The dynamics of toothache pain and dental services utilization: 24-month incidence

Effectiveness of and Patient’s Satisfaction with Dental Emergency Unit in Pitié Salpêtrière Hospital (Paris), Focusing on Pain and Anxiety

Background

The Dental Emergency Unit (DEU) of the Pitié Salpêtrière Hospital receives mainly painful emergencies. This study aimed at evaluating the suppression of pain and anxiety as well as the patient's satisfaction after a visit to the DEU. Patients and Methods. A prospective study was carried out in 2019 (NCT03819036) in adult patients. Data was collected on D0 on site and then on D1, D3, and D7 by phone, during daytime. The main objective and secondary objectives were, respectively, to assess the intensity of pain on D1; the intensity of pain on D3 and D7; the evolution of anxiety on D1, D3, and D7; and the patients' satisfaction. They were evaluated with a 0–10 numeric scale (NS) on D1, D3 and D7; mean scores were compared with nonparametric statistics (ANOVA, Dunn's test).

Results

814 patients were contacted and 581 patients included; 87 were lost to follow-up. 376 patients completed all the questionnaires. In the final sample (59% men, 40 ± 16 y.o.), 86% had health insurance. The mean pain scores were as follows: D0: 6.36 ± 0.12; D1: 3.49 ± 0.13; D3: 2.23 ± 0.13; D7: 1.07 ± 0.11—indicating a significant decrease of 45%, 65%, and 93% on D1, D3, and D7, respectively, compared to D0 (p < 0.0001) between D0 and D1, D3, D7. The mean NS anxiety scores were as follows: D0: 3.32 ± 0.15; D1: 3.69 ± 0.16; D3: 2.75 ± 0.16; D7: 1.98 ± 0.15. The decrease was significant between D0 and D7 (p < 0.0001). The perception of general heath improved between D1 and D7. The overall score of satisfaction was 8.64 ± 0.06.

Conclusion

DEU enabled a significant reduction in pain and anxiety with high overall satisfaction.

Oral health and happiness in adolescents: A cohort study

OBJECTIVES

To investigate the influence of oral health conditions, socioeconomic status and dental care utilization on subjective happiness and identify the factors associated with changes in happiness among adolescents.

METHODS

Data were collected in 2012 and 2014. Oral health conditions were evaluated by performing clinical examinations; socioeconomic status and dental care utilization were assessed by using a questionnaire. The participants answered the Child Perceptions Questionnaire 11-14 for the evaluation of the impact of these variables on oral health-related quality of life (OHRQoL). Happiness was assessed using the Brazilian version of the Subjective Happiness Scale. For longitudinal data analysis, a mixed-effect model of linear regression was used to assess the factors related to happiness and multinomial logistic regression to appraise prospective changes in happiness.

RESULTS

A total of 1134 12-year-old adolescents were examined at baseline (response rate: 93%), and 770 were reevaluated after 2 years (retention rate: 68%). The adolescents who lived in households with lower equivalized income and greater overcrowding, had not visited the dentist in the later 6 months, had a higher number of cavitated carious lesions, and reported a higher impact on OHRQoL in 2012 presented lower happiness levels. Additionally, the adolescents with a higher number of decayed, missing or filled teeth and who reported a higher impact on OHRQoL were more likely to belong to the most unfavourable happiness trajectory categories.

CONCLUSIONS

The presence of dental caries, socioeconomic conditions, dental care utilization and OHRQoL influence happiness in adolescents. Having more teeth affected by dental caries and worse self-perception in early adolescence can lead to a decrease in happiness.

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.

Prevalence and predictors of early periodontal disease among adolescents

Background

Periodic estimation of periodontal disease burden is essential for formulating new treatment strategies, for evaluating preventive strategies, and for framing of new policies. The previous national-level survey among adolescents was held 15 years ago. The objective of this study was to estimate the prevalence of periodontal disease among older adolescent students and to analyze its predictors as part of an oral health assessment survey conducted in Kerala.

Materials and Methods

A multistage cluster sampling was employed among five districts of Kerala to examine 1065 students in the age group of 15-18 years from government and private schools of selected urban and rural areas. Sociodemographic and oral health behavioral data, modified Community Periodontal Index, Oral Hygiene Index Simplified, and Dental Aesthetic Index were taken. Descriptive statistics and bivariate and multivariate logistic regression analyses were done to identify the predictors of gingival bleeding and periodontal pockets.

Results

The prevalence of gingival bleeding, periodontal pockets, and loss of attachment was 42%, 13.4%, and 2.7%, respectively. In the adjusted multivariate model for predictors of gingival bleeding, rural location of residence, studying in government schools, high mother's education and their working status, orthodontic treatment need, oral hygiene frequency, and poor oral hygiene status emerged as significant predictors of gingival bleeding. In the multivariate model for periodontal pockets, bleeding on probing emerged as the strongest predictor with an odds ratio of 12.85 when adjusted to poor oral hygiene.

Conclusion

The prevalence of early periodontal disease among adolescents is significant. Sociodemographic factors, poor oral hygiene, and malocclusion are significant predictors for periodontal disease among adolescents.

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.

Comparing epidemiologically estimated treatment need with treatment provided in two dental schemes in Ireland

BACKGROUND

Valid estimation of dental treatment needed at population level is important for service planning. In many instances, planning is informed by survey data, which provide epidemiologically estimated need from the dental fieldworkers' perspective. The aim of this paper is to determine the validity of this type of information for planning. A comparison of normative (epidemiologically estimated) need for selected treatments, as measured on a randomly-selected representative sample, is compared with treatment actually provided in the population from which the sample was drawn.

METHODS

This paper compares dental treatment need-estimates, from a national survey, with treatment provided within two choice-of-dentist schemes: Scheme 1, a co-payment scheme for employed adults, and Scheme 2, a 'free' service for less-well-off adults. Epidemiologically estimated need for extractions, restorations, advanced restorations and denture treatments was recorded for a nationally representative sample in 2000/02. Treatments provided to employed and less-well-off adults were retrieved from the claims databases for both schemes. We used the chi-square test to compare proportions, and the student's t-test to compare means between the survey and claims databases.

RESULTS

Among employed adults, the proportion of 35-44-year-olds whose teeth had restorations was greater than estimated as needed in the survey (55.7% vs. 36.7%;p <0.0001). Mean number of teeth extracted was less than estimated as needed among 35-44 and 65+ year-olds. Among less-well-off adults, the proportion of 16-24-year-olds who had teeth extracted was greater than estimated as needed in the survey (27.4% vs. 7.9%;p <0.0001). Mean number of restorations provided was greater than estimated as needed in the survey for 16-24-year-olds (3.0 vs. 0.9; p <0.0001) and 35-44-year-olds (2.7 vs. 1.4;p <0.01).

CONCLUSIONS

Significant differences were found between epidemiologically estimated need and treatment provided for selected treatments, which may be accounted for by measurement differences. The gap between epidemiologically estimated need and treatment provided seems to be greatest for less-well-off adults.

Influences of adult-onset diabetes on orofacial pain and related health behaviors

OBJECTIVES

This study tested the hypothesis that persons with orofacial pain and comorbid adult-onset diabetes will experience greater functional and emotional impact than persons experiencing orofacial pain without diabetes.

METHODS

A random-digit dialing sampling procedure was used for a disproportionate probability sample of 10,341 persons who were screened for orofacial pain in the past 6 months and diabetes. This paper reports on 1,767 individuals reporting toothache pain and 877 reporting painful oral sores. A structured telephone interview assessed diabetes history, orofacial pain characteristics, oral health-care behaviors, and emotional and functional impacts of orofacial pain.

RESULTS

The 6-month point prevalence was 16.8 percent for toothache pain, 8.9 percent for painful oral sores, and 9.6 percent for adult-onset diabetes. Individuals with comorbid orofacial pain and adult-onset diabetes differed significantly on many of the pain characteristics and health behaviors compared with nondiabetic sufferers of orofacial pain. Diabetics were more likely than nondiabetics to have pain every day, to suffer negative emotions associated with pain, to experience disruption of daily activities and sleep, to make an emergency room visit for orofacial pain, and to report the current need for a pain-related health-care visit.

CONCLUSIONS

Although diabetes is well known to be associated with neuropathic pain, these results indicate that the experience of nociceptive pain is exacerbated by diabetes. Findings have significance for the subjective experience of oral pain, dental-care outcomes, and health-related quality of life associated with oral-health outcomes among individuals with diabetes.

Predictors of dental care utilization among working poor Canadians

OBJECTIVE

This study used the Gelberg-Andersen Behavioral Model for Vulnerable Populations to identify predictors of dental care utilization by working poor Canadians.

METHODS

A cross-sectional stratified sampling study design and telephone survey methodology was used to collect data from a nationally representative sample of 1049 working poor individuals aged 18 to 64 years. Working poor persons worked > or = 20 h a week, were not full-time students and had annual family incomes <$34,300. A pretested questionnaire included sociodemographic items, self-reported oral health measures and two dental care utilization outcomes: time since their last dental visit and the usual reason for dental visits.

RESULTS

Hierarchical stepwise logistic analyses identified independent predictors associated with visiting the dentist >1 year ago: male gender (OR = 1.63; P = 0.005), aged 25-34 years (OR = 2.05; P = 0.02), paying for dental care with cash or credit (OR = 2.31; P < 0.001), past welfare recipients (OR = 1.65; P = 0.03), <21 teeth (OR = 4.23; P < 0.001) and having a perceived need for dental treatment (OR=2.78; P < 0.001). Sacrificing goods or services to pay for dental treatment was associated with visiting the dentist within the past year. The predictors of visiting the dentist only when in pain/trouble were lone parent status (OR = 4.04; P < 0.001), immigrant status (OR = 1.72; P = 0.006), paying for dental care with cash or credit (OR = 2.71; P < 0.001), a history of an inability to afford dental care (OR = 1.62; P = 0.01), a satisfactory/poor/very poor self-rated oral health (OR = 2.10; P < 0.001), number of teeth <21 (OR = 2.58; P < 0.001) and having a perceived need for dental treatment (OR = 2.99; P < 0.001).

CONCLUSIONS

This study identified predisposing and enabling vulnerabilities that jeopardize the dental care-seeking practices of working poor persons. Dental care utilization was associated with relinquishing spending on other goods and services, which suggests that dental care utilization is a competing financial demand for economically constrained adults.

Toothache pain: behavioral impact and self-care strategies

A computer-assisted telephone interview in Maryland of adults who had low income and were Hispanic, Black, and White and who had experienced a toothache during the previous 12 months was conducted. Respondents reported a high prevalence of toothaches, with 44.3% having experienced more than five toothaches during the preceding 10 years. Pain intensity associated with the most recent toothache was high with 45.1% of the respondents reporting the highest pain possible. Pain interfered with many aspects of normal functioning. Self-care strategies generally took precedence over professional health services. Pain sufferers used a combination of self-care and formal care strategies. Initial strategies most often focused on nonprescription medicines(home remedies and prayer. The majority of respondents ultimately sought pain relief from a dentist. We identified a number of significant differences in the strategies used across racial/ethnic groups.

The role of non-dental health professionals in providing access to dental care for low-income and minority patients

The disadvantaged suffer disproportionately from dental problems. These persons are more likely to have untreated oral health problems and associated pain, and also are more likely to forego dental treatment even when in pain. There has been increased emphasis on the potential role of physicians in alleviating oral health disparities, especially among children. In addition, many adults lacking access to traditional dental services seek care and consultation from hospital emergency departments, physicians, and pharmacists. The delivery of oral health care services by non-dental health professionals may assume increasing importance as the population continues to age and becomes more diverse. This is because, in general, the elderly and ethnic and racial minorities face significant economic barriers to accessing private dental services.

Toothache and associated factors in Brazilian adults: a cross-sectional population-based study

BACKGROUND

Toothache is a dental public health problem and one of the predictors of dental attendance and it is strongly associated with the life quality of individuals. In spite of this, there are few population-based epidemiological studies on this theme.

OBJECTIVE

To estimate the prevalence of toothache and associated factors in adults of Lages, Southern Brazil.

METHODS

A cross-sectional population-based study was carried out in a sample of 2,022 adults aged 20 to 59 years living in the urban area of a medium sized city in Southern Brazil. A questionnaire including socioeconomic, demographic, smoking, alcohol, and use of dental service variables was applied at adults household. Toothache occurred six months previous of the interview was considered the outcome. Poisson regression analyses were performed following a theoretical hierarchical framework. All analysis was adjusted by the sample design effect.

RESULTS

The response rate was 98.6%. The prevalence of toothache was 18.0% (95% CI 16.0; 20.1). The following variables were associated with toothache after adjustment: female (PR = 1.3 95% CI 1.3; 2.0), black skin colour vs. whites (PR = 1.5 95% CI 1.1, 1.9), low per capita income (PR = 1.7 95% CI 1.2, 2.3), smokers (PR = 1.5 95% CI 1.2, 1.9) and those who reported alcohol problems (PR = 1.4 95% CI 1.1; 1.9). To be 40 years of age (PR = 0.5 95% CI 0.4, 0.7) and use dental service in the last year (RR = 0.5 95% CI 0.4, 0.6) were protective factors for toothache.

CONCLUSION

The prevalence of toothache in adults of Lages can be considered a major problem of dental public health.

Toothache pain: a comparison of visits to physicians, emergency departments and dentists

BACKGROUND

Researchers' understanding of the use of emergency departments (EDs) and physicians' offices for the treatment of toothaches is limited. The authors conducted a study to explore their use by low-income and minority adults in comparison with the use of traditional dental services.

METHODS

Participants included low-income white, African-American and Hispanic adults who had experienced a toothache during the previous 12 months. A stratified random sample of 4,200 households in Maryland participated in a cross-sectional telephone survey. Trained survey staff completed interviews with someone in 272 (68.3 percent) of 398 eligible households.

RESULTS

Only 8.7 percent of respondents contacted an ED for toothache pain relief, while 20.1 percent contacted physicians. The majority of respondents who contacted an ED (80.5 percent) or a physician (82.6 percent) also contacted a dentist. Contacts with a dentist were reported by 58.6 percent of respondents. The authors conducted tabular analyses using chi(2) tests of statistical significance (P < .05) and SUDAAN's multivariable logistic regression procedure (Research Triangle Institute, Research Triangle Park, N.C.) (P < .05).

CONCLUSIONS

Respondents experiencing toothache pain ultimately sought definitive resolution of their pain from dentists while visiting EDs and physicians for temporary relief. Access to dentists' services was particularly problematic for Hispanics and was exacerbated by health literacy issues.

CLINICAL IMPLICATIONS

The elimination of oral health disparities must involve consideration of cultural influences on minority populations, as well as the responsibilities of the dental profession.

Demographic and socio-economic correlates of dental pain among adults in the United Kingdom, 1998

OBJECTIVE

To report the demographic and socio-economic correlates for dental pain in UK adults, and characterise those with dental pain who did not access dental services and perceived treatment need.

DESIGN

Secondary analysis of the 1998 UK Adult Dental Health Survey data.

SETTING

Survey of random sample of UK households between September and December 1998.

SUBJECTS AND METHODS

Face-to-face interviews with community-dwelling adults, aged 16 years and over. MAIN: outcome measures Self-reported dental pain in the past 12 months. Dental attendance and perceived treatment need of those reporting dental pain.

RESULTS

Of the 4,942 valid responses, 46.1% were men, the proportion of subjects in each 10-year band age group up to 65 years ranged from 10 to 23%, and 42.6% were manual workers. Dental pain was reported by 28%. After controlling for gender and age, manual workers were more likely to report dental pain (OR = 1.21, 95% CI = 1.06-1.37), non-utilisation of dental services (OR = 1.43, 95% CI = 1.12-1.82), and perceived treatment need (OR = 1.28, 95% CI = 1.03-1.60).

CONCLUSIONS

Inequality by social class, age and gender exists in the experience of dental pain, access to dental services and perceived treatment need in the UK adult population. Dental health services need to address the needs of this particular section of the population if the Government is to live up to its commitment to reducing oral health inequality and improving access.

Changes in reported orofacial symptoms over a ten-year period as reflected in two cohorts of fifty-year-old subjects

OBJECTIVE

The study presents changes in reported orofacial symptoms over the course of a 10-year period. It was hypothesized that there was an increase of temporomandibular disorder (TMD) and orofacial pain symptoms during the period concurrent with social and demographic changes.

MATERIAL AND METHODS

All 50-year-old subjects living in two Swedish counties were asked to answer a mail questionnaire in 1992 and 2002. In the two cohorts, 6,343 and 5,798, respectively, responded (response rate 71.3% and 70.2%).

RESULTS

Striking differences in demographic, occupational, general, and oral health conditions were found. General health was reported to be less good, utilization of dental care decreased, whereas number of teeth increased. The prevalence of a number of intra-oral symptoms and orofacial symptoms increased significantly between 1992 and 2002. Reported bruxism increased from 18% in 1992 to 28% in 2002.

CONCLUSION

The observed increase in reported orofacial pain symptoms during the 10-year period, concurrent with changes in society, deserves further attention by society and the dental community.