Factor Analysis on Implementation of Domiciliary Dental Care in Metropolitan Tokyo

Analysis of trends and disparities in domiciliary dental care distribution in Taiwan from 2018 to 2023

Background/purpose

Domiciliary dental care (DDC) is essential for maintaining oral health in disabled and homebound patients who face barriers to accessing dental services. With Taiwan nearing super-aged society status, the demand for DDC is rising. However, comprehensive data on DDC availability and distribution across Taiwan are lacking. Hence, this study aimed to provide a comprehensive overview of the distribution of DDC across Taiwan's districts from 2018 to 2023, and to analyze the estimated ratios of disabled individuals per healthcare provider in each district.

Materials and methods

Data on DDC-providing hospitals and dental clinics from these years were obtained from government sources. Descriptive statistics quantified DDC facilities distribution and growth. The number of disabled individuals per district was used to estimate ratios of disabled persons to DDC facilities.

Results

DDC facilities increased from 47 in 2018 to 98 in 2023. Urban areas showed higher prevalence of DDC services, while some rural and offshore areas had limited or no access. Taichung and Kaohsiung had the highest numbers of DDC providers, while Penghu and Lianjiang had none. Ratios of disabled individuals to DDC facilities varied widely, with Taichung having the lowest ratio and Yunlin and Chiayi the highest. In conclusion, DDC availability in Taiwan has significantly increased, but geographical disparities persist.

Conclusion

These findings underscore the need for targeted policies and resource allocation to address gaps in DDC provision, particularly in underserved areas.

Investigating the Challenges and Opportunities of Domiciliary Oral Care for the Older Adults: A Scoping Review

BACKGROUND/OBJECTIVES

Older adults need specialised dental care due to age-related changes and chronic conditions, but inadequate coordination and capacity hinder access to domiciliary oral care. This review explores the characteristics, barriers, facilitators, caregiver education, and outcomes of domiciliary oral care to improve services for frail older adults.

METHODS

A systematic scoping search was conducted following the PRISMA guidelines. A literature search was performed to identify the key search terms and the databases that were relevant to the objectives. A total of 454 documents were retrieved, 31 of which were included in the final synthesis.

RESULTS

Overall, the barriers and facilitators in delivering domiciliary dental service for the elderly can be categorised into four groups: system, oral healthcare provider, caregiver, and patient. Having policies or guidelines supporting domiciliary oral care was one of the most frequently reported factors. Six studies reported outcomes of educational programme for caregivers and all were with positive results.

CONCLUSIONS

The review highlights the need for a multi-pronged approach involving the healthcare system, oral healthcare providers, caregivers, and older adults themselves to improve access to and quality of oral healthcare services for this vulnerable population.

The implementation of domiciliary dental care from a university hospital: A retrospective review of the patients and performed treatments in central Taiwan from 2010 to 2020

BACKGROUND/PURPOSE

People who suffer with chronic illness, functional impairment, or cognitive impairment are not easily to visit dental clinics. Domiciliary dental care (DDC) can provide the feasible alternative for these clients. In this study, we first reported the DDC services from a university hospital in central Taiwan from 2010 to 2020.

MATERIALS AND METHODS

This retrospective study collected the DDC data from Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan. The data including age, sex, geographic locations, place of residence, grade of disability, and type of dental treatment for the patients were obtained and analyzed.

RESULTS

A total of 419 patients (168 females and 251 males) who received dental treatment were included in the study. The average age was 57.4 years old. The total DDC services were up to 2444 visits. The top of place of residence for DDC is patient's home (231/419; 55.13%). Scaling was the most common type of dental treatment for DDC (317/419; 75.67%). The male patients whose age <60 years old had received more DDC (p = 0.002). The profound grade of disability had higher DDC in age <60 years old group (p < 0.001).

CONCLUSION

Taken together, this study demonstrates the demographic data of DDC in central Taiwan. The results may be valuable for governmental policy to improve the availability of DDC and in turn to facilitate oral health in this specific group of dental patients.

Japan's Dental Care Facing Population Aging: How Universal Coverage Responds to the Changing Needs of the Elderly

Although universal health coverage (UHC) is pursued by many countries, not all countries with UHC include dental care in their benefits. Japan, with its long-held tradition of UHC, covers dental care as an essential benefit, and the majority of dental care services are provided to all patients with minimal copayment. Being under UHC, the scope of services as well as prices are regulated by the uniform fee schedule, and dentists submit claims according to the uniform format and fee schedule. The author analyzed the publicly available dental health insurance claims data as well as a sampling survey on dental hygiene to illustrate how Japan’s dental care is responding to the challenges from population aging. A marked improvement was found in dental health status in the elderly population as measured by improved tooth-specific survival. The improvement may be attributable to the universal coverage of dental care, as evidenced by the steady increase in home visits by dentists/dental hygienists as well as home oral rehabilitation services.

Domiciliary dental care among homebound older adults: A nested case-control study in Japan

AIM

Improving the availability of dental care is essential to maintain older adults' general health and wellbeing. Domiciliary dental care is a feasible alternative. The present study aimed to investigate factors affecting the use of domiciliary dental care among home-dwelling dependent older adults.

METHODS

A retrospective nested case-control study was carried out. We identified long-term care recipients who used home care services between April 2012 and March 2014 using Japan's nationwide long-term care service claim database. One-to-one case-control matching was carried out between those with and without domiciliary dental care, based on sex, age and the time home care service use was started. We carried out multivariable conditional logistic regression analyses to assess various factors associated with using domiciliary dental care.

RESULTS

We identified 3 377 998 eligible homebound long-term care beneficiaries aged ≥65 years. Of these, 278 302 (8.2%) received domiciliary dental care. Factors associated with a higher probability of receiving domiciliary dental care were: higher level of care need (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.93-2.06), exemption from out-of-pocket payment (OR 1.35, 95% CI 1.32-1.39]), living in a group home (OR 7.93, 95% CI 7.71-8.16), using other domiciliary services such as physician visits (OR 3.15, 95% CI 3.08-3.22) and a large number of dental clinics providing domiciliary dental care in their municipality (OR 1.74, 95% CI 1.70-1.77). Significant barriers to receiving domiciliary dental care were living alone (OR 0.64, 95% CI 0.62-0.66) and dementia (OR 0.89, 95% CI 0.88-0.91).

CONCLUSIONS

Our findings might help to improve the availability of dental care in this population. Geriatr Gerontol Int 2019; 19: 679-683.

Trends in domiciliary dental care including the need for oral appliances and dental technicians in Japan

The need for domiciliary dental care (DDC) for people requiring long-term nursing care is increasing as the super-aged society of Japan grows still older. Dysphagia diagnosis and rehabilitation are becoming more important in DDC; thus, the need for prostheses used for dysphasia rehabilitation is presumed to be increasing. To identify DDC trends in Japan, as well as the need for prostheses and dental technicians for DDC, we sent a self-administered questionnaire to dentists providing DDC and analyzed responses from 138 dentists (valid response rate, 39.8%). The results showed that 37.7% of respondents reported treating ≥50 patients per month. The most frequently performed procedures were removable prosthetic treatment and oral care, followed by dysphagia rehabilitation. Use of palatal augmentation prostheses was experienced by 54.3% of respondents, and most indicated that the prostheses were effective for improvement of oropharyngeal function. The rates of cooperation with primary care doctors and nursing care professionals were 76.8% and 85.5%, respectively. Only 6.5% of respondents reported accompanying dental technicians to DDC. The present analysis of trends in DDC indicates that oral care and dysphagia rehabilitation have become more frequent and that cooperation with healthcare professionals other than dental technicians has increased in recent DDC.