of the oral health team, and trained undergraduate dental students from outreach programs. Better organizational support and improved work incentives may be needed to get the majority of oral health teams to start providing dental prostheses to their patients.

Predisposing, enabling, and need characteristics of dental services utilization among socially deprived schoolchildren

OBJECTIVES

To test the relationship of predisposing, enabling and need characteristics with dental services utilization and pattern of dental attendance among 12-year-old schoolchildren living in a socially deprived urban area.

METHODS

A cross-sectional study was carried out involving 358 children enrolled in public schools located in a deprived area of the city of Manaus, Brazil. Predisposing, enabling, and need characteristics were selected according to Andersen's behavioral conceptual model. Self-completed questionnaires were used to collect the predisposing characteristics (child's gender, sense of coherence, self-esteem, oral health beliefs). Parents or guardians provided data on enabling characteristics, including dental health insurance and socioeconomic status. Evaluated need characteristics included oral clinical status assessed through dental examinations conducted by five calibrated examiners. Structural equation modeling was used to test the predictors of dental services utilization and pattern of dental attendance.

RESULTS

Predisposing characteristics, including male gender and low parents/guardians sense of coherence predicted poor dental services utilization and inadequate pattern of dental attendance, respectively. Low socioeconomic status and poor oral clinical status were linked to poor dental services utilization and worse children's pattern of dental attendance.

CONCLUSIONS

The present findings suggest that predisposing (child's gender and parental sense of coherence), enabling (socioeconomic conditions) and evaluated need characteristics (oral clinical status) are associated with dental services utilization among children.

Predisposing and enabling factors associated with public denture service utilization among older Thai people: a cross-sectional population-based study

Backgrounds

Tooth loss is one of the major oral health problems among older Thai people. However, there is the existence of socioeconomic-related inequalities in dental service utilization, especially denture service. The aim of this study was to assess the determinants associated with inequalities in denture service utilization among older Thai people using the Andersen Behavioural model.

Method

This cross-sectional study involved secondary data analysis of the 2014 survey of older Thai people (N = 38,695). The dependent variable was a public denture service utilization over the past 5 years. Determinants were classified as predisposing and enabling factors. Predisposing variables included age, sex, education, economic condition and dependency status. Enabling variables included working status, health behaviours, health care utilization experience and social/community support. Data were analysed by using bivariate and multivariable analyses at α = 0.05. For bivariate analysis, chi-square test was used to determine the association between dependent and each independent variable. Then, all variables were incorporated into a multivariable binary logistic regression.

Results

The odds of denture service utilization were significantly higher for individuals who were older, female, and had a higher educational level and health-promoting behaviors. A positive dose-response relationship was demonstrated between denture service utilization and increased quartile of household assets.

Conclusions

Predisposing variables had a greater impact than enabling variables in denture service utilization among older Thai people. Despite free public denture service, socioeconomic-related inequalities persist. The government needs to reduce socioeconomic disparities to improve denture treatment inequality.

Dental care use by immigrant Canadians in Ontario: a cross-sectional analysis of the 2014 Canadian Community Health Survey (CCHS)

BACKGROUND

Ontario is home to the largest number of immigrants in Canada. However, very little is known about their dental care utilization patterns. The purpose of this study is to determine the prevalence of poor dental health care use among the immigrant population of Ontario and how various socio-demographic, socio-economic and health-related factors are associated with it.

METHODS

Analysis was performed on a total of 4208 Ontarian immigrants who participated in the dental care module of the 2014 cycle of the Canadian Community Health Survey. Poor dental care use was defined by the two variables: not visiting the dentist in the past year and/or visiting the dentist only for emergency purposes. Multivariable logistic regression was performed to assess the associations between the two outcomes and the socio-demographic, socio-economic and health-related factors.

RESULTS

Thirty three percent of immigrants reported not visiting the dentist in the past year and 25% reported visiting only for emergencies. The leading components associated with poor dental care utilization were being a new immigrant, of male gender, having low educational attainment, low household income and lacking dental insurance.

CONCLUSIONS

This study is the first to highlight oral health care use patterns amongst immigrants in Ontario. Given that a large proportion of the immigrant population in Ontario have poor dental care use, education and outreach programs informing incoming immigrants of preventative dental care may improve overall dental health.

Predictors of dental care utilization in north-central Appalachia in the USA

OBJECTIVES

Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound.

METHODS

This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members.

RESULTS

On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23).

CONCLUSIONS

Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.

The Oral Health of Refugees and Asylum Seekers in Canada: A Mixed Methods Study Protocol

Canada received over 140,000 refugees and asylum seekers between 2015 and 2017. This paper presents a protocol with the purpose of generating robust baseline data on the oral health of this population and build a long-term program of research to improve their access to dental care in Canada. The three-phase project uses a sequential mixed methods design, with the Behavioral Model for Vulnerable Populations as the conceptual framework. In Phase 1a, we will conduct five focus groups (six to eight participants per group) in community organizations in Ontario, Canada, to collect additional sociocultural data for the research program. In Phase 1b, we will use respondent-driven sampling to recruit 420 humanitarian migrants in Ontario and Quebec. Participants will complete a questionnaire capturing socio-demographic information, perceived general health, diet, smoking, oral care habits, oral symptoms, and satisfaction with oral health. They will then undergo dental examination for caries experience, periodontal health, oral pain, and traumatic dental injuries. In Phase 2, we will bring together all qualitative and quantitative results by means of a mixed methods matrix. Finally, in Phase 3, we will hold a one-day meeting with policy makers, dentists, and community leaders to refine interpretations and begin designing future oral health interventions for this population.

College Students' Knowledge Concerning Oropharyngeal Cancer, Human Papillomavirus, and Intent Toward Being Examined

The purpose of this study was to assess college students' knowledge of oral/oropharyngeal cancer and the relationship of human papillomavirus (HPV) to oropharyngeal cancer. Data were also collected to determine their perceived susceptibility to oropharyngeal cancer and awareness of emotions toward and intentions to receive an oral cancer examination in order to design tailored messages for promoting oropharyngeal cancer prevention on college campuses. Two hundred ten baccalaureate students in nonhealth majors from a public southeastern university were surveyed. Descriptive statistics were calculated, and multiple regression analysis was conducted to determine the predictors of knowledge of oral/oropharyngeal cancer and the HPV and intentions to be examined. Results indicated most were unaware of oropharyngeal cancer, did not understand the purpose of an oral cancer examination, and could not affirm they had received one or had one explained to them. Results also indicated poor understanding of some of the signs and risk factors of oropharyngeal cancer, especially HPV. In addition, oral/oropharyngeal cancer knowledge and negative emotions were predictors of examination intentions, confirming current behavioral theories that postulate rational decisions require collaboration from both cognitive and affective systems. Recommendations are offered for tailored educational communications and strategies about oropharyngeal cancer on college campuses.

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

Background

Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model.

Methods

Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes.

Results

Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics.

Conclusions

Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.

Dental care use in Ontario: the Canadian community health survey (CCHS)

BACKGROUND

Oral health is a significant measure of overall health, and regular dental visits are recommended for the maintenance of oral health. The purpose of this study is to determine the pattern (amount and type) of, and factors associated with dental care use among Ontarians.

METHODS

Data from the 2014 cycle of the Canadian Community Health Survey was used and analysis was restricted to individuals aged 12 and above residing in Ontario. Dental care use was defined by two distinct outcomes: not visiting a dentist within the past year and visiting a dentist only for emergencies. Multivariable logistic regression was performed to examine the association between socio-demographic, health behavior, oral health, and other health-related factors and the two outcomes.

RESULTS

More than a quarter of participants reported not visiting the dentist in the last year, and 19% reported usually visiting a dentist only for emergencies. Multivariable logistic regression analysis suggested that males, individuals of Aboriginal status, those with low educational attainment, low household income, no dental insurance, who smoked, less frequent teeth brushing, poor health of teeth and mouth, or had diabetes were at a significant increased likelihood of not visiting the dentist within the past year, and only visiting a dentist for emergency care.

CONCLUSIONS

Socioeconomic status, self-reported oral health, and general health behaviors were associated with dental care use. These findings highlight the need for focusing efforts toward improving dental care use among Ontarians.

The household food insecurity gradient and potential reductions in adverse population mental health outcomes in Canadian adults

PURPOSE

Household food insecurity is related to poor mental health. This study examines whether the level of household food insecurity is associated with a gradient in the risk of reporting six adverse mental health outcomes. This study further quantifies the mental health impact if severe food insecurity, the extreme of the risk continuum, were eliminated in Canada.

METHODS

Using a pooled sample of the Canadian Community Health Survey (N = 302,683), we examined the relationship between level of food insecurity, in adults 18-64 years, and reporting six adverse mental health outcomes. We conducted a probit analysis adjusted for multi-variable models, to calculate the reduction in the odds of reporting mental health outcomes that might accrue from the elimination of severe food insecurity.

RESULTS

Controlling for various demographic and socioeconomic covariates, a food insecurity gradient was found in six mental health outcomes. We calculated that a decrease between 8.1% and 16.0% in the reporting of these mental health outcomes would accrue if those who are currently severely food insecure became food secure, after controlling for covariates.

CONCLUSION

Household food insecurity has a pervasive graded negative effect on a variety of mental health outcomes, in which significantly higher levels of food insecurity are associated with a higher risk of adverse mental health outcomes. Reduction of food insecurity, particularly at the severe level, is a public health concern and a modifiable structural determinant of health worthy of macro-level policy intervention.

Enabling and Predisposing Factors for the Utilization of Preventive Dental Health Care in Migrants and Non-Migrants in Germany

Background

In many European countries including Germany, migrants utilize preventive services less frequently than the majority population. This is also true for the utilization of dental checkups. Little is known about which demographic, social, behavioral, and health-related factors influence the decision of migrants to seek preventive dental health care and how these factors differ from those in non-migrants. The aim of the present study was to examine the role of these factors among migrants and non-migrants residing in Germany.

Methods

Data from cross-sectional national health surveys are used, providing information on preventive dental health behavior from n = 41,220 individuals, of which 15.0% are migrants. Andersen’s Behavioral Model of Health Services Use is the conceptual framework of the investigation. Multiple logistic regression models were applied to examine the role of different predisposing and enabling factors. Interaction terms were included in order to examine whether determinants differ between migrants and non-migrants. Average marginal effects (AMEs) are reported in addition to odds ratios (ORs) as measures of effect size which are robust against bias arising from unobserved heterogeneity.

Results

Migrants are at an about 36% lower chance of utilizing regular dental checkups than non-migrants [OR = 0.64 (95% confidence interval, 95% CI: 0.61, 0.68); AME = −0.081 (95% CI = −0.093, −0.069)]. Differences are partly explained by the influence of demographic, social, behavioral, and health-related factors [adjusted OR = 0.69 (95% CI: 0.64, 0.73); AME = −0.065 (95% CI = −0.076, −0.053)]. Younger age, being male, lower socioeconomic status, a non-statutory health insurance, not living in a relationship, living in the Western part of Germany and in an urban setting, and poor limited social support were associated with a lower chance of utilizing regular dental checkups. Interaction effects could be observed for age and for the type of health insurance.

Discussion

The study identifies different enabling and predisposing factors that are relevant for the utilization of dental checkups among the population in Germany, some of which differ between migrants and non-migrants. Differences are particularly pronounced for younger ages. This differs from findings on other preventive services where older migrants tend to be more disadvantaged. Additional explanatory factors such as barriers that migrants experience in the dental health care system need to be considered in order to implement patient-oriented services and to reduce disparities in access to dental prevention.

Basic income guarantee: a review of implications for oral health

OBJECTIVES

To: a) Familiarize readers with the concept of a basic income guarantee (BIG) and its different forms; b) Consider how BIG could improve oral health and decrease oral health disparities; c) Motivate readers to advocate for the evaluation of oral health outcomes in BIG experiments.

METHODS

Published articles and book chapters that have analyzed and reviewed data from past BIG pilot projects were examined for their findings on health and socioeconomic outcomes.

RESULTS

Our findings suggest various areas and mechanisms whereby BIG can influence oral health-related outcomes, whether through impacts on work, illness and injury, education, a social multiplier effect, expenditure behavior, and/or mental illness and other health outcomes.

CONCLUSION

Our findings illustrate the importance of assessing oral health-related outcomes in future BIG pilot projects.

Predictable prosthetic space maintenance during staged complete-mouth rehabilitation

Staged complete-mouth rehabilitation to accommodate a patient's financial constraints during the course of treatment is presented. Clear acrylic resin added to the anterior cameo surface of the maxillary fixed complete denture (FCD) served as a space maintainer. The restoration of the maxillary FCD addressed the patient's chief complaint. By adding the space maintainer, supraeruption of mandibular anterior teeth and encroachment of the prosthetic space, which could have resulted in additional treatment, was avoided. During the second stage of the complete-mouth rehabilitation, zirconia restorations were used to restore the mandibular arch to the maxillary FCD after straightforward removal of the space maintainer. This allowed a smooth transition after a delay in treatment without having to modify the previous treatment.

Patterns of analgesic use to relieve tooth pain among residents in British Columbia, Canada

The use of prescription opioids has increased dramatically in Canada in recent decades. This rise in opioid prescriptions has been accompanied by increasing rates of opioid-related abuse and addiction, creating serious public health challenges in British Columbia (BC), one of Canada's most populated provinces. Our study explores the relationship between dental pain and prescription opioid use among residents in BC. We used data from the 2003 Canadian Community Health Survey (CCHS), which asked respondents about their use of specific analgesic medications, including opioids, and their history of tooth pain in the past month. We used logistic regression, controlling for potential confounding variables, to identify the predictive value of socioeconomic factors, oral health-related variables, and dental care utilization indicators. The Relative Index of Inequality (RII) was calculated to assess the magnitude of socioeconomic inequalities in the use of particular analgesics by incorporating income-derived ridit values into a binary logistic regression model. Our results showed that conventional non-opioid based analgesics (such as aspirin or Tylenol) and opioids were more likely to be used by those who had experienced a toothache in the past month than those who did not report experiencing a toothache. The use of non-opioid painkillers to relieve tooth pain was associated with more recent and more frequent dental visits, better self-reported oral health, and a greater income. Conversely, a lower household income was associated with a preference for opioid use to relieve tooth pain. The RII for recent opioid use and conventional painkiller use were 2.06 (95% CI: 1.75-2.37) and 0.62 (95% CI: 0.35-0.91), respectively, among those who experienced recent tooth pain, suggesting that adverse socioeconomic conditions may influence the need for opioid analgesics to relieve dental pain. We conclude that programs and policies targeted at improving the dental health of the poor may help to reduce the use of prescription opioids, thereby narrowing health inequalities within the broader society.

Oral impacts on quality of life and problem-oriented attendance among South East London adults

BACKGROUND

Dental care seeking behaviour is often driven by symptoms. The value of oral health related quality of life (OHRQoL) measures to predict utilisation of dental services is unknown. This study aims to explore the association between OHRQoL and problem-oriented dental attendance among adults.

METHODS

We analysed cross-sectional data for 705 adults, aged 16 years and above, living in three boroughs of Inner South East London. Data were collected during structured interviews at home. The short form of the Oral Health Impact Profile (OHIP-14) was used to assess the frequency of oral impacts on daily life in the last year. Problem-oriented attendance was defined based on time elapsed since last visit (last 6 months) and reason for that visit (trouble with teeth). The association between OHIP-14 (total and domain) scores and problem-oriented attendance was tested in logistic regression models adjusting for participants' sociodemographic characteristics.

RESULTS

Problem-oriented attenders had a higher OHIP-14 total score than regular attenders (6.73 and 3.73, respectively). In regression models, there was a positive association between OHIP-14 total score and problem-oriented attendance. The odds of visiting the dentist for trouble with teeth were 1.07 greater (95% Confidence Interval: 1.04-1.10) per unit increase in the OHIP-14 total score, after adjustment for participants' sociodemographic characteristics. In subsequent analysis by OHIP-14 domains, greater scores in all domains but handicap were significantly associated with problem-oriented attendance.

CONCLUSION

This study shows that oral impacts on quality of life are associated with recent problem-oriented dental attendance among London adults. Six of the seven domains in the OHIP-14 questionnaire were also associated with dental visits for trouble with teeth.

Inequality in unmet dental care needs among South Korean adults

Background

The current public health research agenda was to identify the means to reduce oral health inequalities internationally. The objectives of this study were to provide evidence of inequality in unmet dental needs and to find influencing factors attributable to those among South Korean adults.

Methods

Pooled cross-sectional data from the fourth Korean National Health and Nutrition Examination Survey (2007–2009) on 17,141 Korean adults were used. Demographic factors (sex, age, and marital status), socioeconomic factors (education level, employment status, and income level), need factors (normative dental needs and self-perceived oral health status), and oral health-related factors (the number of decayed teeth, the presence of periodontitis, and the number of missing teeth) were included. Multiple logistic regression analysis was performed.

Results

Of South Korean adults, 43.9% had perceived unmet dental needs, with the most common reason being financial difficulties. The disparities in unmet dental care needs were strongly associated with income level, normative treatment needs, and self-perceived oral health status. The low-income group, people with normative dental treatment needs, and those with perceived poor oral health status were more likely to have unmet dental needs. There was considerable inequality in unmet dental care needs due to economic reasons according to such socioeconomic factors as income and education level.

Conclusions

Public health policies with the expansion of dental insurance coverage are needed to reduce inequalities in unmet dental care needs and improve the accessibility of dental care services to vulnerable groups who are experiencing unmet dental care needs due to socioeconomic factors despite having normative and self-perceived needs for dental treatment.

Preventive dental visiting: a critical interpretive synthesis of theory explaining how inequalities arise

BACKGROUND

In many countries, those with lower socioeconomic status are disproportionately affected by poor oral health. This can be attributed, at least in part, to differences in preventive dental visiting. While several theories have been applied to the area, they generally fail to capture the recursive nature of dental visiting behaviour, and fall short of informing the design of complex interventions to tackle inequalities.

OBJECTIVE

To undertake a systematic review and synthesis of theory in order to provide an overview of the pathways which bring about socioeconomic inequalities in early dental visiting, and identify possible intervention points.

METHODS

Electronic searching identified 8947 titles and abstracts. Paper screening and citation snowballing left 77 included papers. Drawing on the tenets of Critical Interpretive Synthesis, data extraction involved capturing concepts and relationships and translating these sometimes into synthetic constructs.

RESULTS

We theorize that at the individual (micro-level), dental visiting behaviour is influenced by: the 'Importance of obtaining care', 'Emotional response' and 'Perceived control', which feed into a balancing of 'Competing Demands' against 'Internal resources' (coping, self-identity), although attendance is tempered by the effective 'Affordability and Availability of services'. Positive Care experiences are theorized to lower the demands and increase internal resources associated with dental visiting. We also outline meso-level factors 'Social norms and sanctions', 'Obligations, expectations and trust', 'Information channels', 'Social structures' and theorize how these can exert an overwhelming influence in deprived areas.

CONCLUSIONS

Socioeconomic inequalities in early dental visiting emerge from several stages in the care-seeking process. Dental visiting behaviour should be viewed not just as a one-off event, but extending over time and social space. Since there is recursivity in peoples' most recent dental experience any future visits we identify that interventions which make care a positive experience for low socioeconomic patients may be particularly beneficial in reducing inequalities.

Social gradient in the cost of oral pain and related dental service utilisation among South African adults

Background

Oral pain affects people’s daily activities and quality of life. The burden of oral pain may vary across socio-economic positions. Currently, little is known about the social gradient in the cost of oral pain among South Africans. This study therefore assessed the social gradient in the cost of oral pain and the related dental service utilisation pattern among South African adults.

Methods

Data were obtained from a nationally representative cross-sectional survey of South African adults ≥16 year-old (n = 2651) as part of the South African Social Attitudes Survey conducted by the South African Human Sciences Research Council. The survey included demographic data, individual-level socio-economic position (SEP), self-reported oral health status, past six months’ oral pain experience and cost. The area-level SEP was obtained from the 2010 General Household Survey (n = 25,653 households) and the 2010/2011Quarterly Labour Force Survey conducted in South Africa. The composite indices used for individual-level SEP (α = 0.76) and area-level SEP (α = 0.88) were divided into tertiles. Data analysis was done using t-tests and ANOVA. Significance was set at p < 0.05.

Results

The prevalence of oral pain among the adult South Africans was 19.4 % (95 % CI = 17.2–21.9). The most commonly reported form of oral pain was ‘toothache’ (78.9 %). The majority of the wealthiest participants sought care from private dental clinics (64.7 %), or from public dental clinics (19.7 %), while the poorest tended to visit a public dental clinic (45 %) or nurse/general medical practitioner (17.4 %). In the poorest areas, 21 % responded to pain by ‘doing nothing’. The individual expenditure for oral pain showed a social gradient from an average of ZAR61.44 spent by those of lowest SEP to ZAR433.83 by the wealthiest (national average ZAR170.92). Average time lost from school/work was two days over the six-month period, but days lost was highest for those living in middle class neighbourhoods (3.41), while those from the richest neighbourhood had lost significantly fewer days from oral pain (0.64).

Conclusions

There is a significant social gradient in the burden of oral pain. Improved access to dental care, possibly through carefully planned universal National Health Insurance (NHI), may reduce oral health disparities in South Africa.

Barrier to Access or Cost Share? Coinsurance and Dental-Care Utilization in Colombia

BACKGROUND

Copayments, deductibles, and coinsurance, are elements of health-care systems to make prices salient for the insured. Individuals may respond differently to cost sharing, according to the type of care they seek; dental care, as a combination of both acute and elective care, is an ideal setting to study the effects of cost-sharing mechanisms on utilization.

OBJECTIVE

To test how coinsurance affects dental-care utilization in a middle-income country context.

METHODS

This study uses policy variations in the Colombian health-care system to analyze changes in dental-care utilization due to different levels of coinsurance. We used matching procedures to balance observed differences in pre-treatment variables between those who face coinsurance (non-policy holders, or beneficiaries) and those who don't (policyholders). We use zero-inflated negative binomial models for the count of visits and two-part models for total expenditures, and test for unobservable confounders with random-effect models and instrumental variables.

RESULTS

Individuals who face coinsurance are less likely to have any dental-care utilization, at a relatively small scale. Facing coinsurance does not correlate with changes in total expenditures. Falsification tests with dental-care visits exempt from coinsurance show no statistically distinguishable changes in utilization. Random-effect models and instrumental variable models show results similar to the main specification.

CONCLUSIONS

Cost-sharing policies in Colombia seem to be well designed because they don't represent an important barrier to dental-care access.

Comparison of risk factors for tooth loss between professional drivers and white-collar workers: an internet survey

This cross-sectional study was conducted to examine tooth loss and associated factors among professional drivers and white-collar workers. The participants were recruited by applying screening procedures to a pool of Japanese registrants in an online database. The participants were asked to complete a self-reported questionnaire. A total of 592 professional drivers and 328 white-collar workers (male, aged 30 to 69 years) were analyzed. A multiple logistic regression analysis was performed to identify differences between professional drivers and white-collar workers. The results showed that professional drivers had fewer teeth than white-collar workers (odds ratio [OR], 1.74; 95% confidence interval [95% CI], 1.150-2.625). Moreover, a second multiple logistic regression analysis revealed that several factors were associated with the number of teeth among professional drivers: diabetes mellitus (OR, 2.68; 95% CI, 1.388-5.173), duration of brushing teeth (OR, 1.66; 95% CI, 1.066-2.572), frequency of eating breakfast (OR, 2.23; 95% CI, 1.416-3.513), frequency of eating out (OR, 1.70; 95% CI, 1.086-2.671) and smoking status (OR, 2.88; 95% CI, 1.388-5.964). These findings suggest that the lifestyles of professional drivers could be related to not only their general health status, but also tooth loss.

Assessing the Oral Health Needs of African American Men in Low-Income, Urban Communities

Despite improvements in oral health status in the United States, pronounced racial/ethnic disparities exist. Black men are less likely to visit the dentist, are twice as likely to experience tooth decay, and have a significantly lower 5-year oral cancer survival rate when compared to White men. The Minority Men's Oral Health Dental Access Program employed a community-based participatory research approach to examine the oral health barriers and opportunities for intervention among Black men in a low-income, urban neighborhood. A cross-sectional study design was implemented through a self-administered survey completed among 154 Black males. The majority reported not having dental insurance (68.8%). Most frequently cited oral health care barriers were lack of dental insurance and not being able to afford dental care. Attitudes related to the significance of dental care centered on cancer prevention and feeling comfortable with one's smile. The impact of oral health on daily life centered on social interaction, with men citing insecurities associated with eating, talking, and smiling due to embarrassment with how their teeth/mouth looked to others. Multivariate logistic regression revealed that those who had difficulty finding dental care were 4.81 times (odds ratio = 4.65, 95% confidence interval [1.80, 12.85]) more likely to report no dental insurance, and 2.73 times (odds ratio = 3.72; 95% confidence interval [1.12, 6.70]) more likely to report poor oral health. Community-based participatory approaches include assessment of neighborhood residents affected by the health issue to frame interventions that resonate and are more effective. Social, physical, and infrastructural factors may emerge, requiring a multilevel approach.