Income, dental insurance coverage, and financial barriers to dental care among Canadian adults

An exploration of the relationship between attitudes and experiences of prevention and oral health behaviours of the public within six European countries

OBJECTIVES

To survey the public's self-reported attitudes and knowledge towards prevention in oral healthcare and to explore their relationship with tooth brushing frequency and frequency of dental visits.

METHODS

Adults (18+) were approached by email to complete a questionnaire about their attitudes and knowledge towards prevention in oral healthcare in UK, Ireland, Denmark, Germany, the Netherlands and Hungary. Tooth brushing frequency and dental attendance were assessed to see if there was an association with: cost, motivation, responsibility, advice received, personalised advice and knowledge.

RESULTS

3372 participants were recruited. Participants who visited the dentist less often were more likely to see cost as a barrier, with the adjusted odds ratio (aOR) of the last visit being more than 2 years ago versus last visit less than one year ago being 2.58 (95% CI: 2.05 to 3.24). For both motivation and perceived responsibility to care for teeth/gums there was a relationship with frequency of brushing. Comparing those brushing ≥ twice-a-day to participants brushing less than once-a-day or never, the adjusted mean difference for the motivation score was - 1.18 (95% CI: -1.67 to - 0.68) and the aOR for perceived responsibility was 0.15 (95% CI: 0.09 to 0.25). Those who brushed their teeth less frequently were less likely to report receiving preventive advice, with the aOR for those brushing their teeth less than once-a-day or never compared to those who brush ≥ twice-a-day being 0.57 (95% CI: 0.36 to 0.90). Participants who brushed their teeth less frequently (aOR of less than once-a-day or never versus ≥ to twice-a-day 0.50 (95% CI: 0.31 to 0.79)) or visited the dentist less frequently (aOR of 2 or more years ago versus less than one year ago 0.30 (95% CI: 0.23 to 0.38)) were less likely to agree their dental professional knows them well enough to provide personalised oral health advice.

CONCLUSIONS

Self-reported frequent tooth brushing and regular dental visits correlated with higher motivation, responsibility, and personalized advice from dental professionals. Less regular dental visits were correlated with viewing cost as a barrier. Strengthening dentist-patient relationships and addressing barriers such as cost could further improve preventive dental behaviours and oral health outcomes. Demonstrating the successful use of a tool to allow for the first time multiple country exploration of the relationship between attitudes towards prevention and oral health behaviours.

Policy Options to Complement the New Canadian Dental Program Enabling High Quality Care for People With Disabilities and Older Adults

BACKGROUND

The newly announced Canadian Dental Care Plan (CDCP) particularly aims to reduce financial barriers to dental care for individuals living below a family income threshold. The Canadian government has also launched an "Oral Health Access Fund" to support projects aiming to address financial barriers to dental care for older adults, those with disabilities and other groups. Evidence from programs implemented elsewhere in the world could inform policy decisions and address such non-financial barriers for older Canadians and those with disabilities.

AIM

To identify dental programs and policies in OECD countries focusing on people with disabilities and older people, and to outline how they might be applied to the Canadian context.

METHODS

The strategy for this narrative literature review comprised a combination of Medical Subject Headings (MeSh) or their equivalent, title/abstract keywords, truncations, and Boolean operators. Medline (Ovid), Embase (Ovid), CINAHL and Scopus were used. The searches were limited to English language publications involving programs and policies in all OECD countries. All searches ran from inception to January 25, 2023, with no restrictions on publication time.

RESULTS

The search identified 129 articles eligible for review. Findings were categorized as (1) interventions at the institutional-level (subdivided into patient-, professional- and community-focused programs) and (2) interventions at the governmental-level (subdivided into universal, population-specific, and community-based programs). Evidence suggests that targeted, integrated coaching or education programs for oral health care are beneficial, especially when programs are constantly evaluated and improved. Programs with a unified network system that integrates various relevant organizational and health domains have demonstrated to be most effective in the improvement of oral health care and overall health. Dental and medical healthcare workers play a crucial role in improving oral health outcomes and need motivation and fair compensation when caring for older people.

CONCLUSIONS

There is limited quality evidence supporting approaches to improving oral health care and oral health for older people and those with disabilities. It is important for policymakers and stakeholders to consider programmes from other countries when expanding the CDCP.

Determinants of the number of dental visits in the general adult population in Germany during the COVID-19 pandemic

BACKGROUND

Oral health is essential to general health and well-being. The utilization of oral health care services represents an important factor in reducing oral health morbidities. In order to understand the disparities in the frequency of dental visits, it is necessary to identify determinants that influence the use of those services. The aim of the current study was to investigate the determinants of the number of dental visits in Germany during the COVID-19 pandemic.

METHODS

We used data from the general adult population in Germany with n = 2,807 individuals in the analytical sample. Average age was 46.5 years (SD: 15.2 years, range 18 to 74 years) and 48.2% of the individuals were female. The number of dental visits in the preceding 12 months served as outcome measure. Grounded on the extended Andersen model, various determinants were included in regression analysis. Multiple negative binomial regressions were used.

RESULTS

Negative binomial regressions showed that a higher number of dental visits was significantly associated with personality-related (higher conscientiousness, IRR: 1.09, 95% CI: 1.03-1.15; higher neuroticism, IRR: 1.06, 95% CI: 1.00-1.12) and psychosocial factors (higher loneliness, IRR: 1.12, 95% CI: 1.02-1.22). In contrast, only very few predisposing characteristics, and none of the enabling resources and need factors were significantly associated with the outcome measure.

CONCLUSIONS

This study particularly emphasized the importance of personality-related factors and psychosocial factors (in terms of loneliness) for the number of dental visits during the pandemic. These factors, often overlooked in prior research, deserve further attention in upcoming studies dealing with the number of dental visits.

Factors influencing emergency dental care utilization among resettled Syrian refugee parents in Ontario: A cross-sectional study

Regular dental visits are crucial for maintaining optimal oral health, yet adequate access to oral healthcare services remains a significant challenge for refugee populations, including resettled Syrian refugees in Ontario. This study aimed to assess the factors associated with visiting the dentist only for emergency care among resettled Syrian refugee parents in Ontario. A cross-sectional study of 540 Syrian refugee parents, who had resided in Ontario for an average of four years and had at least one child less than 18 years of age, was conducted from March 2021 to March 2022. Information about visiting the dentist only for emergency reasons was gathered through the question, "How often do you usually visit the dentist?" Respondents who indicated that they visit the dentist only for emergency care were categorized as "yes." Multivariable logistic regression was performed to examine the relationship between each of the sociodemographic-, migration-, and health-related factors with the primary outcome of visiting the dentist only for emergency. 73% of respondents reported visiting the dentist only for emergencies. Factors associated with emergency dental visits included dental insurance, number of children, and self-rated oral health. Individuals without dental insurance, higher number of children, and poorer self-rated oral health were more likely to seek emergency dental care. These findings highlight the barriers to regular dental visits among Syrian refugees in Ontario and underscore the need for more inclusive and accessible dental care services for such vulnerable population to enhance their oral health outcomes.

From Clinics to Communities: Understanding Public Perceptions of Dental Services in Pakistan

INTRODUCTION

Access to dental services is a core component of public healthcare. The aim of this study was to evaluate the perceptions and experiences of the public regarding access, quality and affordability of dental services in Pakistan.

METHODS

It was an analytical cross-sectional study based on an online survey. The data collection instrument was based on eight items related to participant perceptions and experiences of dental services in public and private sectors. Pretesting of the survey questionnaire was done, and the target participants were approached through social media, and dental service providers.

RESULTS

A total of 1007 participants representing all provinces of the country responded to the study questionnaire including 54.32% (n = 547) females and 45.68% (n = 460) males. Education and financial status showed the largest effect on perceptions. Although all groups agreed that dental professionals contribute positively to improving public health, those in the 'No Education' or 'Poor' groups showed fewer positive perceptions about the accessibility, quality, and affordability of dental services. Perceptions of dental services between genders showed minimal differences. Chi-squared tests of association showed significant (p < 0.001) relationships between personal awareness of oral health and respondent characteristics such as education, employment, financial status and location.

CONCLUSIONS

This study provides useful insights into the public perceptions and experiences of dental health services in Pakistan. The findings reveal disparities in access, quality, and affordability of dental services among disadvantaged groups, particularly within the public sector. Oral health awareness was also reported to be low amongst people with low educational and financial status. Given the limitations of the current study, further research using qualitative methods may provide a more in-depth understanding of the facilitators and barriers to dental services to inform a major reform to improve public dental services in the country.

PATIENT AND PUBLIC INVOLVEMENT AND ENGAGEMENT (PPIE)

Members of the public with previous experience of using dental services were involved in pretesting of the study questionnaire Pretesting of the survey questionnaire was done in two phases: In the first phase, cognitive interviews were conducted with eight members of the public including four participants each with proficiency in English and Urdu. The purpose of the cognitive interviews was to determine that the participants were able to comprehend all items of the questionnaire accurately. In the second phase the questionnaire was piloted with 15 members of the public who were given a choice to answer the questionnaire in English or Urdu based on their individual preference.

Dental Visiting Patterns and Their Associations With Dental Caries and Periodontal Diseases

OBJECTIVES

This study was conducted to describe the dental visiting patterns and ascertain their associations with clinically assessed dental caries and periodontal disease levels of dentate Australian adults.

MATERIALS AND METHODS

A three-stage stratified probability sampling design was used to randomly select a cross-section of Australians aged 15+ years. Self-reported oral health and related information was obtained using questionnaire-based interviews. Dental visiting patterns studied were usual frequency of dental visits, usual reason for dental visit, and use of a regular dentist. Oral examinations were conducted following a standardized protocol in public dental clinics. A total of 5022 dentate adults aged 15+ years who were interviewed and orally examined were included in the current analysis.

RESULTS

Higher proportions of adults with lower education levels and no dental insurance usually visited for a dental problem, made dental visits less frequently, and did not use a regular dentist. Individuals who were usually visiting for a dental problem, making dental visits less frequently, and not using a regular dentist had higher levels of dental caries and periodontal diseases.

CONCLUSIONS

Dental visiting patterns of Australian adults were associated with their socioeconomic backgrounds. Usually visiting for a dental problem, making dental visits less frequently, and not using a regular dentist were more likely to be associated with higher levels of dental caries and periodontal diseases. These findings may help clinicians to recognize patients at increased risk for dental caries and periodontal diseases while apprising policy makers to plan and implement programs for dental service provision.

Preventive and curative dental services utilization among children aged 12 years and younger in Tehran, Iran, based on the Andersen behavioral model: A generalized structural equation modeling

World Health Organization invites the nations to progress towards universal health care coverage. This study evaluated preventive and curative dental services utilization among children aged 12 years and younger in Tehran, Iran, based on the Andersen behavioral model using a generalized structural equation modeling. A phone-based cross-sectional study was conducted in Tehran, Iran, on 886 children in 2023. Information on curative and preventive/consultation dental service utilization and associated factors was collected by a standard questionnaire. We used a generalized structural equation model (GSEM) to build a model based on Andersen's behavioral model. Of 886 children, 22.1% used curative dental services, and 19.9% used preventive/consultation services in the past year. Among children aged 6 years and younger, age (OR = 1.87, p-value <0.001) and parent-perceived oral health need (OR = 54.77, p-value <0.001) predicted curative services utilization and age (OR = 1.45, p-value <0.001), knowledge (OR = 1.36, p-value <0.001), dental visit before the age of one (OR = 6.05, p-value = 0.04), and socioeconomic status (OR = 1.65, p-value = 0.03) predicted preventive/consultation services utilization. Regarding children aged 7 to 12, knowledge (OR = 1.28, p-value = 0.03), dental visit before the age of one (OR = 11.12, p-value = 0.02), socioeconomic status (OR = 2.53, p-value = 0.01), dental insurance (OR = 4.17, p-value <0.001), and parent-perceived oral health need (OR = 19.48, p-value <0.001) associated with curative dental services utilization, and dental visit before the age of one (OR = 10.05, p-value = 0.02), oral health behavior (OR = 1.25, p-value = 0.04), socioeconomic status (OR = 3.74, p-value <0.001), and parent-perceived oral health need (OR = 4.62, p-value <0.001) related to preventive/consultation services utilization. The findings of this study underscore the significant influence of predisposing, enabling, and need factors on dental services utilization among children aged 12 years and younger. These results provide a valuable perspective for policymakers, highlighting the modifiable determinants that could be targeted to improve dental services utilization in this age group.

Impact of public health and patient-centered prevention strategies on periodontitis and caries as causes of tooth loss in high-income countries

In high-income countries, the oral health of the population is influenced by public health interventions, widespread use of oral care products, dental practice measures, and the cost of dental treatment. We compiled information on changes of the prevalence of proximal and upstream determinants of periodontitis, caries, and tooth loss over the last three decades to outline their potential effects on changes of oral health during this period. Information was retrieved from repeated cross-sectional studies and from published literature. While both the prevalence of edentulism and the number of missing teeth (from the DMF-T index) decreased, the number of sound teeth as well as the total number of teeth increased. The prevalence of severe periodontitis was unchanged, whereas the prevalence of periodontal health and moderate periodontitis may have increased to a minor extent. Concerning oral health risk factors, the proportion of individuals with tertiary education increased, while smoking prevalence declined. More and more people used oral care products. Whether one reimbursement system worked better than another one in terms of tooth retention could not be elucidated. In tooth retention, population-wide use of fluoridated toothpastes had the greatest impact. To some extent, the higher number of teeth present may be related to the more frequent use of interdental cleaning aids and powered toothbrushes. Since there was no decrease in severe periodontitis in most cohorts, periodontal interventions probably contributed little to improved tooth retention.

Enhancing seniors' dental care access: Analyzing the impact of government insurance in Canada

A crucial policy question for the government is whether publicly funded insurance programs effectively improve access to care. Using 2015 and 2018 Canadian Community Health Survey (CCHS) data, we first estimated the effect of government dental insurance for seniors on promoting regular care access and lowering cost barrier. When controlling for individual heterogeneity, we found that having government coverage is associated with significantly lower probability of reporting avoidance of dental care due to cost compared to having no coverage. This effect is comparable with other types of insurance. However, the impact of the government program on regular access to dental care is modest. Secondly, using a portion of data collected in Alberta, we found that the government plan does not increase the overall coverage rate. Moreover, switching from an employer-based plan to government-provided coverage for seniors reduces the probability of regular access to care and increases the probability of experiencing cost barrier. This finding indicates that without expansion of overall coverage rate, the current government dental program may not be generous enough to offset the negative impact of leaving the employer-based plan.

Evaluating the harmonization potential of oral health-related questionnaires in national longitudinal birth and child cohort surveys

BACKGROUND/OBJECTIVES

Effective use of longitudinal study data is challenging because of divergences in the construct definitions and measurement approaches over time, between studies and across disciplines. One approach to overcome these challenges is data harmonization. Data harmonization is a practice used to improve variable comparability and reduce heterogeneity across studies. This study describes the process used to evaluate the harmonization potential of oral health-related variables across each survey wave.

METHODS

National child cohort surveys with similar themes/objectives conducted in the last two decades were selected. The Maelstrom Research Guidelines were followed for harmonization potential evaluation.

RESULTS

Seven nationally representative child cohort surveys were included and questionnaires examined from 50 survey waves. Questionnaires were classified into three domains and fifteen constructs and summarized by age groups. A DataSchema (a list of core variables representing the suitable version of the oral health outcomes and risk factors) was compiled comprising 42 variables. For each study wave, the potential (or not) to generate each DataSchema variable was evaluated. Of the 2100 harmonization status assessments, 543 (26%) were complete. Approximately 50% of the DataSchema variables can be generated across at least four cohort surveys while only 10% (n = 4) variables can be generated across all surveys. For each survey, the DataSchema variables that can be generated ranged between 26% and 76%.

CONCLUSION

Data harmonization can improve the comparability of variables both within and across surveys. For future cohort surveys, the authors advocate more consistency and standardization in survey questionnaires within and between surveys.

Socio-demographic predictors of not having private dental insurance coverage: machine-learning algorithms may help identify the disadvantaged

BACKGROUND

For accessing dental care in Canada, approximately 62% of the population has employment-based insurance, 6% have some publicly funded coverage, and 32% have to pay out-of pocket. Those with no insurance or public coverage find dental care more unaffordable compared to those with private insurance. To support the development of more comprehensive publicly funded dental care programs, it is important to understand the socio-demographic attributes of all those, who find dental care unaffordable.

METHODS

This study is a secondary analysis of the data collected from Ontarians during the latest available cycle of the Canadian Community Health Survey (2017-18), a cross-sectional survey that collects information on health status, health care utilization, and health determinants for the Canadian population. First, bivariate analysis was conducted to determine the characteristics of Ontarians who lack dental insurance. Afterwards, we employed machine learning (ML) to analyze data and identify risk indicators for not having private dental insurance. Specifically, we trained several supervised ML models and utilized Shapley additive explanations (SHAP) to determine the relative feature importance for not having private dental insurance from the best ML model [the gradient boosting (GBM)].

RESULTS

Approximately one-third of Ontarians do not have private insurance coverage for dental care. Individuals with an income below $20,000, those unemployed or working part-time, seniors aged above 70, and those unable to afford to have their own housing are more at risk of not having private dental insurance, leading to financial barriers in accessing dental care.

CONCLUSION

In the future, government-funded programs can incorporate these identified risk indicators when determining eligible populations for publicly funded dental programs. Understanding these attributes is critical for developing targeted and effective interventions, ensuring equitable access to dental care for Canadians.

Integration of an evidence-based caries management approach in dental education: The perspectives of dental instructors

PURPOSE/OBJECTIVES

Evidence-based caries management (EBCM) has developed into an internationally recognized tool for integration of comprehensive non-surgical caries treatment in dental education. However, uptake of the EBCM approach remains uneven across Canadian dental schools. Our project sought to understand how dental instructors perceive the challenges and solutions to the integration of the EBCM approach in undergraduate clinical education.

METHODS

Using a qualitative descriptive design, we recruited a purposeful sample of clinical instructors supervising undergraduate dental students in caries-related dental care. Semi-structured, online interviews focused on the main characteristics of EBCM. Interviews were analyzed using the awareness, desire, knowledge, ability, and reinforcement (ADKAR) change management model to understand challenges with EBCM implementation in undergraduate education. The analysis process started with verbatim transcription; then, transcripts were coded deductively based on the interview guide and the ADKAR model domains, and inductively to generate emergent codes. Finally, thematic analysis was used to develop themes and subthemes.

RESULTS

We interviewed 11 dental instructors with a wide range of clinical experience. Our results show that participants had sufficient awareness regarding the need for the EBCM approach and portrayed a strong desire to participate in bringing curricular changes. Knowledge and ability of participants depended on their training, experience, and involvement in continuing education courses. A lack of standardized caries management practices, less chairside time, and poor remuneration for instructors were major barriers in EBCM clinical implementation. Potential solutions suggested included providing continuing education courses, credits for students for non-surgical caries management, and remunerating instructors for implementation.

CONCLUSIONS

In conclusion, most participants were aware of the need for a substantive change toward EBCM and demonstrated the desire to participate and improve its implementation. Our analysis showed that to facilitate full integration of the EBCM approach into the undergraduate dental clinics, organizational focus needs to be placed on the individual's knowledge and ability, with tailored efforts toward reinforcement.

Association between dental visit behavior and mortality: a nationwide longitudinal cohort study from NHANES

OBJECTIVES

The benefits of professional dental treatment for oral diseases have been widely investigated. However, it is unclear whether professional dental treatment provides additional benefits for improving general health.

MATERIALS AND METHODS

Data were obtained from the US National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 and 2011 to 2018 cycles. A total of 36,174 participants were included and followed-up for mortality until December 31, 2019. Dental visit behavior was defined as the time interval of last dental visit (TIDV, < 0.5 year, 0.5-1 year, 1-2 years, 2-5 years, and > 5 years) and the main reasons of the last dental visit (treatment, examination, and other reasons). The Cox proportional risk model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

Compared with participants with time interval of less than 0.5 year, the multivariate-adjusted HRs and 95%CI for participants with time interval of more than 5 years were 1.45 (1.31, 1.61) for all-cause mortality (P trend < 0.0001), 1.49 (1.23, 1.80) for cardiovascular diseases mortality (P trend = 0.0009) and 1.53 (1.29, 1.81) for cancer mortality (P trend = 0.013). Compared with dental visit for examination, participants who had their dental visit for treatment had higher risk for mortality. For participants with dental visit for examination, TIDV of less than 1 year showed lower risk for mortality, whereas TIDV of less than 0.5 year is recommend for population with dental visit for treatment.

CONCLUSIONS

Poor dental visit behavior is associated with an increased risk of mortality. Further well-designed studies are needed to confirm the association between professional dental visit and mortality.

CLINICAL RELEVANCE

This study highlights the potential benefits of regular dental visits in maintaining general health.

Knowledge and Attitude Toward Esthetic Dentistry and Smile Perception

INTRODUCTION

A smile is important in human communication and is increasingly valued in modern society. The perception of smile attractiveness is subjective and depends on many factors.

AIM

This study aimed to evaluate and compare knowledge and attitude related to esthetic dentistry in dental students versus dental interns, general dentists, and dental specialists, examine the self-perception of their smile, and identify parameters that influence smile perception.

METHODS

This cross-sectional study was conducted at King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. Participants included dental students, interns, general practitioners, and specialists. They completed an electronic questionnaire covering demographics, knowledge about esthetic dentistry, attitudes toward smile perception, and previous dental treatments. Data analysis involved descriptive statistics, bivariate analysis, and chi-square tests.

RESULTS

A total of 275 individuals participated in our study. The study found that dental students' exposure and awareness of esthetic dentistry topics increased with academic progression. Gender, age, and marital status influenced self-perception and smile evaluation. More females perceived gender as an influencing factor in smile evaluation, while more males believed in the existence of an ideal smile. A substantial portion of the sample had undergone dental treatments, with no significant income-related disparities observed.

CONCLUSION

This study highlights differences in knowledge and attitudes among dental students and professionals. Dental education appears to impact students' exposure to esthetic dentistry concepts. Moreover, gender, age, and marital status influence self-perception and evaluation of others' smiles.

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.

Barriers to oral care: a cross-sectional analysis of the Canadian longitudinal study on aging (CLSA)

BACKGROUND

Oral health plays a role in overall health, indicating the need to identify barriers to accessing oral care. The objective of this study was to identify barriers to accessing oral health care and examine the association between socioeconomic, psychosocial, and physical measures with access to oral health care among older Canadians.

METHODS

A cross-sectional study was conducted using data from the Canadian Longitudinal Study on Aging (CLSA) follow-up 1 survey to analyze dental insurance and last oral health care visit. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between socioeconomic, psychosocial, and physical measures with access to oral care, measured by dental insurance and last oral health visit.

RESULTS

Among the 44,011 adults included in the study, 40% reported not having dental insurance while 15% had not visited an oral health professional in the previous 12 months. Several factors were identified as barriers to accessing oral health care including, no dental insurance, low household income, rural residence, and having no natural teeth. People with an annual income of <$50,000 were four times more likely to not have dental insurance (adjusted OR: 4.09; 95% CI: 3.80-4.39) and three times more likely to report not visiting an oral health professional in the previous 12 months (adjusted OR: 3.07; 95% CI: 2.74-3.44) compared to those with annual income greater than $100,000.

CONCLUSIONS

Identifying barriers to oral health care is important when developing public health strategies to improve access, however, further research is needed to identify the mechanisms as to why these barriers exist.

Dental health status, dentist visiting, and dental insurance of Asian immigrants in Canada

OBJECTIVE

This study examined the dental care utilization and self-preserved dental health of Asian immigrants relative to non-immigrants in Canada. Factors associated with oral health-related disparities between Asian immigrants and other Canadians were further examined.

METHODS

We analyzed 37,935 Canadian residents aged 12 years and older in the Canadian Community Health Survey 2012-2014 microdata file. Factors (e.g., demographics, socioeconomic status, lifestyles, dental insurance coverage, and year of immigration) associated with disparities in dental health (e.g., self-perceived teeth health, dental symptoms during past one month, and teeth removed due to decay in past one year) and service utilization (e.g., visiting dentist within the last three years, visiting dentist more than once per year) between Asian immigrants and other Canadians were examined using multi-variable logistic regression models.

RESULTS

The frequency of dental care utilization was significantly lower in Asian immigrants than their non-immigrant counterparts. Asian immigrants had lower self-perceived dental health, were less likely to be aware of recent dental symptoms, and more likely to report tooth extractions due to tooth decay. Low education (OR = 0.42), male gender(OR = 1.51), low household income(OR = 1.60), non-diabetes(OR = 1.87), no dental insurance(OR = 0.24), short immigration length (OR = 1.75) may discourage Asian immigrants from dental care utilization. Additionally, a perceived lack of necessity to dentist-visiting was a crucial factor accounting for the disparities in dental care uptake between Asian immigrants and non-immigrants.

CONCLUSION

Asian immigrants showed lower dental care utilization and oral health than native-born Canadians.

Comparison of self-perceived competence of recent dental graduates from the Universities of Otago and Dalhousie

INTRODUCTION

This study investigates and compares the self-perceived competencies of recent dental graduates from the University of Otago (UoO) (Dunedin, New Zealand) and Dalhousie University (DU) (Nova Scotia, Canada).

MATERIALS AND METHODS

A validated survey was emailed to recent graduates from the UoO (December 2019) and DU (May 2020). Chi-squared statistical analysis examined the differences between groups.

RESULTS

The response rate was 73% from the UoO class and 75% from the DU class. Out of 59 competencies, 11 items showed a significant difference. Orthodontics and the surgical aspects of dentistry were the main areas where significant differences have been observed between the two cohorts. Out of the four items in orthodontics, a significantly higher proportion of DU graduates felt more competent than graduates from UoO in three items ("performing orthodontic treatment planning," "performing space maintenance/regaining" and "performing orthodontic full-arch alignment"; p < .001). Similarly, graduates from DU felt significantly more competent in three of the eight items in the oral and maxillofacial surgery domain ("managing complications of oral surgery," "performing soft-tissue biopsies" and "managing trauma to the dentofacial complex"; p < .001), all requiring surgical training and skills.

CONCLUSION

Of the differences identified, graduates from DU reported higher levels of self-perceived competence compared with their UoO counterparts, especially in the orthodontics and oral and maxillofacial surgery domains. This could be because DU students have more practice in these specialties during their training. The results suggest that increased exposure for UoO students in these areas may be beneficial to their self-perceived competence.

The effects of orthodontic treatment on personal dental expenditures in South Korea: a follow-up study using Korean health panel survey

BACKGROUND

This study aimed to investigate the effects of orthodontic treatment on cumulative out-of-pocket (OOP) expenditures for up to 8 years and the factors contributing to changes in individual OOP dental expenses.

METHODS

The data of adults aged ≥19 years, 218 with experience of orthodontic treatment (OT group) and 654 without experience of orthodontic treatment (non-OT group) were extracted from the Korea Health Panel Survey between 2009 and 2017 using the propensity score matching method. The total personal OOP expenditure for dental care incurred after orthodontic treatment in the OT group and that incurred in the matched non-OT group were calculated. Since dependent variables, cumulative dental expenditures, were continuous with excess zeros, Tweedie compound Poisson linear models were used to explore the influence of orthodontic treatment experience and demographic and socioeconomic factors, including private insurance, on per capita OOP dental expenditures.

RESULTS

The OT group had socioeconomic characteristics distinct from those of general dental patients. The Box-Cox transformed per capita OOP expenditures for dental care in the OT group were lower than those in the non-OT group (P < 0.05). When all covariates were held constant, the non-OT group spent 1.4-times more on OOP dental expenditures, but this was not statistically significant (P > 0.1). The data from those with higher incomes revealed the opposite trend (P < 0.05), while the other covariates were not statistically significant.

CONCLUSIONS

Orthodontic treatment had no positive or negative effect on future oral care use. This finding is similar to the inconsistent results of previous clinical studies on oral health and orthodontic treatment.

Access to oral health care for children with fetal alcohol spectrum disorder: a cross-sectional study

Background

Individuals with developmental disabilities, including Fetal Alcohol Spectrum Disorder (FASD), often suffer from poorer oral health than the general population as they experience challenges with accessing care. However, few studies have investigated access to oral health care specific to children diagnosed with FASD. Thus, the objective of this cross-sectional study is to examine the use of oral health care services by children diagnosed with FASD in Saskatchewan, Canada, and to identify perceived barriers that affect their access to oral health care.

Methods

Parents or caregivers for children with FASD under the age of 16 were recruited through community organizations. Between July 2020 and January 2021, 189 participants completed a 64-item questionnaire that assessed sociodemographic characteristics, oral health care utilization, and perceived barriers to care.

Results

Most children (85%) had visited the dentist within the last 24 months. 55% of children had required sedation for some treatment. 43% of caregivers experienced frustration trying to access care for their child. Common barriers were cost (63%), location (55%), the child’s behaviour (78%) and caregiver anxiety (60%). 35% of caregivers believed their dentist lacked adequate knowledge of FASD. Univariate analysis reveals that income, caregiver education, residence location, and insurance status were significantly associated with reporting barriers. Multivariate logistic regression analysis reveals that caregivers who reported a high school education (OR=1.23; 95% CI 1.03 – 1.38); or public insurance (OR=1.33; 95% CI 1.24 – 1.42) or out-of-pocket payments (OR=1.37, 95% CI 1.20 – 1.46); or rural (OR=1.19, 95% CI 1.07 – 1.26) or remote (OR=1.23; 95% CI=1.12 – 1.31) residences were more likely to report difficulties accessing oral health care.

Conclusion

Our findings indicate that children with FASD experience various barriers to accessing oral health care. Social determinants of health were significant variables that increased likelihood of barriers. Like other vulnerable populations, cost and clinic location are notable barriers. Oral health care providers’ assessment and management of children with FASD are noteworthy for future research.

Preserving natural teeth versus extracting them: a willingness to pay analysis

BACKGROUND

Maximum willingness to pay (WTP) for a health benefit is related to perceived value. The goal of this study was to find out how much Iranian healthy people would be willing to pay to keep their natural teeth instead of having them pulled. This was done separately for the anterior and posterior teeth.

METHODS

The highest value was posed as an open-ended question in this cross-sectional analysis conducted in 2021. Four distinct scenarios for treating a tooth with a poor prognosis for natural tooth preservation versus extraction were offered. WTP for the preferred treatment option was asked for painful and painless anterior and posterior teeth separately. A two-stage hurdle approach was employed to determine factors influencing the WTP for a hopeless case. The level of significance was fixed at 0.05.

RESULTS

Out of 795 individuals, 355 (44.7%) were male and 209 (26.3%) had poor self-stated dental health. Over 65% of those interviewed said they wanted to keep their teeth. The mean WTP was highest for dental preservation up to 94 USD and the lowest was for extraction without replacement 19 USD. The WTP for anterior tooth therapy was greater than the WTP for posterior dental care, regardless of treatment type or tooth discomfort. Participants with higher education, jobs, income-to-expenditure matching, older age, preference for the treatment in a private office, and female gender (except for WTP for a painful posterior tooth) were more likely to have a WTP of at least 1 USD.

CONCLUSION

The average WTP for treatment of teeth with a poor prognosis was lower than the average fee charged in dental facilities, and more than 65% of participants preferred to keep their teeth. Regardless of the treatment option or whether it was painful or not, WTP for anterior teeth treatment was higher than for posterior teeth. Generally, we found that sociodemographic factors influenced WTP decision-making the most. This study has practical implications for public oral health policymakers and insurance organizations.

Burden of Oral Diseases and Access to Oral Care in an Ageing Society

OBJECTIVE

The total years lived with disability among older people, and the concomitant burden of tooth loss in ageing societies have increased. This study is an overview of the burden of oral diseases and access to oral care in an ageing society.

METHODS

We selected key issues related to the burden of oral diseases and access to oral care and reviewed the relevant literature.

RESULTS

The rising number of older people with teeth increases their oral health care needs. To improve access to oral care, affordability of care is a great concern with respect to universal health coverage. In addition, accessibility is a crucial issue, particularly for vulnerable older adults. To improve oral care access, attempts to integrate oral health care into general care are being made in ageing countries. For this purpose, provision of professional oral care at home through domiciliary visits and provision of daily oral health care by non-dental professional caregivers are important. Oral health care for older people reduces general diseases such as pneumonia and malnutrition, which in turn could reduce further healthcare costs.

CONCLUSIONS

To address the growing burden of oral care in ageing societies, special provision of oral health care to vulnerable older people, and integration of oral care with primary care will be required.

Food insecurity, home ownership and income-related equity in dental care use and access: the case of Canada

Background

It has been documented that income is a strong determinant of dental care use in Canada, mostly due to the lack of public coverage for dental care. We assess the contributions of food insecurity and home ownership to income-related equity in dental care use and access. We add to the literature by adding these two variables among other socio-economic determinants of equity in dental care use and access to dental care. Evidence on equity in access to and use of dental care in Canada can inform policymaking.

Methods

We estimate income-related horizontal inequity indexes for the probability of 1) receiving at least one dental visit in the last 12 months; and 2) lack of dental visits during the 3 years before the interview. We conduct the analyses using data from the 2013–2014 Canadian Community Health Survey (CCHS) at the national and regional level.

Results

There is pro-rich inequity in the probability of visiting a dentist or an orthodontist and in access to dental care in Ontario. Inequities vary across jurisdictions. Housing tenure and food insecurity contribute importantly to both use of and access to dental care, adding information not captured by standard socio-economic determinants.

Conclusions

Redistributing income may not be enough to reduce inequities. Careful monitoring of equity in dental care is needed together with interventions targeting fragile groups not only in terms of income but also in improving house and food security.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12760-6.

An interprofessional model of care for oral health during pregnancy

The study aim was to appraise the relevance and appropriateness of an interprofessional prenatal oral care model among pregnant women and healthcare providers in British Columbia (BC), Canada. Audio-recorded semi-structured interviews with 39 purposefully selected participants (13 pregnant women and 26 healthcare professionals) were used qualitatively to appraise relevance of an existing model. The existing model emphasizes communication and collaboration among multiple health providers for the delivery of integrated prenatal oral care. All interviews were transcribed verbatim and analyzed using an inductive thematic approach and N-Vivo® software. During the first round of interviews, most participants considered the existing model as simple and well-defined but not fully relevant to the BC context. The participants suggested revisions to Steven's model to incorporate facilitators of integrated care, including interprofessional education, oral health funding, and advocacy for oral healthcare. Participants suggested a different graphical portrayal for the revised model; an implementation guide was also suggested. A revised model based on participants' feedback, was shared with 14 of the initial participants during secondary interviews. Further evaluation of the appropriateness of the revised model is warranted.

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.

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.

Association between Dental Scaling and Reduced Risk of End-Stage Renal Disease: A Nationwide Matched Cohort Study

Periodontitis is prevalent in patients with chronic kidney disease (CKD) and is also associated with kidney function decline. It is unclear whether dental scaling treatment prevents the progression of CKD. In a nationwide cohort study, Taiwan's National Health Insurance Research Database was used to select people with CKD. Propensity score-matching procedures were performed to compare the long-term risk of end-stage renal disease (ESRD) between CKD patients with and without the receipt of dental scaling. A total of 33,637 matched pairs with CKD were included, with 503,373 person-years of follow-up for analyses. Dental scaling was significantly associated with a lower risk of ESRD (adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.77-0.90). In addition, there was a dose-dependent relationship between the frequency of dental scaling and a reduced risk of ESRD. Dental scaling was also linked to reduced risks of major adverse cardiovascular events (aHR: 0.91, 95% CI: 0.87-0.95), sepsis (aHR: 0.81, 95% CI: 0.77-0.85), and all-cause mortality (aHR: 0.81, 95% CI: 0.76-0.87). Dental scaling was significantly associated with lower risks of progression to ESRD in patients with CKD. Regular dental scaling may serve as a prophylactic measure for kidney function decline.

Inequalities in utilization and provision of dental services: a scoping review

BACKGROUND

There are many determinants that can affect inequality in oral and dental health. This study is aimed to explore the main determinants of inequality in both utilization and provision of dental services in Organization for Economic Co-operation and Development (OECD) countries.

METHODS

Four databases including PubMed, ISI WOS, Scopus, and ProQuest were searched up to 8 Aug 2020, applying the relevant keywords. Thematic analysis was used for synthesizing and extracting data. Trend analysis was applied to determine the trends of the inequality determinants.

RESULTS

Thematic analysis led to 6 main themes, 13 sub-themes, and 53 sub-sub-themes. The main themes represent the main inequality determinants for both utilization and provision of dental services. The streamgraph illustrated that fewer studies have been conducted on social and cultural determinants, and for almost all determinants the trend of published articles has been increasing since 2007, with the exception of health policies.

CONCLUSIONS

Inequality in the utilization and provision of dental services is addressed by various factors including individual, social, cultural and economic determinants, health policies, and availability of services. The first four determinants are related to utilization and the last two are related to the provision of services. All these aspects must be considered to reduce inequality in dental services.

Neighborhood Contexts and Oral Health Outcomes in a Pediatric Population: An Exploratory Study

Aims: This study aimed to explore the impacts of neighborhood-level socioeconomic contexts on the therapeutic and preventative dental quality outcome of children under 16 years. Materials and Methods: Anonymized billing data of 842 patients reporting to a university children’s dental over three years (March 2017–2020) met the inclusion criteria. Their access to care (OEV-CH-A), topical fluoride application (TFL-CH-A) and dental treatment burden (TRT-CH-A) were determined by dental quality alliance (DQA) criteria. The three oral health variables were aggregated at the neighborhood level and analyzed with Canadian census data. Their partial postal code (FSA) was chosen as a neighborhood spatial unit and maps were created to visualize neighborhood-level differences. Results: The individual-level regression models showed significant negative associations between OEV-CH-A (p = 0.027) and TFL-CH-A (p = 0.001) and the cost of dental care. While there was no significant association between neighborhood-level sociodemographic variables and OEV-CH-A, TRT-CH-A showed a significant negative association at the neighborhood level with median household income and significant positive association with percentage of non-official first language (English or French) speakers. Conclusion: Initial analysis suggests differences exist in dental outcomes according to neighborhood-level sociodemographic variables, even when access to dental care is similar.

What is the evidence of outcomes of endodontically treated cracked teeth?

Data sources Ovid, PubMed and Cochrane were searched using the indexed terms. Additional searches were made using endodontic textbooks and endodontic-related journals.Study selection Two independent reviewers screened the titles, abstracts and/or full text for clinical studies evaluating the treatment outcomes of healthy patients over 18 years of age who received root canal treatment with at least one year in occlusal function.Results The study included four articles and reported an overall survival of 84% after 60 months in endodontically treated cracked teeth. The authors reported that teeth with single crack, cracks contained within crowns and teeth with pre-treatment periodontal probing less than 3 mm had a lower risk of being extracted.Conclusion This study reported a moderately high survival rate of endodontically treated cracked teeth.

Multilevel Analysis of the Association of Dental-Hygienist-Related Factors on Regular Dental Check-Up Behavior

Few studies have examined the factors related to dental clinics during dental check-ups. We examined the association between dental-hygienist-related factors and patients’ regular dental check-ups. This nationwide cross-sectional study was based on a survey conducted in Japan in 2014. The analyzed population included 12,139 patients from 1181 dental clinics. We used three-level Poisson regression analysis, considering patient‒clinic‒prefecture, to examine the association of dental-hygienist-related factors with dental check-up behavior. Patients attending treatment and regular check-ups constituted 63.0% and 37.0%, respectively. The adjusted prevalence ratios (PRs) for patients undergoing regular dental check-ups at dental clinics with dedicated dental hygienists’ units, spending ≥20 min in patient education (compared to 0 min), and with three or more dental hygienists (compared to 0 hygienists) available were 1.17 (95% confidence interval [CI]: 1.06–1.30), 1.25 (95%CI: 1.07–1.46), and 2.05 (95%CI: 1.64–2.56), respectively. The median PR indicates that when a patient randomly moves to another dental clinic with more regular dental check-ups, this prevalence increased 1.69 times. These results suggest that dental check-up behavior is determined not only by individual factors but also dental-clinic-level factors. Improving the dental-hygienist-related factors is necessary to encourage people to visit dentists for regular check-ups.

Children and parents perspectives on children's dental treatment under general anesthesia: a narratology from Saskatoon, Canada

Aim

This study aimed to explore the emotional and psychological effects of dental treatment under general anesthesia (DTGA) on children and parents in Saskatoon city, Saskatchewan, Canada.

Design

Semi-structured interviews, video diaries, drawings, and a questionnaire were used to collect data. The study used a narrative perspective and thematic analysis to analyze data.

Results

The findings from children and their parents (N = 25) indicated DTGA is disconcerting from both views. Parental guilt and the desire of both parents and children to not have to go through the experience again fueled at least short-term compliance with brushing, flossing, and changes in dietary habits.

Conclusion

The children participants provided valuable information to augment that gathered from parents. As the study revealed that the DTGA is psychologically and emotionally troubling for both children and their caregivers, it is imperative to explore ways to ease the GA experience. Specific recommendations were provided for optimizing dental and health services for those children and their families.

Access to root canal treatment in a Nigerian sub-population: assessment of the effect of dental health insurance

Background

The final pathway of tooth mortality lies between tooth extraction, and the more expensive and less accessible root canal treatment (RCT).

Aim

To determine the extent to which individuals' financial resources as measured by socioeconomic status and dental insurance coverage affects their access to RCT.

Methods

A hospital-based study that used a 15-item questionnaire to collect data among patients scheduled for RCT. All scheduled subjects (N = 291) over a one-year period constituted the sample for the study. Using the SPSS software, associations between the subjects' variables, and the dental insurance status were carried out with Chi square and independent t test respectively at 95% confidence interval.

Results

Two hundred and ninety-one subjects were to have 353 RCTs within the study period. A high proportion (79.7%, p < 0.001) of the subjects had dental health insurance, majority (95.3%) of which was government funded. 20.9% of those with previous tooth loss was due to inability to afford cost of RCT. The lowest socioeconomic group had the highest proportion (90%, p = 0.421) of insured that visited for RCT.

Conclusion

Dental insurance increased access to RCT. Socioeconomic status did not affect dental insurance status and dental visit for RCT.

Frequency and source of prescription eyewear insurance coverage in Ontario: a repeated population-based cross-sectional study using survey data

BACKGROUND

Insurance coverage may reduce cost barriers to obtain vision correction. Our aim was to determine the frequency and source of prescription eyewear insurance to understand how Canadians finance optical correction.

METHODS

We conducted a repeated population-based cross-sectional study using 2003, 2005 and 2013-2014 Canadian Community Health Survey data from respondents aged 12 years or older from Ontario, Canada. In this group, the cost of prescription eyewear is not covered by the government unless one is registered with a social assistance program or belongs to a specific population. We determined the frequency and source of insurance coverage for prescription eyewear in proportions. We used survey weights provided by Statistics Canada in all analyses to account for sample selection, a complex survey, and adjustments for seasonal effect, poststratification, nonresponse and calibration. We compared unadjusted proportions and adjusted prevalence ratios (PRs) of having insurance.

RESULTS

Insurance covered all or part of the costs of prescription eyewear for 62% of Ontarians in all 3 survey years. Of those insured, 84.1%-86.0% had employer-sponsored coverage, 9.0%-10.3% had government-sponsored coverage, and 5.7%-6.8% had private plans. Employer-sponsored coverage remained constant for those in households with postsecondary graduation but decreased significantly for those in households with less than secondary school graduation, from 67.0% (95% confidence interval [CI] 63.2%-70.8%) (n = 175 000) in 2005 to 54.6% (95% CI 50.1%-59.2%) (n = 123 500) in 2013-2014. Government-sponsored coverage increased significantly for those in households with less than secondary school graduation, from 29.2% (95% CI 25.5%-32.9%) (n = 76 400) in 2005 to 41.7% (95% CI 37.2%-46.1%) (n = 93 900) in 2013-2014. In 2013-2014, Ontarians in households with less than secondary school graduation were less likely than those with secondary school graduation to report employer-sponsored coverage (adjusted PR 0.79, 95% CI 0.75-0.84) but were more likely to have government-sponsored coverage (adjusted PR 1.27, 95% CI 1.06-1.53).

INTERPRETATION

Sixty-two percent of Ontarians had prescription eyewear insurance in 2003, 2005 and 2013-2014; the largest source of insurance was employers, primarily covering those with higher education levels, whereas government-sponsored insurance increased significantly among those with lower education levels. Further research is needed to elucidate barriers to obtaining prescription eyewear and the degree to which affordability impairs access to vision correction.

Untreated Dental Caries May be Associated with Subsequent Mortality among Working-Age Adults: Evidence from NHANES III

OBJECTIVES

Poor oral health has been shown to be associated with selected adverse health outcomes. This study assessed the association between untreated dental caries and mortality and examined whether having dental insurance mitigates the risk of mortality among working-age US adults with dental caries.

METHODS

Analysis used the publicly available linked mortality file for NHANES III, an observational study conducted in 1988-1994, with follow-up through December 2015. Propensity score matching was conducted to create similar populations of insured and uninsured adults, resulting in a sample of 4420 matched observations. The Cox proportional hazard model was used to investigate the effect of untreated dental caries and that of dental insurance on risk of all-cause mortality. The descriptive and final outcome statistical analyses were adjusted for complex sampling technique using weights, strata and cluster variables.

RESULTS

Adults with untreated dental caries had a higher risk of mortality (HR: 1.33; 95% CI: 1.06-1.68) than those with no dental caries. Having dental insurance was associated with a lower risk of mortality (HR: 0.73; 95% CI: 0.59-0.92). An interaction between caries treatment status and dental insurance was not statistically significant.

CONCLUSIONS

Adults with untreated dental caries have a higher risk of mortality, even in the presence of dental insurance. Untreated caries may be an indicator for multiple risk factors, including personal attitudes regarding health and healthcare-seeking behaviour.

Just say "no": Can dentists refuse care on the basis of finances? A survey using an ethical vignette in an Iranian Dental School

Background

Decision making when patients ask a dentist for fee reduction is a real ethical dilemma at dental settings. The aim of this study was to evaluate how dental students and tutors think about their position for, or against fee reduction at dental offices.

Method

It was a questionnaire-based survey, which examined the ethical attitudes of students and tutors of an Iranian Dental School. The questionnaire included a vignette about an ethical dilemma at a dental office. Different ethical approaches, i.e. duty-based, virtue-oriented and consequentialist arguments, for or against fee reduction at dental office were suggested. Respondents were asked to rank those ethical options. Data was entered and analyzed in SPSS 16.0.

Result

121 dental students and thirty-six faculty members (dental specialists) participated in this study. It revealed that a majority of dental students and tutors (68%) are in favor of charging patients less, when facing an imagined request at dental office, using either virtue-oriented (54%) or consequentialist (14%) argument for fee reduction. The difference between rankings of four options was statistically significant, while no statistically significant difference exists neither between male and female respondents, nor students and tutors.

Conclusion

This case study provides a basis for fruitful discussions in ethics courses for dental students. Our study suggests that financial issues should be considered as a part of ethical training within the dental student's curriculum.

Narrative review of affinities and differences between the social determinants of oral and general health in Canada: establishing a common agenda

BACKGROUND

This article overviews Canadian work on the social determinants of oral and general health noting their affinities and differences.

METHODS

A literature search identified Canadian journal articles addressing the social determinants of oral health and/or oral health inequalities. Analysis identified affinities and differences with six themes in the general social determinants of health literature.

RESULTS

While most Canadian social determinants activity focuses on physical and mental health there is a growing literature on oral health-literature reviews, empirical studies and policy analyses-with many affinities to the broader literature. In addition, since Canada provides physical and mental health services on a universal basis, but does not do so for dental care, there is a special concern with the reasons behind, and the health effects-oral, physical and mental-of the absence of publicly financed dental care.

CONCLUSIONS

The affinities between the social determinants of oral health and the broader social determinants of health literature suggests the value of establishing a common research and action agenda. This would involve collaborative research into common social determinants of oral and general health and combined policy advocacy efforts to improve Canadians' living and working conditions as means of achieving health for all.

Unmet Dental Care Needs among Korean National Health Insurance Beneficiaries Based on Income Inequalities: Results from Five Waves of a Population-Based Panel Study

This study investigates whether self-employed beneficiaries experience greater difficulties in accessing dental care than insured employees based on their income level. This analysis uses 2011–2015 data from the Korea Health Panel, a population-based and nationally representative sample, covering 7083 participants aged 18 years and older. We measured barriers to dental access based on unmet needs or the inability to receive necessary dental care owing to the past year’s economic burdens. The type of health insurance and household income are considered independent variables. We applied multiple panel logistic regressions and two-panel logistic regression models with a fixed-effects approach to analyze the data. Self-employed beneficiaries were 1.16 times (95% confidence interval (CI) = 1.08–1.24) more likely to experience unmet dental needs than were insured employees. Insured employees and self-employed beneficiaries belonging to the lowest income bracket were 1.76 times (95% CI = 1.53–2.03) and 2.33 times (95% CI = 1.89–2.87) more likely to have unmet needs than those in the highest income bracket. Self-employed beneficiaries were 1.31 times (95% CI = 1.21–1.43) more likely to experience unmet dental needs caused by economic burdens than are insured employees. Insured employees of the lowest income quintile were 4.15 times (95% CI = 3.41–5.05) more likely to experience unmet needs caused by economic burdens, while the odds ratio for self-employed beneficiaries was 5.47 (95% CI = 4.05–7.39). Our findings indicate gaps in unmet dental needs between self-employed beneficiaries and insured employees. The government should adopt strategies to reduce unmet needs among marginalized groups and redefine the role of national health insurance.

Providing dental insurance can positively impact oral health outcomes in Ontario

Background

Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population.

Methods

We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013–2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada’s most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups.

Results

Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9–24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6–11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9–19.8 vs. ME lowest: 27.2; 95% CI: 25.0–29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: − 13.2 to − 9.9 vs. ME lowest: -27.2; 95% CI: − 29.5 to − 24.8).

Conclusions

Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.

What are the self-reported unmet dental treatment needs of people living with HIV in British Columbia? A case of minority subpopulation in Canada

OBJECTIVES

To identify associations of Andersen and Newman's (A&N) predisposing, enabling, and need factors with self-reported oral health status and self-reported unmet dental treatment needs in a sample of people living with HIV (PLHIV) in British Columbia (BC), Canada.

METHODS

Participants responded anonymously to a 41-item online questionnaire with the following inclusion criteria: a) be at least 19 years old; b) self-identify as HIV-positive; c) be able to provide consent and be willing to voluntarily participate in the study; d) be residing in British Columbia; and e) be able to proficiently respond to the questions in English. Following the descriptive statistics, associations between A&N model factors and the main outcome variables (self-reported oral health status and self-reported dental treatment needs) were evaluated using bivariate inferential analyses.

RESULTS

A total of 186 participants met the inclusion criteria. Approximately 40% (n = 74) of participants rated the health of their mouth as fair/poor and more than half (n = 112; 60.2%) reported having bleeding gums, tooth decay or tooth sensitivity. The bivariate analysis for the self-reported oral status as the outcome variable showed "having fair/poor general health" (P = 0.001), "unemployment" (P = 0.019), "avoiding dental treatment due to cost" (P = 0.005), and "not visiting a dental professional within the last year" (P < 0.001) as the strongest predictors. For the second outcome variable unmet dental treatment needs, the strongest predictors were "experience of being discriminated by dental professionals" (P = 0.001), "having fair/poor general health" (P = 0.006), and "suffering from past and current medical conditions due to HIV" (P < 0.001).

CONCLUSIONS

Several predisposing, enabling and need factors from the A&N model were associated with self-reported oral health status and unmet dental treatment needs of PLHIV. Results from this study highlight the needs of improving access to affordable dental care to address the unmet oral health needs of PLHIV.

CAEP Dental Care Statement

Oral health is an important part of an individual's overall health; however, dental care is not included in the Canadian public healthcare system. Many Canadians struggle to access dental care, and six million Canadians avoid visiting the dentist each year due to cost.1 The most vulnerable groups include children from low-income families, low-income adults, seniors, indigenous communities, and those with disabilities.1–5 The lack of affordable, equitable, and accessible dental care puts undue strain on emergency departments across the country, as patients desperately seek the care of a physician when they actually need the care of a dental professional.6 Emergency physicians do not have the same expertise or equipment as dentists and, in most cases, are only able to provide temporary symptom relief. This results in an increased reliance on prescription opioids that would otherwise be unnecessary if patients could access the dental care they required.

Masticatory Capacity and Mortality: The Preventive and Clinical Investigation Center (IPC) Cohort Study

Poor oral health (OH) has been associated with mortality, but the association between OH components and mortality remains imprecise. The present observational study aimed to investigate if there is an association between oral masticatory efficiency and cardiovascular (CV) mortality in a large French subject cohort. The study was based on a cohort of 85,830 subjects aged between 16 and 94 y at recruitment. The follow-up extended from 2001 to 2014 and the mean follow-up was 8.06 ± 2.73 y. The number of deaths totaled 1,670. Full-mouth examinations were performed. Dental plaque, dental calculus, gingival inflammation, missing teeth, and masticatory units were recorded. Masticatory units represent the number of natural or prosthetic opposing premolars and molar pairs and can be considered an accurate indicator for masticatory efficiency. Causes of death were ascertained from death certificates. Cox regression analyses were used to calculate hazard ratios (HRs). In the fully adjusted model, the number of masticatory units <5 is associated with an HR of 1.72 (95% confidence interval [CI], 1.54 to 1.91) for all-cause mortality, HR of 1.41 (95% CI, 1.01 to 1.99) for CV mortality, HR of 1.76 (95% CI, 1.44 to 2.15) for cancer mortality, and HR of 1.85 (95% CI, 1.55 to 2.20) for non-CV and noncancer mortality. Significant statistical associations with the other oral variables were also found for all-cause mortality, cancer mortality, and non-CV and noncancer mortality in the adjusted models. Our study indicates that after full adjustment, all oral parameters are associated with all-cause, cancer, and non-CV and noncancer mortality. However, the low number of masticatory units is associated with an increased risk of CV mortality. We highlight the association of masticatory units and CV mortality.

Income-related disparities in private prescription drug coverage in Canada

BACKGROUND

Canada does not have universal public coverage for prescription drugs, which leaves an important role for private insurance plans. However, we do not have recent data on the characteristics of Canadians who report holding such coverage, particularly differences based on household income. We performed a study to examine the relation between household income and private drug insurance coverage in Canada.

METHODS

We used data from the 2015-2016 cycle of the Canadian Community Health Survey to investigate the relation between household income and holding private drug insurance. We constructed modified multivariate Poisson regression models with robust error variances, including several potential confounders.

RESULTS

Overall, 59.4% of respondents reported having private drug insurance. We found a strong dose-response relation between household income level and private drug insurance coverage: 19.8% of those with a household income less than $20 000 reported private coverage, compared to 76.2% of those with a household income of $80 000 or more.

INTERPRETATION

Higher-income households are much more likely to hold private drug insurance coverage in Canada. This likely contributes to differential access to medicines and health outcomes by different income groups.

Predictors of Routine Dental Check-up Among Male Adolescents in Saudi Arabia

Objective

To evaluate the association of socioeconomic factors and self-perceived oral conditions with routine dental check-up among male adolescents.

Methods

This cross-sectional study was conducted on male children (grade 10-12) from public schools in different cities of the Eastern province of Saudi Arabia. A multistage random sampling was used for the recruitment of study participants. A piloted questionnaire translated into the Arabic language was used for data collection.

Results

There were 586 students with mean age 16.86±0.87 years. The prevalence of routine dental visit within last year was 18.9%. Half of the entire sample had dental cavities (50.5%) and tooth sensitivity (50%) followed by dental pain (42.2%). Bivariate analyses found that the children with dental cavities (OR 0.4, 95% CI 0.26, 0.61), dental pain (OR 0.63, 95% CI 0.41, 0.97), and malodor (OR 0.41, 95% CI 0.23, 0.71) had significantly lower odds of routine dental visits than those without these conditions. The final model of multivariable logistic regression showed that dental cavities (OR 0.42, 95% CI 0.27, 0.66) and malodor (OR 0.45, 95% CI 0.25, 0.78) were significantly associated with lower likelihood of visiting dental office for a regular dental check-up. No significant influence of socioeconomic factors on routine dental attendance was observed.

Conclusions

A small proportion of children performed routine dental visits. The children with dental cavities and malodor were less likely to perform routine dental visits. The awareness about the importance of regular dental check-up should be raised to reduce the burden of oral diseases in schoolchildren.

Dental expenditure and catastrophic dental expenditure in Eastern Saudi Arabia: Pattern and associated factors

Background

Dental services have one of the highest expenses among health services. The aims of the study were to assess (1) dental expenditure (DE), (2) catastrophic dental expenditure (CDE), (3) dental services payment and (4) factors associated with DE and CDE.

Material and Methods

A cross sectional study was conducted in 2018 in Saudi Arabia. Using convenience sample, participants were recruited from governmental and private dental clinics/hospitals. A questionnaire assessed (a) personal information, (b) dental background: payment methods, type of clinics visited, perceived oral health status, frequency of pain and (c) payment for dental services received. The number of remaining teeth was clinically assessed. Two outcome variables were assessed (1) total DE in linear regression and (b) CDE (DE exceeds 10% of income) in logistic regression. Personal and dental background variables were explanatory variables.

Results

The response rate was 83.8% (419/500) with 43% reporting expenditure, 16.5% facing CDE and 36.3% using multiple payment methods. The greatest DE was for crowns and bridges, root canal therapy, fillings and implants. Income, payment method and pain were associated with DE and CDE.

Conclusions

Participants used multiple payment methods including out of pocket and faced CDE. The bulk of expenditure was for rehabilitative services. The availability and quality of health-insured primary care services may reduce the financial burden facing dental patients.

Key words:Health expenditure, Saudi Arabia, dental care, insurance, dental, universal health insurance.

Determinants of Postponed Dental Visits Due to Costs: Evidence from the Survey of Health, Ageing, and Retirement in Germany

High costs are an important reason patients postpone dental visits, which can lead to serious medical consequences. However, little is known about the determinants of postponing visits due to financial constraints longitudinally. Thus, the purpose of this study was to examine the determinants of postponing dental visits due to costs in older adults in Germany longitudinally. Data from wave 5 and 6 of the Survey of Health, Ageing, and Retirement in Europe was used. The occurrence of postponed dental visits due to costs in the last 12 months served as the outcome measure. Socioeconomic and health-related explanatory variables were included. Conditional fixed effects logistic regression models were used (n = 362). Regressions showed that the likelihood of postponing dental visits due to costs increased with lower age, less chronic disease, and lower income. The outcome measure was neither associated with marital status nor self-rated health. Identifying the factors associated with postponed dental visits due to costs might help to mitigate this challenge. In the long term, this might help to maintain the well-being of older individuals.

Factors Associated with Untreated Decayed Teeth in Male Sales Workers: An Internet Survey

The purpose of this study was to identify factors associated with untreated decayed teeth (DT) in male sales workers. The participants were recruited by screening a pool of Japanese registrants in an online database for eligibility for inclusion in the study. Between 20 February 2015 and 11 March 2015, those deemed eligible were asked to complete a questionnaire on the status of their oral health. Responses from a total of 142 male sales workers aged between 30 and 49 years were analyzed. Of these, 40 reported DT and 102 no untreated decayed teeth (NDT). The percentage of participants with DT was higher than that with NDT among night shift workers (p<0.001). A higher percentage of participants with DT reported pain when eating or drinking something cold (p=0.041), pain in the teeth or gingiva (p<0.001), or frequent stomatitis (p=0.030). A higher percentage of participants with DT reported eating between meals (p=0.027) and a lower percentage visiting a dental clinic in the past 6 months (p=0.017) compared with among participants with NDT. Those with NDT were more likely to report an inability to visit a dental clinic when they wanted to (p=0.033), but those with DT were more likely to report that their reasons for not visiting a dental clinic were that multiple visits were required for treatment (p=0.012) or that they did not like the treatment (p=0.005). Working the night shift (Odds Ratio [OR], 3.492; 95% Confidence Interval [CI], 1.347-8.725) and visiting a dental clinic in the past 6 months (OR, 0.084; 95%CI, 0.010-0.733) were identified as independent variables correlated with leaving DT untreated. Requiring oral health education and dental checkups at least once every 6 months may have a positive effect on oral health among male sales workers, especially those doing night shifts.