Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents

Unmet oral health needs and barriers to dental services among socially marginalized youth: a scoping review

Objectives

Barriers limiting access to oral health significantly impact dental service utilization among socially marginalized youth, often resulting in unmet needs and poor oral health outcomes. Identifying and understanding these barriers is critical to inform the development of strategies to enhance oral healthcare access for this vulnerable population. This review examines the barriers restricting access to oral healthcare and unmet dental needs among socially marginalized youth worldwide, offering insight to guide the development of targeted interventions.

Methods

A comprehensive search was performed across electronic databases, including Embase, MEDLINE (Ovid), Scopus, and the Cochrane Library. Two independent reviewers screened all primary studies, irrespective of publication year, to identify relevant research on barriers to care and unmet oral health needs among socially marginalized youth. Primary studies addressing barriers to oral healthcare access and unmet needs were included, with no restrictions on publication date. Studies published in languages other than English were excluded. Any discrepancies identified during the screening process were resolved through consensus. The CLARITY tool was utilized to evaluate the risk of bias in the included studies.

Results

Of the 484 studies identified, six quantitative and one qualitative study met the inclusion criteria. The review identified multiple barriers such as financial constraints, structural impediments, and psychological factors that inhibit access to dental care facilities among socially marginalized youth. Three studies were conducted in the United States, two in Australia, and one each in the United Kingdom and Kenya. Among the identified barriers, four studies reported financial constraints and structural and logistical challenges, respectively while one study reported psychological barriers to dental care. A high prevalence of unmet needs such as dental caries and periodontal diseases, was observed within this demographic. The unmet dental needs identified in the included studies encompassed dental caries (n = 3), missing teeth (n = 2), periodontal diseases (n = 1), tooth pain (n = 1), and dental infections (n = 1). However, small sample sizes and lacking in robust study design limit the findings' generalizability, emphasizing the need for more diverse studies on oral health outcomes in socially marginalized youth.

Conclusion

This scoping review identified critical research gaps in regards to access to oral health and dental service utilization among socially marginalized youth. Oral health initiatives are warranted to reduce oral health inequalities among socially marginalized youth.

Systematic Review Registration

https://doi.org/10.17605/OSF.IO/T82D3.

Assessment of treatment needs, barriers, and self-perception regarding oral health among female university students: a cross-sectional study

BACKGROUND

The study aimed to compare the self-perceived oral health status measured through a self-administered questionnaire with clinically determined oral health status measured by decayed-missing-filled teeth (DMFT) and community periodontal index of treatment need (CPITN) indices in university going females. In addition, access barriers to treatment related to oral healthcare were also determined.

METHODS

A 3-month analytical cross-sectional study was designed for consenting university going females (aged 18-22 years) in Islamabad, Pakistan. The self-perceived oral health was recorded through a questionnaire requesting information regarding socio-demographics, self-perception of oral health, frequency of dental visits and barriers to seeking oral health. Seven independent examiners performed intraoral clinical examination and assessed the oral health status using globally standardized oral health assessment indices (DMFT and CPITN).

RESULTS

A total of 400 students were included in the final sample. The study revealed a significant disparity between self-perceived oral health and clinical assessment. Although perceived oral health was considered "good" by 80.0% of the respondents, clinical examination revealed moderate DMFT scores (mean 2.95 ± 1.41) and periodontal disease requiring treatment in 89.5% of the individuals. The most common barriers in seeking dental care were lack of knowledge, dental phobia, affordability issue and false self-perception.

CONCLUSION

The present study demonstrated a notable discrepancy between self-perception of oral health and clinically assessed oral health. These results emphasize the importance of focused educational programs and community outreach programs, especially directed towards this demographic. Prioritizing such initiatives will help individuals to recognize their actual oral health condition thus encouraging positive oral health behaviors and outcomes.

Oral Health Barriers for African American Caregivers of Autistic Children

The most persistent oral health disparities in the United States impact children from racial and ethnic minoritized groups and children diagnosed as autistic. This paper aims to describe barriers to oral care as depicted by Black/African American (B/AA) parents of autistic children to further explore how and why oral health disparities persist in this population. A purposeful sample of eleven caregivers of autistic children, ages 4 to 14 years, who identified as B/AA were interviewed twice for approximately 60-90 min each. Thematic analysis utilizing a narrative approach was employed. Three themes emerged from the data concerning the barriers that affect oral health experiences: (a) difficulty in maintaining good oral health practices, (b) challenges with access to care and resources, and (c) poor patient-provider relationships. Due to the limited research that examines the intersection of autism, B/AA culture, and oral health practices, this study provides a rich picture of the barriers families face when obtaining oral care. Many families raised issues that other parents of autistic children also identified. B/AA caregivers have demonstrated that despite their own negative dental experiences, they understand the value of good oral care practices and are willing to pursue oral care for their children.

Predicting Flossing through the Application of the Multi-Theory Model (MTM) of Health Behavior Change among Minority Adolescents in the United States

Adolescents from minority groups are particularly susceptible to poor oral hygiene behaviors, including lack of daily flossing. This cross-sectional study aimed to conduct an exploratory behavioral research to identify evidence-based (theory-based) approaches to promote flossing behavior among African American/Black and Latinx/Hispanic (minority) adolescents. A 39-item psychometrically valid web-based questionnaire was used to collect responses from a nationwide sample of minority adolescents aged 10-17 years residing in the United States. The data were analyzed using bivariate and multivariate statistical methods. Of 520 minority adolescents (260 African American/Black and 260 Latinx/Hispanic adolescents), the proportion of flossing was nearly equally split in the sample. A significantly higher proportion of minority adolescents who were flossing had access to floss as opposed to those who were not flossing (86.8% vs. 69.8%, p < 0.001). A significantly higher proportion of minority adolescents who were not flossing did not visit the dentist over the past year as opposed to those who floss (25.2% vs. 14.7%, p < 0.001). Among the participants who were not flossing, gender, grade level, instruction in school regarding flossing, and multi-theory model (MTM) of health behavior change constructs were the significant predictors (p < 0.001) of initiating and sustaining flossing. The findings of this study will serve as baseline data for developing and evaluating effective evidence-based interventions using the MTM.

Oral Care Knowledge, Attitudes, and Practices of Black/African American Caregivers of Autistic Children and Non-Autistic Children

Oral health is a vital component of overall health. Children from underserved, minoritized populations (i.e., Black/African Americans, autistic children) are at even greater risk for experiencing oral health disparities. This study aims to illuminate the oral health knowledge, attitudes, and practices of Black/African American caregivers of autistic and non-autistic children. Black/African American caregivers of children (4-to-14 years) on the autism spectrum (n = 65) or not on the autism spectrum (n = 60), participated in a survey, with input from literature reviews, interviews, previous research, and reviews by experts. Caregivers demonstrated basic knowledge of oral health with significantly lower scores for caregivers of autistic children. Caregivers care about oral health and would like to increase their knowledge. Significant differences in oral care practices were found between the autistic and non-autistic groups. Caregivers reported they can access dental services with relative ease, including finding their child a dentist, scheduling a dental appointment, and accessing transportation (personal or public) to attend the visit. Black/African American caregivers of autistic children and children without autism seem to have foundational knowledge about oral health and basic practices; however, they are interested in learning more. Therefore, tailored oral health education programs may help mitigate oral health disparities for Black/African American families.

“Oral health as an important milieu for social and mental health”: Perspectives of adolescents emerging from a qualitative study

Background

Recent evidence showed that the prevalence of oral diseases is still high among adolescents in many developing countries, including Nigeria. It therefore has becomes pertinent to focus on appropriate oral health interventions to promote oral health among them. This necessitates investigating the perspectives of adolescents, who are the major stakeholders, on the importance of oral health as baseline data needed in planning appropriate primary interventions.

Aim

The aim of the study was to explore the perspectives of adolescents on the importance of oral health.

Methods

An explorative qualitative study was conducted among adolescents attending senior secondary school I (grade 10) in the metropolis of Ibadan, Nigeria. A total of 12 focus group discussions were conducted among 120 adolescents aged 14 to 19 years. The discussions were transcribed verbatim, and triangulation and organization, as well as thematic analysis, of data were carried out.

Results

Some adolescents had positive perceptions of oral health and valued it as highly important, although some had contrary views and believed oral health was unimportant. Oral health is described as being integral to general health, is associated with eating and communication, is a means of survival and confidence building, and is a prelude to attract the opposite gender. Adolescents perceived the need for oral health education and dental treatment.

Conclusion

Adolescents have mixed perspectives on the importance of oral health; while some valued it as highly important, others believed it was of no significance. Those who valued oral health as important described it as a milieu for general health, human survival, and social and mental health and thus requested for oral health promotion in schools.

Evaluating True Barriers to Dental Care for Patients with Periodontal Disease

Background:

The cost of care is often reported as a primary reason why patients fail to seek dental treatment; however, this may not the only component.

Aims/Objectives:

To examine an underserved population’s perspective on the importance of dental care and barriers they face to seek treatment. The effectiveness of compliance incentives, such as gift cards, was also examined.

Methods:

We conducted a survey study to gain insight of an underserved population’s perspective of barriers to care and correlated the reported barriers with the true reasons of missed appointments in our study cohort. Appointment compliance was also examined before and after implementation of gift card incentives, appoitment reminder letters and additional staff.

Results:

Most patients felt dental care was important/very important to them. However, no correlations were found between survey responses and true reasons for missing appointments. Eighty-seven percent of patients report having some form of financial difficulty and compliance statistically improved after implementation of financial compensation in this population (69% completed appointments before gift card implementation versus 75% after gift card implementation, p=0.01), but not after the implementation of additional appointment reminders and contact staff.

Discussion:

Although the majority of patients reported dental care was important to them, there was an average of 31% missed appointments for patients who completed the survey and no correlations were found between the information patients reported and true reasons for non-compliance. Interestingly, even though care was free of charge, most patients reported to be in some form of financial difficulty and compliance was slightly improved through the implementation of financial compensation. Other potential barriers that need to be further examined include economic barriers, transportation, insurance utilization, and patient anxiety towards dental care.

Conclusion:

A survey is a resource to identify reasons why patients abstain from seeking care but may be not the best one as reasons reported do not correlate with true reasons of appointment failure. Financial compensation was shown to improve compliance with appointments. Further information gathering is necessary to gain insight into true barriers to dental care within an underserved population.

Oral Health Screening Status of Diabetes Patients in Selected Hospitals of Addis Ababa, Ethiopia, 2018

Objective

The study assessed the oral health screening status of diabetes patients and its associated factors in selected public hospitals of Addis Ababa, 2018.

Patients and Methods

An institutional-based cross-sectional study was conducted on 388 diabetes patients selected on the bases of a systematic random sampling method from March to May 2018 at two selected public hospitals in Addis Ababa. Data were collected with a pre-tested, structured, and translated questionnaire. Bi-variable and multivariable logistics regression were undertaken to identify predictors of oral health screening among diabetes with their respective 95% CI and a p-value of less than 5% level of significance.

Results

The oral health screening status among diabetes patients in this study was 21.1%. The odds of having had an oral health screening was 82.4% higher in those with an educational status of college and above than those who cannot read and write and it was ten and five folds higher in participants with a monthly income of less than 750 birr than those with above 2,000 birr and those who brushed their tooth twice or more times a day than occasionally, respectively. The odds of having had an oral health screening was 17, four, and five folds higher among participants with perceived susceptibility, perceived severity, and benefit, respectively, whilst it was 8.8% lower in participants with a perceived barrier and it was as high as 19.782 times among participants with malocclusion.

Conclusion

A lower level of oral health screening was observed. A higher educational level, a lower monthly income, a higher frequency of tooth brushing per day, positive perceptions of susceptibility, severity, and benefits, and presence of malocclusions were statistically associated with a higher frequency of oral health screening. Concerned bodies were recommended to work on the identified predictors and improve the oral health screening of diabetes patients.

Geospatial analysis of the urban and rural/remote distribution of dental services in Scotland, Wales and Northern Ireland

AIM

To address deficits in human resources for oral health data (HROH) in rural and remote areas in Wales, Scotland and Northern Ireland by spatially profiling and modelling the distribution pattern of dental practices according to Health Boards.

METHODS

National Health Service (NHS) dental practices were located and mapped against population and rural-urban classifications of Scotland, Wales and Northern Ireland, using Geographic Information System (GIS) tools. All data collected were at the smallest geographical statistical hierarchy level in each country, and population data were retrieved from the 2011 census.

RESULTS

A total of 1,695 NHS dental practices were mapped against 27 Health Board regions. In Scotland, Northern Ireland and Wales, 18.3%, 18.7% and 7.7%, respectively, of the population living in the most remote areas resided within 2.5 km of a dental practice. In each country, the Health Boards with the largest proportion of the population living more than 10 km from a dental practice were the Western Isles (Scotland), Western Health and Social Care Trust (HSCT) (Northern Ireland) and Hywel Dda University Health Board (UHB) (Wales). In each country, the highest practice-to-population (PtP) ratios were found in Forth Valley (1:7,194) (Scotland), Southern HSCT (1:5,115) (Northern Ireland) and Hywel Dda UHB (Wales) (1:7,907).

CONCLUSION

Dental services are distributed unequally between urban and rural areas. PtP ratios coupled with GIS analysis are important tools to improve HROH distribution.

School Achievement and Oral Health Behaviour Among Adolescents in Finland: A National Survey

PURPOSE

We examined oral health behaviour and its association with school achievement among Finnish adolescents.

MATERIALS AND METHODS

This study is part of the Finnish national School Health Promotion study (SHP). The study population comprised a representative sample of Finnish 15-year-olds (N = 45,877). A questionnaire inquired about the respondents' school achievements and health habits (toothbrushing, smoking), background factors (age, gender, school type, family structure), and their parents' background factors (education, smoking). Chi-square tests and logistic regression models were used in the statistical analyses.

RESULTS

Better school achievements were associated with better oral health behaviour: 73.1% of students with the highest mean grades (9-10) brushed their teeth twice daily, compared to 33.8% of those with the lowest mean grade (6.9 or less). The lowest mean grade was associated with brushing less than twice daily, especially among boys (odds ratios (OR) = 4.1; 95% CI 3.6-4.7) when compared to those with the highest mean grade, but also among girls (OR = 2.3; 95% CI 2.1-2.7). Smoking among boys was associated with poor oral hygiene (OR = 1.3; 95% CI 1.2-1.4).

CONCLUSION

School success is strongly associated with oral health behaviour among adolescents. Preventive treatment should be targeted especially at boys with poor school achievement and smoking behaviour.

Barriers and facilitators for adolescent girls to take on adult responsibility for dental care - a qualitative study

Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county. Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis. Results: The study findings could be summed into the theme "Triggers for adolescent girls to take on or not take on adult responsibility for dental care". The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories. Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.

An Examination of Dental Health Among Metropolitan and Appalachian Adolescents in Ohio

BACKGROUND

Poor dental health is a common chronic condition among youth. Appalachian versus metropolitan residence, socioeconomic status, and health behaviors contribute to poor dental health. Limited research has directly compared dental health and risk factors for poor dental health among Appalachian and metropolitan youth. We examined the association between dental health and residence among adolescent boys and explored socioeconomic and behavioral factors that may contribute to differences in dental health.

METHODS

Adolescent males from metropolitan and rural Appalachian Ohio (n = 1220, age 11-16 years) reported their diet and tobacco use. Parents or guardians reported when boys had last visited the dentist and rated their dental health (excellent/very good/good versus fair/poor). Unadjusted logistic regression modeled the association between fair/poor dental health and residence (metropolitan versus Appalachian). Adjusted analyses controlled for race, household income, dental visits, diet, and tobacco use.

RESULTS

Appalachian (versus metropolitan) boys were more likely to have used tobacco in the past 30 days and consumed fewer fruit and vegetables, more added sugar, and more sugary beverages. The relation between dental health and Appalachian versus metropolitan residence did not reach statistical significance, and adjusting for behavioral factors did little to change the observed association.

CONCLUSION

Our findings suggest that some of the urban/rural disparities in dental health observed in other studies may be related to behavioral factors like tobacco use and diet, but much remains unexplained. We provide support for behavioral interventions to address these issues in the Appalachian community.

The Effect of a Community Based Educational Intervention on Oral Health Knowledge Levels of Adult Caregivers of Young Children in the Rural Upper Peninsula of Michigan

Low levels of oral health literacy in parents and caregivers may place a child at risk for poor oral health (Miller, Lee, DeWalt, & Vann, 2010). The purpose of this project was to determine baseline oral health literacy levels for a sample of adult caregivers of young children living in rural communities and to determine the effectiveness of a community-based education program on increasing these baseline levels of knowledge. A convenience sample of sixty-four participants who attended educational programs aimed at adult caregivers of young children comprised the sample. The Upper Peninsula Oral Health Literacy Assessment Survey was administered prior to and after participants attended the educational programming. A paired sample t-test was utilized to analyze the data. There was a statistically significant increase in oral health literacy levels after the implementation of a community-based educational program. Scores reflecting oral health literacy rose from 68.8% on the pre-test to 92.6% on the post-test. This study confirms a need for further oral health education. Increasing oral health literacy levels in adult caregivers of young children may lead to an increase in oral health seeking behaviors and a decrease in preventable dental caries in the pediatric population.

The Persistence of Oral Health Disparities for African American Children: A Scoping Review

Oral health is an important yet often neglected component of overall health, linked to heart disease, stroke, and diabetic complications. Disparities exist for many groups, including racial and ethnic minorities such as African Americans. The purpose of this study was to examine the potential factors that perpetuate oral health care disparities in African American children in the United States. A systematic search of three literature databases produced 795 articles; 23 articles were included in the final review. Articles were analyzed using a template coding approach based on the social ecological model. The review identified structural, sociocultural, and familial factors that impact the ability of African Americans to utilize oral care services, highlighting the importance of the parent/caregiver role and the patient⁻provider relationship; policy-level processes that impact access to quality care; the value of autonomy in treatment and prevention options; and the impact of sociocultural factors on food choices (e.g., food deserts, gestures of affection). In conclusion, oral health care remains an underutilized service by African American children, despite increasing access to oral care secondary to improvements in insurance coverage and community-based programs.

Look at my pearly white teeth: Exploring adolescents' oral health behavior

Informed by grounded theory, this study explored adolescent oral health behaviors to determine what factors influence them and to develop a substantive theory explaining the social process behind the behaviors identified. Multiple types of data were collected and analyzed simultaneously: demographic and oral health questionnaires, 16 individual interviews, eight small group discussions, field notes, and investigator memoing. Participants were 37 Midwestern adolescents aged 13-18, and most were White or African-American females 14 years of age whose parents had at least a high school education. While more than half reported using mouthwash and brushing their teeth regularly, almost all participants described their behavior in terms of relationships, confidence, and attractiveness rather than health. Top motivators were habits learned as children and the desire to be attractive or "kissable." To reflect teens' understanding of "healthy" as good-looking, and their primary concern not with having healthy teeth but with being attractive to peers, our model of the basic social process of adolescent oral health behavior is called "Look at my Pearly White Teeth." Understanding the actual motivations behind adolescent oral health behavior can help public health administrators develop more effective interventions, especially for teens who did not learn healthy habits as children.

Effect of an oral health education program based on the use of quantitative light-induced fluorescence technology in Uzbekistan adolescents

OBJECTIVES

The aim of this study was to determine whether an oral health education program using a Qscan device based on quantitative light-induced fluorescence (QLF) technology could improve the oral hygiene status and oral health literacy of adolescents.

MATERIALS AND METHODS

One hundred adolescents aged 14-16 years attending a school in Tashkent city were included in this study. The participants were assigned to the following two groups using permuted block randomization technique: (i) control group (traditional learning) and (ii) experimental group (Qscan device-based learning). The participants included in the experimental group received additional education and training on dental plaque removal using the Qscan device. The accumulated levels of plaque were assessed in all participants, who also completed questionnaires about their oral health status, oral health knowledge, attitude, and behavior during an 8-week period.

RESULTS

There were statistically significant improvements in the experimental group compared to the control group in the plaque index (0.46 vs 0.07, p < .05), oral health knowledge (19.4 vs 28.8, p < .05), attitude (16.7 vs 20.2, p < .05), and behavior (19.9 vs 30.5, p < .05).

CONCLUSIONS

This study has demonstrated that an oral health education program based on the use of QLF technology could be useful for improving the oral hygiene status and oral health literacy of adolescents in Uzbekistan.

Parental Consent and Access to Oral Health Care for Adolescents

While most states allow minors 12 years and older to consent to services for contraception, prenatal care, or sexually transmitted infections, the same adolescents are required to have parental consent for even preventive oral health care. Many adolescents are denied access to preventive oral health care because of the challenge of securing parental consent for care when parents are unwilling, unable, or unavailable to consent. Our purpose is to examine the barriers to preventive oral health care for U.S. adolescents related to parental consent laws, explore the issues surrounding these laws, and recommend policy changes. We explain the current range and status of consent laws across the country and arguments for parental consent law as it now stands. We discuss the difficulty of applying general medical consent law to preventive oral health care, neuroscience research on cognitive capacity among adolescents, and the distinction between parental consent and adolescent assent. We recommend replacing required "opt-in" consent with simpler "opt-out" consent; developing a tool for assessing adolescent decision-making capacity; advocating for consent laws that apply specifically to preventive oral health care; and empowering school nurses to lead local, state, and nationwide policy and legislation efforts.

Transportation Matters: A Health Impact Assessment in Rural New Mexico

This Health Impact Assessment (HIA) informed the decision of expanding public transportation services to rural, low income communities of southern Doña Ana County, New Mexico on the U.S./Mexico border. The HIA focused on impacts of access to health care services, education, and economic development opportunities. Qualitative and quantitative data were collected from surveys of community members, key informant interviews, a focus group with community health workers, and passenger surveys during an initial introduction of the transit system. Results from the survey showed that a high percentage of respondents would use the bus system to access the following: (1) 84% for health services; (2) 83% for formal and informal education opportunities; and (3) 81% for economic opportunities. Results from interviews and the focus group supported the benefits of access to services but many were concerned with the high costs of providing bus service in a rural area. We conclude that implementing the bus system would have major impacts on resident's health through improved access to: (1) health services, and fresh foods, especially for older adults; (2) education opportunities, such as community colleges, universities, and adult learning, especially for young adults; and (3) economic opportunities, especially jobs, job training, and consumer goods and services. We highlight the challenges associated with public transportation in rural areas where there are: (1) long distances to travel; (2) difficulties in scheduling to meet all needs; and (3) poor road and walking conditions for bus stops. The results are applicable to low income and fairly disconnected rural areas, where access to health, education, and economic opportunities are limited.