Factors associated with the use of oral health care services among Canadian children and youth

Background

This study investigates the association between dental insurance, income, and dental care access for Canadian children and youth aged 1 to 17 years. It contributes to a baseline understanding of oral health care use before the implementation of the Canadian Dental Care Plan (CDCP).

Data and methods

This study used data from the 2019 Canadian Health Survey on Children and Youth (n=47,347). Descriptive statistics and logistic regression models were employed to assess the association of dental insurance, adjusted family net income, and other sociodemographic factors on oral health care visits and cost-related avoidance of oral health care.

Results

A large percentage of children under the age of 5 had never visited a dentist (79.8% of 1-year-olds to 16.4% of 4-year-olds). Overall, 89.6% of Canadian children and youth aged 5 to 17 had visited a dental professional within the past 12 months: 93.1% of those who were insured and 78.5% of those who were uninsured. Insured children and youth had a 4.5% cost-related avoidance of dental care, contrasting with 23.3% for uninsured children and youth. After adjustment for sociodemographic variables, children and youth with dental insurance were nearly three times more likely (odds ratio [OR]: 2.94; 95% confidence interval [CI]: 2.60 to 3.33) to have visited a dental professional in the past 12 months than uninsured children and youth. Having dental insurance (OR: 0.19; 95% CI: 0.16 to 0.21) was protective against barriers to seeing a dental professional because of cost. There was a strong income gradient for both dental service outcomes.

Interpretation

The study emphasizes the significant association of dental insurance and access to oral health care for children and youth. It highlights a significant gap between insured and uninsured children and youth and points out the influence of sociodemographic and income factors on this disparity.

Geospatial Analysis of Dental Access and Workforce Distribution in Kenya

Background and Objective

One of the major factors affecting access to quality oral healthcare in low- and middle-income countries is the under-supply of the dental workforce. The aim of this study was to use Geographical Information System (GIS) to analyse the distribution and accessibility of the dental workforce and facilities across the Kenyan counties.

Methods

This was a cross-sectional study targeting dental professionals and their practices in Kenya in 2013. Using QGIS 3.16, these data were overlaid with data on population size and urbanization levels. For access measurement, buffers were drawn around each clinic at distances of 2.5, 5, 10 and 20 km, and the population within each determined.

Findings

Nine hundred six dental professionals in 337 dental clinic locations were included in the study. Dentists, community oral health officers (equivalent to dental therapists) and dental technologists comprised 72%, 15% and 12%, respectively. Nairobi county with 100% urbanization and >4000 people/km² had 43% of the workforce and a dentist to population ratio of 1:9,018. Wajir with an urbanization level of 15% and 12 people/km² had no dental facility. Overall, 11%, 19%, 35% and 58% of the Kenyan population were within 2.5, 5, 10 and 20 km radius of a dental clinic respectively.

Conclusion

Maldistribution of dental workforce in Kenya persists, particularly in less urbanized and sparsely populated areas. GIS map production give health planners a better visual picture of areas that are most in need of health care services based on population profiles.

Training dental hygienists to place interim therapeutic restorations in a school-based teledentistry program: Oregon's virtual dental home

OBJECTIVES

The objectives of this study on Oregon's virtual dental home were to: 1) demonstrate the feasibility of pilot project training of existing Expanded Practice Dental Hygienists (EPDHs) to perform interim therapeutic restorations (ITRs) in the community settings after diagnosis by the supervising dentist via teledentistry and 2) evaluate satisfaction of parents/guardians of children participating in a pilot program that provides school-based/on-site preventive dental care services utilizing expanded scope EPDHs to conduct dental screenings and place ITRs.

METHODS

This demonstration project was a 4-years longitudinal cohort study (2016-2019) in the school/community-based settings focusing on children in kindergarten to 3rd grade. EPDHs and dentists from a Dental Care Organization were trained to utilize teledentistry and EPDHs were trained to place ITRs, the latter provided onsite dental care. Data was collected regarding child's demographics and oral health status; and parents reported level of satisfaction from services received by their children. Data analysis included descriptive statistics and logistic regression analysis to assess the relative importance of demographic and clinical factors on caries status.

RESULTS

Onsite dental care was provided to 759 children. Of repeat patients (n = 377), 201 (53.3%) children had untreated decay at their first visit. Of these, 13% saw improvements in oral health status at their most recent visit (MRV). There were 162 ITRs planned out of which 50 patients received 99 ITRs. No adverse events were experienced. Of the repeat children receiving ITRs (n = 43), 28% saw improvement in their caries status at their MRV. Parents reported very high levels of satisfaction with the dental care program.

CONCLUSION

Oregon's virtual dental home project was successful in training EPDHs to perform ITRs safely in school settings after caries diagnosis by the supervising dentist via teledentistry and in integrating this component into a regular school-based preventive dental program.

e-Oral health interventions for older patients in an outreach primary dental care centre: A pilot trial nested acceptability study

OBJECTIVE

To compare the acceptability and perceived helpfulness of an e-Oral Health intervention in form of text messages versus standard dental leaflets provided after a dental visit to patients aged 65 years and over.

BACKGROUND

Oral health care needs for older people are increasing. Remote interventions using e-Health can ensure oral care is provided despite physical hindrances or situations where dental appointments are limited such as has happened more widely during the COVID-19 pandemic.

MATERIALS AND METHODS

Mixed-method nested study within a pilot trial. Dental patients (n = 150) at an outreach primary dental care centre, ≥ 65 years old, were recruited and randomly allocated to e-Oral health text messages or leaflet intervention arms. Post-intervention (6 months), participants responded to open and closed-ended two-way survey phone texts. Survey questions investigated: (a) whether they would recommend the intervention, (b) intervention helpfulness and (c) OPEN feedback. Average helpfulness scores (Scale:1= Very Helpful to 5= Not Helpful at All) were compared for each arm using Independent Sample t-test. Percentage of participants providing positive recommendations in each arm were compared using chi-squared tests. Qualitative findings were analysed using thematic analysis.

RESULTS

N = 68 (45%) responded. Mean helpfulness scores in text group M = 2.2, SD=1.1) and leaflet group M = 2.3, SD=1.9, P = .29. Amongst the text arm respondents, 89% compared with 68.2% in leaflet arm; P = .005 would recommend the intervention. Four qualitative themes were outlined: intervention approach, content, behavioural impact and recommendations.

CONCLUSION

e-Oral Health text interventions are acceptable and helpful to older people, but these messages need to be tailored.

Oral health and behaviours of people living with Multiple Sclerosis in Australia

OBJECTIVES

The literature describing the oral health of people with Multiple Sclerosis (MS) is scant and the findings equivocal. The aim of this study was to describe the oral health and oral self-care behaviours of people living with MS and compare it to the Australian population.

METHODS

Participants enrolled with the Australian MS Longitudinal Study (AMSLS) were invited to participate in the survey using an online or paper-based questionnaire. Data were collected on level of disability, oral health, oral self-care and factors influencing attendance for oral health care.

RESULTS

Completed questionnaires were received for 1523 respondents. Over one-fifth (n = 320; 22%) rated their oral health as fair or poor, and more than half (n = 840; 57%) reported toothache in the last 12 months. These proportions were higher than those for the general Australian adult population (oral health prevalence ratio (PR) = 1.25 [1.12, 1.40]; toothache PR = 3.63 [3.39, 3.88]), and this is despite comparable or better self-maintenance habits and dental attendance reported by respondents. People with MS reported high rates of mouth dryness (68.4%), teeth sensitivity (64.7%), change of taste (40.5%) and orofacial pain (39.0%); fewer than 10% experienced none of these. There was a lower prevalence of self-reported need for treatment (extraction or filling) than in the Australian adult population (15.8% vs 32.9%).

CONCLUSIONS

People with MS have a greater oral health burden, demonstrated by their poorer self-reported oral health than the Australian adult population. Furthermore, they experience high rates of toothache, mouth dryness, teeth sensitivity, change of taste and orofacial pain. These findings are contrary to their self-reported good oral self-care and dental attendance habits and suggest some of the oral health impacts are due to MS rather than dental behaviours.

A National Survey of U.S. Dental Students' Experiences with International Service Trips

Globalization, along with the increasing prevalence of non-communicable diseases, their risk factors, and poor oral health, demands global approaches to oral health care. Trained health care workers' providing volunteer services abroad is one model used for improving access to dental services for some communities. Currently, little is known about U.S. dental student involvement in international clinical service volunteerism. The aim of this exploratory study was to capture national survey data from predoctoral dental students about their interest in and experience with global health service trips. The survey sought to assess students' past experiences and current and future interest in programs providing dental and/or medical services in order to lay the foundation for further research. A 12-question web-based survey was distributed in May 2017 to 22,930 students enrolled in U.S. dental schools. A total of 1,555 students responded, for a response rate of 7%. Respondents were evenly distributed across the four academic years. Approximately 22% (n=342) of the respondents had already participated in a service trip experience, 83% reported interest in a service trip while in school, and 92% were interested after graduation. Reported motivations for international trips included the desire to care for the underserved and to obtain a more global view of health and disease. Concerns were expressed regarding costs and time constraints. This study provided preliminary, exploratory data on dental student engagement with international service trips. Both interest and participation in international service trips among responding students were high, reflecting current trends in both dentistry and medicine. Dental education may have an opportunity to guide student engagement in more sustainable and ethical volunteering in the U.S. and abroad.

Individual dental expenditure by Australian adults

BACKGROUND

While dental service use in Australia has been extensively reported, little is known about associated costs. The aim of this article was to describe the annual individual dental expenditure of Australian adults.

METHODS

Self-reported service use and expenditure data were sourced from a sample of 3000 adults aged 30 to 61 years who were randomly selected from the electoral roll. Bivariate associations between total individual dental expenditure and out-of-pocket expenditure (fees less insurance rebate) and a range of participant characteristics were explored.

RESULTS

Response rate for the baseline questionnaire was 39.4% and of these, 53.1% responded at 12-month follow-up. The mean total dental expenditure was $702 and mean out-of-pocket expenditure was $489. Toothache was associated with total dental expenditure; adults experiencing toothache had higher median expenditure ($445) than adults who hardly ever/never had toothache ($308) (p < 0.05). Dental insurance status was not associated with total expenditure, but insured had lower median out-of-pocket expenditure ($146) than uninsured adults ($320) (p < 0.01).

CONCLUSIONS

Affordability variables typically associated with access to dental care, such as insurance status, were not associated with total expenditure, while poorer oral health was associated with higher total expenditures.