Factors influencing dental care access in Jordanian adults

Prevalence and socioeconomic factors associated with non-utilization of dental care in Lebanon: A nationwide cross-sectional survey

OBJECTIVES

To assess the prevalence of non-utilization of dental care in Lebanon and associated socioeconomic factors and self-care behaviours.

METHODS

A nationwide, quantitative, survey-based study was conducted by trained interviewers with Lebanese residents aged ≥18 years between July and September 2019. Univariate analyses were performed using Pearson Chi Square test or the Fisher's exact test followed by a binary logistic regression using the SPSS Version 25.

RESULTS

Of the 1070 participants, 247 (23.1%) did not utilise any type of healthcare and 144/247 (58.3%) did not utilise dental care. The prevalence of non-utilization of dental care was estimated at 13.5%. Only 4.7% of the respondents consulted their dentist in the past year, among which 53% cited pain/emergencies as the reason for their consultation. Socioeconomic factors associated with the non-utilization of dental care were lack of social medical insurance (OR, 0.49 [95% CI, 0.31 to 0.79]) and long waiting time/patient time restriction (OR, 2.05 [95% CI, 1.26 to 3.35]). On the other hand, facilitators for utilization of dental care included ethical standards/personal qualities of the dentist (OR, 0.53 [95% CI, 0.32 to 0.88]) and convenient cost with respect to the individual's economic status (OR, 0.28 [95% CI, 0.18 to 0.43]).

CONCLUSION

This study suggests that dental care practices in Lebanon, including the non-utilization of dental care, are suboptimal. Measures such as reducing sugar and tobacco consumption, providing information on oral hygiene, and using fluoride products are inexpensive; however, implementing these measures may take substantial time and input by multiple stakeholders.

Levels of Empathy in Students and Professors with Patients in a Faculty of Dentistry

BACKGROUND

Empathy is an attribute that plays an essential role in the dentist-patient therapeutic relationship, clinical care, and treatment adherence, along with providing other benefits. The main objective of this research was to establish the validity, reliability, and invariance of the Jefferson Scale of Empathy and then characterize the empathy levels of students and teachers at a dental school.

MATERIALS AND METHODS

An observational and cross-sectional study analyzed a sample of undergraduate students and professors from the Universidad Andrés Bello Faculty of Dentistry (Chile) (n = 1727 and n = 267, respectively). The Empathy Scale for Health Professionals (HP) and the same scale for students (HPS) were applied.

RESULTS

The Jefferson Empathy Scale presents adequate psychometric properties. The empathy measure has adequate reliability and construct validity, confirming a fit of the three-factor empathy model to the data. The measurement is invariant within the university campus, the sex of the student, and between teacher and student. Teachers present greater empathy than students except in the Perspective Adoption dimension.

CONCLUSIONS

The Jefferson Empathy Scale is reliable, valid, and invariant among Chilean dental students and professors. Students do not differ from their professors in the cognitive component of empathy, but they present a lower score in the affective component and global empathy. It is inferred that students can develop the affective component of empathy in their interactions with their professors, increasing their overall empathy. Understanding and fostering empathy in dental students and professors can significantly improve patient care and treatment adherence and increase patient and dentist satisfaction.

Caries Experience and Risk Indicators in a Portuguese Population: A Cross-Sectional Study

Oral health surveys are essential for assessing the dental caries experience and to influence national policies. This retrospective cross-sectional study aims to analyze dental caries experience for which dental treatment was sought in a reference university dental hospital at the Lisbon Metropolitan Area between January 2016 and March 2020. Full-mouth examination, and sociodemographic, behavior, and medical information were included. Descriptive analyses and logistic regression analysis were applied to ascertain risk indicators associated with dental caries experience. A final sample of 9349 participants (5592 females/3757 males) were included, aged 18 to 99 years old. In this population, caries experience was 91.1%, higher in female participants. Age (OR = 1.01, 95% CI [1.00-1.02], occupation (OR = 2.94, 95% CI [2.37-3.65], OR = 3.35, 95% CI [2.40-4.67], OR = 2.55, 95% CI [1.66-3.91], for employed, unemployed, and retired, respectively), overweight (OR = 1.52, 95% CI [1.18-1.96]), reporting to have never visited a dentist (OR = 0.38, 95% CI [0.23-0.64], and self-reported week teeth status (OR = 2.14, 95% CI [1.40-3.28]) were identified as risk indicators for the presence of dental caries, according to adjusted multivariable logistic analyses. These results highlight a substantial rate of dental experience in a Portuguese cohort and will pave the way for future tailored oral public health programs in Portugal.

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

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

Investigate the role of positive and negative memories from dentistry in the anxiety of dental patients in Kerman, Iran

BACKGROUND AND AIM

Several research works show that anxiety is more common in women, low-income classes, and middle-aged and elderly populations. The present study aimed to investigate the role of positive and negative memories in patients' anxiety referred to the dental clinics, offices, and schools of Kerman, Iran, in 2018-2019.

MATERIALS AND METHODS

In this cross-sectional, descriptive, analytical study, the participants were selected among individuals referred to the dental offices, schools, and clinics of Kerman, Iran. In this study, 500 questionnaires were distributed among the participants (based on census method), and of these, 482 of which were reviewed (response rate = 96.4%). The questionnaire used in this study contained four categories of questions, including demographic information, general questions about dentistry, Corah's Dental Anxiety Scale, and Autobiographical Memory Questionnaire. Analysis of variance, t-test, and Chi-square test were used to analyze.

RESULTS

Overall, 281 participants were female, and 201 were male. Based on the findings, dental visits were enjoyable and pleasant experiences for 154 participants, and 165 patients were anxious while the dentist prepared for a restorative treatment. This study showed that people with negative memories had more anxiety. Anxiety was also significantly associated with positive memories, higher education, and gender (female) (P < 0.05). Also, the most negative memories of dental treatments were associated with increased anxiety about dental treatments in adults (P < 0.05), while positive memories did not have a relationship any with decreased anxiety (P > 0.05).

CONCLUSION

The most negative memories of dental treatments were associated with increased anxiety about dental treatments in adults, while positive memories did not have any expected inverse relationship with anxiety.

Oral Health Needs and Barriers among Children in Saudi Arabia

(1) Background: Understanding oral health needs and barriers is important to overcome the oral disease burden, especially after the COVID-19 pandemic. The aim of this study was to assess oral health needs and barriers among Saudi children after the COVID-19 pandemic wave started. (2) Methods: Parents of healthy children aged 3-11 years from five regions of Saudi Arabia were surveyed using an electronically administered validated questionnaire from Febuary-2021 to July-2021. Oral lesions/manifestations during the last 12 months reported by parents included tooth discoloration, ulcers, abscess, swelling of the gingiva, halitosis, gingival bleeding, dry mouth, pain while eating, difficulty in speaking or eating, burning sensation, and white spots. Barriers were assessed according to the WHO Oral Health Questionnaire. (3) Results: Children experiencing toothaches were reported by 1098 (72.4%) respondents. When reported, oral manifestations and lesions were associated with a higher inability to visit a dentist (p < 0.001). Barriers to dental care were more frequent among parents with lower education (p < 0.001; adjusted-odds ratio (AOR), 1.815) and a greater number of children (p < 0.001; AOR, 1.197). (4) Conclusion: Parents reported a high frequency of unmet oral health needs. Education could play an important role in improving oral health care in children and as a predictor of public health concerns.

Causes and Severity of Dentophobia in Polish Adults-A Questionnaire Study

Introduction: A phobia is defined as an irrational fear, the intensity of which is inadequate to the circumstances, and it leads to the avoidance of situations that trigger it. A person with dentophobia avoids dental treatment, even when the pain in the teeth or oral cavity exceeds their fear. Fear and anxiety are the most common emotional states experienced by patients in dental offices. The aim of the study was to determine the following: the probable causes of dentophobia, which procedures patients fear the most, and the subjective feeling of fear on a point scale. Materials and Methods: The research was conducted in the form of an anonymous online questionnaire and its printed equivalent. The survey was available from 23 January to 16 March 2020, and it was addressed to adult respondents. In total, 130 respondents and 102 dental students took part in the survey. Results: It is worthwhile emphasizing that the main reason for dentist visits (for almost one-third of men and almost one-fifth of women surveyed) is a toothache. Periodontal problems (2.2%), tooth extractions (1.8%), and prosthetic consultations (0.9%) were relatively rare reasons for the respondents to visit a dentist. The vast majority of respondents see the cause of dentophobia as being related to their previous bad experiences. The second most frequently chosen answer is anxiety, which is caused by the sounds of dental apparatus. Conclusions: Pain is the most common reason given for fear of visiting a dentist, as well as the cause of dentophobia. Pain reduction can positively affect the frequency of visits to a dentist, thus, improving the condition of the oral cavity of patients.

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.

Dental caries experience and associated factors in adults: a cross-sectional community survey within Ethiopia

Background

Ethiopia is a developing sub-Saharan African country with increasing prevalence of non-communicable diseases (NCDs), including oral conditions. Oral health and dental care have been given little consideration, and there is limited information relating to population oral health and use of dental services in the country. The aim of this study was to examine the burden and associated factors of dental caries experience and investigate access to dental care amongst adults within Ethiopia.

Methods

This community-based oral health survey is a baseline study for the ASSET - Health System Strengthening in sub-Saharan Africa project undertaken in the Butajira area, south-central Ethiopia. A stratified random sample of households and individuals participated in the study. The survey instruments were mainly based on the WHO Oral Health Survey Methods manual (5^th ed.). Face-to-face interviews and clinical dental examinations were conducted. The data were analysed for descriptive statistics; and Poisson regression models were built to assess the association of dental caries and predictor variables in adults (≥18 years).

Results

Most of the study population (n = 626) were female (63.9%), married (71.4%) and Muslim (76.0%). Just over half (53.2%) lived in rural areas and many (44.4%) had no formal education. A majority (74.0%) reported never utilising dental care services, and the main reason was never experiencing any dental problem (71.3%). Sixty percent (n = 377) of the adults had experienced dental caries, 88.0% (n = 332) of whom had untreated carious teeth. Pain or discomfort was reported by 16.5, and 7.2% had one or more PUFA component. Most (59.9%) adults with dental caries experience reported tooth pain or discomfort during the last year. In the fully adjusted Poisson regression model, increasing age, dental care utilisation and Khat chewing had positive significant associations with dental caries experience, whilst education status was negatively associated (p < 0.05).

Conclusion

This study demonstrated a high burden of dental caries and considerable consequences resulting from untreated disease in this population of adults. There was evidence of social inequity, limited utilisation of dental care and oral health awareness. This highlights the need for oral health system strengthening focusing on health promotion and expanding overall access to care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10199-9.

Awareness and Practice of Oral Health Measures in Medina, Saudi Arabia: An Observational Study

The aim of this observational study is to investigate the oral health status and practices in the multicultural community of Medina, Saudi Arabia. A cross-sectional questionnaire was distributed that asked about oral health, dental and periodontal conditions, personal attitudes toward dental care, and smoking habits. Cross tabulation with chi-squared testing was carried out to investigate the association of toothbrush usage and smoking with several variables. Four-hundred and sixty subjects enrolled in the study. The majority of the respondents were students and Saudi males. More than 75% of the participants had neither a family dentist nor dental insurance; 7% were smokers, 84% used a toothbrush, 17% used dental floss and 34% used miswak (a teeth cleaning twig made from the Salvadora persica tree). Some of the individuals complained of tooth sensitivity, halitosis and bleeding gums. The main reason for dental visits was pain, with 23% of the participants having never visited a dentist. Tooth brushing was significantly associated with gender, nationality, occupation, education, marital status, having kids and dental insurance (p ≤ 0.05). Tobacco consumption was significantly associated with age, occupation, education level, marital status, having children, having bleeding gingivae and halitosis. Effective dental education programs are needed to improve dental knowledge and awareness in the Medina community.

Barrier to Access and Dental Care Utilization Behavior with Related Independent Variables in the Elderly Population of Saudi Arabia

Objectives:

The study aimed to evaluate barriers associated with access and utilization of dental services among the elderly population of Saudi Arabia.

Materials and Methods:

A systematic random sample of 350 elderly people recruited from various gathering places of the elderly including all nursing home residents (n = 73) was included in this study. The data were collected through face-to-face structured interviews related to access and utilization of dental services, and sociodemographic, behavioral, medical, and financial barriers to dental services. Statistical analysis included frequency distributions, chi-squared tests, and regression analysis using the Statistical Package for the Social Sciences (SPSS) program.

Results:

Approximately 37% of the elderly had proper access to and utilization of dental services. Independent variables that affect access and utilization of dental services were low income (odds ratio [OR] = 2.23, confidence interval [CI] = 1.34–3.72), unmarried participants (OR = 3.25, CI = 1.75–6.05), community residents (OR = 5.15, CI = 2.52–10.53), smokers (OR = 1.93, CI = 1.02–3.68), irregular users of toothbrushing (OR = 3.53, CI = 2.09–5.95), no dental insurance (OR = 1.88, CI = 1.06–3.37), and unaffordable price (OR = 2.55, CI = 1.38–4.69) in the bivariate analysis. In logistic regression analysis, the significant variables that were associated with proper access and utilization of dental services were having dental insurance (OR = 2.24, CI = 1.15–3.82), affordable prices (OR = 2.19, CI = 1.21–3.70), brushing regularly (OR = 3.58, CI = 2.01–6.37), higher education (OR = 1.87, CI = 1.10–3.20), and being married (OR = 1.68. CI = 0.97–2.91).

Conclusion:

Lack of perceived need, no dental insurance, unaffordable price, transportation, and fear from dental treatment were the most common significant barriers to dental services.

Use of oral health care services in Peru: trends of socio-economic inequalities before and after the implementation of Universal Health Assurance

Background

Oral health inequalities are profound worldwide. Despite major improvements in oral health, inequalities exist for many racial and ethnic groups, by socioeconomic status, gender, age, and geographic location. Therefore, the purpose of this study was to investigate trends of socio-economic inequalities in access to oral health services in Peru before and after the implementation of Universal Health Assurance (AUS).

Methods

Analytical cross-sectional study based on the National Household Survey on Living Conditions and Poverty (ENAHO) 2004, 2008, 2010 and 2017. Two periods were defined before and after the AUS Law (2009). Use of oral health services was the dependent variable, for the general population and according to ages, the area of residence, and natural region. Measurements of inequality in the use of health services were made based on the concentration curves (CC), dominance test and concentration index (CI).

Results

We included a number of 85,436 (2004), 88,673 (2008), 87,074 (2010) and 124,142 (2017) participants. The proportion of people who used oral health services was 8.4% (2014), 10.1% (2008), 10.6% (2010) and 10.4% (2017). Use of oral health services showed an increase in different age groups, urban and rural areas, and natural regions of residence during the study period. The CC were distributed below the line of equality, indicating an inequality of use of oral health services, in favor of the richest groups and dominance of the CC in 2017 over the previous years. Changes in the CI were statistically significant for < 5 years and in the rural area, and for the period 2010-2017 they were also significant in the general population, children aged 5-17 years, urban area, and Andean and Jungle regions, which indicates a reduction in the concentration of use of these services in these groups.

Conclusions

The use of oral health services in Peru increased and inequality decreased in the period 2004-2017, coinciding with the implementation of the AUS. However, the use of these services continue having a distribution in favor of the richest populations. It requires the introduction of new strategies and oral health programs in the Peruvian population, with the aim of closing the gap currently mediated by the economic possibilities.

Factors Affecting Access to Oral Health Care among Adults in Abha City, Saudi Arabia

AIMS AND OBJECTIVES

To investigate the self-reported access problems to dental care among adults in Abha city, KSA.

MATERIALS AND METHODS

A cross-sectional descriptive survey was carried out among adults in Abha city, Saudi Arabia. A structured, close-ended, self-administered questionnaire elicited the access and utilization of dental care among a sample of adults. Data were collected and analyzed using SPSS version 21.0 statistical software. The descriptive statistics and logistic regression analysis were performed to predict the variables associated with access and utilization of dental care.

RESULTS

A total of 499 adults (male = 270, female = 229) participated in the study. More than half (289, 57.9%) of the participants utilized dental services and emergency services (283, 56.7%) were the most common reason to visit dentist. For most of the participants (281, 57.1%), the last dental visit was less than 1 year. Majority (409, 82%) of the participants self-funded for their treatment in private dental clinics (382, 76.6%). More than half (258, 51.7%) of the participants received restorative treatment during their last visit to dentist. Cost (39.1%) and lack of time (28.7%) were the main barriers to accessing dental care. Education and income were all involved in predicting nonutilization of dental services among the study participants.

CONCLUSION

Access to and utilization of dental care are the multidimensional concepts influenced by many factors. Cost and lack of time were the predominant barriers to utilization of dental services. Access to dental care is a multidimensional issue with education and income, were considered as the significant predictors of nonutilization of dental services. Similarly, income and transportation problems significantly predicted the use of private dental services. Marital status, transportation problem, health problems, and difficulty in movement were all concerned with multiple barriers to accessing dental services among the study participants.

Patient-dentist relationship and dental anxiety among young Sudanese adult patients

OBJECTIVE

To evaluate the effects of the patient-dentist relationship on dental anxiety among young adult Sudanese patients.

MATERIALS AND METHODS

In this cross-sectional study, 864 patients attending outpatient dental clinics of the governmental dental hospitals in Khartoum, Sudan were recruited; 51.2% were males and 48.8% were females, with an age range of 18-24 years. The questionnaire used evaluated the socio-demographics, education levels, economic status, patient experience, and also included the Dental Anxiety Scale, Corah (J Dent Res 1969 48: 596).

RESULTS

High dental anxiety was reported by 22.2%, 29.5% reported moderate dental anxiety, and 48.3% reported low or no dental anxiety. There were statistically significant associations between dental anxiety and gender, time lapse since the previous dental visit (P < 0.004) and the reason for the previous visit (P < 0.001). In addition, the dental clinic environment (P < 0.002), the time waiting before seeing the dentist (P < 0.001) and the overhearing of pain expressed by other patients (P < 0.001) were also statistically significant. Negative comments by the treating dentist also had a statistically significant impact (P < 0.032). In contrast, a clear explanation of related dental care (P < 0.008), as well as the allowance of adequate time to discuss oral health (P < 0.006), had significantly positive effects.

CONCLUSION

The study showed that the patient-dentist relationship had a significant association with dental anxiety, and may be an important target for improving the delivery and standards of oral health in dentally anxious patients in this region.

The oral microbiome and adverse pregnancy outcomes

Significant evidence supports an association between periodontal pathogenic bacteria and preterm birth and preeclampsia. The virulence properties assigned to specific oral pathogenic bacteria, for example, Fusobacterium nucleatum, Porphyromonas gingivalis, Filifactor alocis, Campylobacter rectus, and others, render them as potential collaborators in adverse outcomes of pregnancy. Several pathways have been suggested for this association: 1) hematogenous spread (bacteremia) of periodontal pathogens; 2) hematogenous spread of multiple mediators of inflammation that are generated by the host and/or fetal immune response to pathogenic bacteria; and 3) the possibility of oral microbial pathogen transmission, with subsequent colonization, in the vaginal microbiome resulting from sexual practices. As periodontal disease is, for the most part, preventable, the medical and dental public health communities can address intervention strategies to control oral inflammatory disease, lessen the systemic inflammatory burden, and ultimately reduce the potential for adverse pregnancy outcomes. This article reviews the oral, vaginal, and placental microbiomes, considers their potential impact on preterm labor, and the future research needed to confirm or refute this relationship.

Self-Reported Obstacles to Regular Dental Care among Information Technology Professionals

INTRODUCTION

Good oral health is important for an individual as well as social well-being. Occupational stress and work exhaustion in Information Technology (IT) professionals may influence the oral health and oral health related quality of life.

AIM

To assess and compare self-reported obstacles for regular dental care and dental visits among IT professionals based on age, gender, dental insurance and working days per week.

MATERIALS AND METHODS

A cross-sectional study was conducted among 1,017 IT professionals to assess the self-reported obstacles to regular oral health care in Hyderabad city, Telangana, India. The Dental Rejection of Innovation Scale (DRI-S) was employed in this study. Comparison between means of DRI-S based on variables was done using t-test and ANOVA. The association between variables and DRI-S was determined using Chi-square test.

RESULTS

A total of 1017 participants comprising of 574 (56%) males and 443 (44%) females participated in the study. As age increased, a significant increase in mean DRI-S scores was seen for total and individual domains except for the "Situational" domain wherein higher mean score (9.42±2.5; p=0.0006) was observed among 30-39 years age group. Even though females reported higher mean scores for total and individual domains when compared to males, nevertheless significant difference was seen only for total (p=0.03) and "Lack of Knowledge" (p=0.001) domain.

CONCLUSION

Self-reported obstacles to regular dental care was more with increasing age, increased number of working days per week, irregular dental visits and absence of dental insurance facility.