The effectiveness of routine dental checks: a systematic review of the evidence base

Ethnic inequalities in child oral health behaviours among five- and eight-year-old children from England, Wales and Northern Ireland

Aim To examine whether there are ethnic inequalities in child oral health behaviours and the role of parental socioeconomic status (SES) in explaining them.Methods Data from 2,186 five- and eight-year-olds of white, Asian, Black and other ethnicity, who participated in the 2013 Children's Dental Health Survey, were analysed. Parents reported their children's toothbrushing and dental attendance. Logistic regression was used to explore ethnic inequalities in child behaviours, adjusting for demographic factors and parental SES.Results Children of Asian ethnicity were less likely to start brushing early in life (odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.15-0.43), brush regularly (OR: 0.56; 95% CI: 0.32-0.97) and have a check-up last year (OR: 0.28; 95% CI: 0.16-0.49) than those of white ethnicity. Children of Black ethnicity were less likely to have a check-up last year (OR: 0.39; 95% CI 0.17-0.89) than those of white ethnicity. Children of other ethnicity were less likely to start brushing early in life (OR: 0.41; 95% CI: 0.23-0.77) and brush regularly (OR: 0.45; 95% CI: 0.23-0.87) than children of white ethnicity. Inequalities in toothbrushing frequency and regular dental attendance between children of Black and white ethnicity were fully attenuated after adjustment for parental SES.Conclusion There were ethnic inequalities in child toothbrushing and dental visiting, with children of Asian ethnicity being the most affected. Parental SES only explained part of these inequalities.

Evolution and development of methodologies in social and behavioural science research in relation to oral health

The aim of this introductory paper is to provide an overview of key methodological developments in social and behavioural research in oral health. In the first section, we provide a brief historical perspective on research in the field. In the second section, we outline key methodological issues and introduce the seven papers in the theme. Conceptual models can contextualize research findings and address the 'why' and 'how' instead of 'what' and 'how many'. Many models exist, albeit they need to be evaluated (and adapted) for use in oral health research and in specific settings. The increasing availability of big data can facilitate this with data linkage. Through data linkage, it is possible to explore and understand in a broader capacity the array of factors that influence oral health outcomes and how oral health can influences other factors. With advances in statistical approaches, it is feasible to consider casual inferences and to quantify these effects. There is a need for not only individual efforts to embrace causal inference research but also systematic and structural changes in the field to yield substantial results. The value of qualitative research in co-producing knowledge with and from human participants in addressing 'the how' and 'the why' factors is also key. There have been calls to employ more sophisticated qualitative methods together with mixed methods approaches as ways of helping to address the complex or Wicked Problems in population oral health. In the final section, we outline possible future methodological directions in social and behavioural oral health research including participatory approaches and the development of core outcome sets. Our overriding goal in the paper is to facilitate a critical debate in relation to methodological issues which can be used to improve understanding and generate knowledge in population oral health and that this, in turn, will help inform oral health policy and practices.

Adherence to individualized recall intervals for oral health examinations

OBJECTIVES

The aim of this follow-up study was to investigate whether adults attend an oral health examination (OHE) based on their individual recall interval (IRI) without a reminder recall system.

METHODS

The study population included adults who were attending an OHE recommended by their dentists based on their IRI in public oral healthcare clinics of Helsinki City January 1, 2009-December 31, 2009. The inclusion criteria were as follows: alive until the end of IRI, length of the IRI of 12-60 months, and study participants had not been treated successfully by a dental specialist during the IRI period (n = 41,255). We used a multinomial model to identify the factors associated with the timing of OHE. The following predictors were included: oral health indices such as Decayed Teeth and the Community Periodontal Index, the length of the IRI based on an OHE in 2009, age, gender, socioeconomic status, presence of chronic diseases, and emergency appointment. Results were presented as odds ratios with 95% confidence intervals.

RESULTS

The OHE based on IRI occurred for 7505 individuals (18.2%) and the OHE was late for 9159 individuals (22.2%). A total of 24,591 (59.6%) adults did not undergo follow-up OHE based on the IRI period of on time or late. Those who came on time for follow-up OHE experienced less caries than those who came later. There was not much difference in periodontal health between the groups. The models indicated that having an emergency appointment was associated with a higher probability of having an OHE. A long IRI (37-60 months) was associated with a higher probability of not participating in OHE even late.

CONCLUSIONS

It would be beneficial for patients to take appointments based on the recall interval. The results of this study indicated that more needs to be done to increase awareness in the adult population of the benefits and availability of follow-up OHEs based on their IRI in oral healthcare.

Regional variations in caries experience, predictors, and follow-up among children and adolescents in Western Norway

OBJECTIVE

To identify regional differences in, and determinants of dental caries among children in western Norway.

MATERIAL AND METHODS

We studied dental caries in 705 children aged 12 years and 18 years living in the southern region (n = 403) and other parts of Hordaland County (n = 302) in Norway. Information on oral hygiene, fluoride intake, and sugar consumption was collected using questionnaires. We also collected information from the Public Dental Service (PDS) on the history of decayed, missing, or filled teeth; professional fluoride application; recall and regular check-up intervals and treatment visits. Residence (southern region versus the rest of Hordaland, the reference) was the independent variable. We analysed regional differences in (i) caries prevalence and severity, (ii) potential contributors to caries, and (iii) procedures and routines in PDS.

RESULTS

Caries prevalence and severity were higher in the southern region (67% and 24%, respectively). Self-reported brushing habits, fluoride use, and sugar consumption patterns were similar between regions. We observed more frequent application of professional fluoride (incidence rate ratio [IRR] = 3.05, 95% CI: 1.99-4.66], fewer check-ups [IRR = 0.88, 95% CI: 0.81-0.95], and fewer treatment visits [IRR = 0.77, 95% CI: 0.60-0.98] among participants in the southern region, compared to the rest of Hordaland. The recall intervals in the southern region were 10% longer among 12-year-olds and 10% shorter among 18-year-olds, compared to their respective counterparts in Hordaland.

CONCLUSIONS

The observed regional gradients in caries experience mirrored regional differences in dental routines and procedures. Caries-related risk behaviours did not explain the observed differences in caries experience.

Follow-up interval for dental appointments: a randomized clinical trial with children with low caries risk

The objective of this study was to evaluate the effect of different follow-up consultation intervals on caries incidence in children with low caries risk. The study was composed of 224 children aged between 3 and 5 years and with low risk of caries. The children were randomly allocated into two groups, according to two different follow-up consultation intervals: Group 1 (G1) - 12-month follow-up interval; Group 2 (G2) - 18-month follow-up interval. All oral clinical examinations were performed by a single examiner who was previously calibrated and blinded in relation to the study groups. An external dentist provided the advice on oral hygiene and diet and evaluated the children's socioeconomic conditions. The Chi-square and Mann-Whitney tests were used to evaluate the differences between groups. Poisson regression analyses were performed to assess the association of caries incidence with the other variables. At the end of the study there was a significant difference between the groups regarding initial active lesions (p = 0.012), and children in G2 were at a higher risk of developing initial active lesions than those in G1 (p = 0.047). Children who had a higher number of teeth with initial active lesions in the follow-up consultations were at a higher risk of developing cavitated dentin caries (p = 0.001). Both follow-up intervals are justifiable. Although significant results have been observed for initial active caries lesions within the 18-month follow-up interval, it should be noted that these lesions can be treated using just preventive measures. Besides, different return interval had no effect in cavitated dentin lesions.

Oral health indices predict individualised recall interval

Objectives

The individualised recall interval (IRI) is part of the oral health examination. This observational, register‐based study aimed to explore how oral health indices DMFT (decayed, missing, filled teeth), DT (decayed teeth), CPI (Community Periodontal Index, maximum value of individual was used) and number of teeth are associated with IRI for adults.

Methods

Oral health examination includes an assessment of all oral tissues, diagnosis, a treatment plan and assessment and a determination of the interval before the next assessment. It is called the IRI. This cross‐sectional study population included 42,533 adults (age range 18–89 years), who had visited for an oral health examination during 2009, provided by the Helsinki City Social Services and Health Care. The recall interval was categorised into an ordinal scale (0–12, 13–24, 25–36 and 37–60 months) and was modelled using a proportional odds model. ORs less than one indicated a shorter recall interval.

Results

Recall interval categories in the study population were 0–12 months (n = 4,569; 11%), 13–24 months (n = 23,732; 56%), 25–36 months (n = 12,049; 28%), and 37–60 months (n = 2,183; 5%). The results of statistical models clearly showed an association between the length of recall intervals and oral health indices. In all models, higher values of DMFT, DT and CPI indicated a shorter recall interval. The number of teeth were not so relevant. The association was not influenced when different combinations of other predictors (age, gender, socioeconomic status, chronic diseases) were included in the model. The severity of periodontitis predicted a short recall interval, for example, in the Model 1, CPI maximum value 4 was OR = 0.35 (95% confidence interval 0.31–0.40).

Conclusions

The oral health indices showed a clear association with the length of the IRI. Poor oral health reduced IRI. The indices provide information about the amount of oral health prevention required and are useful to health organisations.

Oral health-related quality of life among Syrian refugees in Jordan: a cross-sectional study

INTRODUCTION

Reports examining the impact of oral health on the quality of life of refugees are lacking. The aim of this study was to examine factors influencing oral health-related quality of life (OHRQoL) among Syrian refugees in Jordan.

METHODS

A cross-sectional survey was conducted on a convenience sample of Syrian refugees, who attended dental clinics held at Azraq camp. The survey assessed the refugees' oral hygiene practices, and measured their OHRQoL using the Arabic version of the United-Kingdom Oral Health-Related Quality of life measure.

RESULTS

In total, 102 refugees [36 male and 66 female; mean age 34 (SD = 10) years] participated. Overall, 12.7% did not brush their teeth and 86.3% did not use adjunctive dental cleaning methods. OHRQoL mean score was 56.55 (range 32-80). Comparison of the physical, social and psychological domains identified a statistically significant difference between the physical and the psychological domain mean scores (ANOVA; P = 0.044, Tukey's test; P = 0.46). The factors which revealed association with OHRQoL scores in the univariable analyses, and remained significant in the multivariable linear regression analysis, were: age (P = 0.048), toothbrushing frequency (P = 0.001) and attending a dental clinic in the last year (P = 0.004).

CONCLUSION

The physical aspect of quality of life was more negatively impacted than the psychological aspect. Toothbrushing frequency and attending a dental clinic at least once in the last year were associated with more positive OHRQoL scores. Older refugees seemed to be more vulnerable to the impact of poor oral health on OHRQoL.

A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model

Health psychology is multidisciplinary, with researchers, practitioners, and policy makers finding themselves needing at least some level of competency in a variety of areas from psychology to physiology, public health, and others. Given this multidisciplinary ontology, prior attempts have been made to establish a framework for understanding the role of biological, psychological, and socio-environmental constructs in disease development, maintenance, and treatment. Other models, however, do not explain how factors may interact and develop over time. The aim here was to apply and adapt the 3P model, originally developed and used in the treatment of insomnia, to couch the biopsychosocial model in a way that explains how diseases develop, are maintained, and can be treated. This paper outlines the role of predisposing, precipitating, and perpetuating factors in disease states and conditions (the 3Ps) and provides examples of how this model may be adapted and applied to a number of health-related diseases or disorders including chronic pain, gastrointestinal disorders, oral disease, and heart disease. The 3P framework can aid in facilitating a multidisciplinary, theoretical approach and way of conceptualizing the study and treatment of diseases in the future.

Bayesian Nonparametric Policy Search with Application to Periodontal Recall Intervals

Tooth loss from periodontal disease is a major public health burden in the United States. Standard clinical practice is to recommend a dental visit every six months; however, this practice is not evidence-based, and poor dental outcomes and increasing dental insurance premiums indicate room for improvement. We consider a tailored approach that recommends recall time based on patient characteristics and medical history to minimize disease progression without increasing resource expenditures. We formalize this method as a dynamic treatment regime which comprises a sequence of decisions, one per stage of intervention, that follow a decision rule which maps current patient information to a recommendation for their next visit time. The dynamics of periodontal health, visit frequency, and patient compliance are complex, yet the estimated optimal regime must be interpretable to domain experts if it is to be integrated into clinical practice. We combine non-parametric Bayesian dynamics modeling with policy-search algorithms to estimate the optimal dynamic treatment regime within an interpretable class of regimes. Both simulation experiments and application to a rich database of electronic dental records from the HealthPartners HMO shows that our proposed method leads to better dental health without increasing the average recommended recall time relative to competing methods.

Oral health and healthcare utilization in Belgian dentate adults

OBJECTIVES

In 2012-2014, the Belgian National Oral Health Data Registration and Evaluation Survey, integrated in the Health Interview Survey (HIS), was carried out. The present study investigated, in a sample of 1340 dentate adults (≥25 years), the association between oral healthcare utilization, oral health status and sociodemographic status.

METHODS

A multistage, stratified cluster sampling procedure was used. Oral examination for caries experience (World Health Organization, D₃ MFT-Index), periodontal status (Dutch Periodontal Screening Index, DPS-Index), number of teeth present and occlusal contacts without wearing removable dentures was performed by calibrated examiners. Oral healthcare utilization data were retrieved from the records of the Belgian Intermutualistic Agency. Participants' oral health and sociodemographic data were linked to registered oral care utilization in the previous 5-year period. Regular attenders (annual attenders and those with at least one registered contact in three different years) were compared with irregular attenders (those having had dental visits but not according to the definition of regular attenders) and nonattenders. Data were weighted to compensate for sampling and participation bias.

RESULTS

Six hundred and seventy-nine participants attended regularly, of whom 276 annually; 256 did not attend in the reference period. The overall D₃ MFT-Index was not noticeably different between attendance patterns (varying between 11 and 13), although regular attenders had more restored teeth than nonattenders (P < 0.01). No difference was seen for DPS-Index and number of teeth/occluding pairs (χ² test, P > 0.05). Females, participants with higher education, older participants and those in employment had higher rates of regular attendance.

CONCLUSIONS

Regular attenders had fewer untreated caries lesions, but neither lower caries experience nor lower DPS-Index than irregular attenders. Regular attendance was associated with sociodemographic variables.

The Predictive Validity of Physical Performance Measures in Determining Markers of Preclinical Disability in Community-Dwelling Middle-Aged and Older Adults: A Systematic Review

BACKGROUND

Identification of preclinical disability in middle-aged and older adults might allow early identification of and treatment for functional mobility deficits.

PURPOSE

This study aimed to determine which physical performance measures (PPMs) were effective in identifying preclinical disability in individuals at risk for future disability.

DATA SOURCES

CINHAL, PubMed, Scopus, and Web of Science databases were searched until September 2017 using key words.

STUDY SELECTION

Two individuals screened peer-reviewed prospective longitudinal studies that assessed healthy individuals > 45 years old using PPMs at baseline. Eight studies met inclusion criteria.

DATA EXTRACTION

Two individuals extracted data on participant demographics, PPMs, predictive validity effect size, and disability outcomes. Risk of bias was assessed using the Quality Assessment Tool for Cohort Studies II (Q-Coh II).

DATA SYNTHESIS

Four constructs were used to guide data synthesis: functional mobility, activities of daily living disability, fall(s), and hospitalization. Multiple sit-to-stands from a chair, standing balance, and gait speed were found to have some merit in identifying preclinical disability across all 4 disability constructs. All studies were scored as good-quality studies using the Q-Coh II.

LIMITATIONS

The heterogeneity in follow-up times and reporting of risk prediction statistics made it difficult to compare results across studies, PPMs, and constructs. The 4 constructs used as markers of preclinical disability potentially do not fully capture the progression of disability.

CONCLUSIONS

Physical therapists should consider using PPMs on healthy adult populations to gather baseline data during annual health screens for use in identifying preclinical disability.

Number of Non-vital Teeth as Indicator of Tooth Loss during 10-year Maintenance: A Retrospective Study

The purpose of this study was to investigate whether number of non-vital teeth was an indicator of tooth loss during maintenance. Thirty-three general practitioners provided data on 321 patients undergoing maintenance over 10 years. The number of present teeth (PT), smoking status, level of bone loss, number of non-vital teeth, and reason for tooth loss during that period were investigated. Multiple logistic regression was performed to identify whether the number of non-vital teeth was associated with tooth loss. The average number of lost teeth was 1.07±1.82; that of PT at baseline was 24.4±3.9; and that of non-vital teeth at baseline was 5.4±4.5. Multiple logistic regression revealed a significant association between >8 non-vital teeth and tooth loss during maintenance (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 1.18-4.87). It also demonstrated relationships between >8 non-vital teeth and root fracture or caries (OR: 3.90; 95%CI: 1.68-9.03 or OR: 2.85, 95%CI: 1.14-7.10, respectively). The number of non-vital teeth was associated with tooth loss during maintenance. The results suggest that patients with many non-vital teeth before commencement of maintenance are particularly at risk of tooth loss due to root fracture or caries. Therefore, the number of non-vital teeth offers a useful indicator of potential tooth loss.

Tooth Loss in Problem-oriented, Irregular, and Regular Attenders at Dental Offices

The aim of this retrospective study was to compare number of teeth lost among regular attenders (RAs), irregular attenders (IRAs), and problem-oriented attenders (POAs) at dental offices over a 10-yr observation period. Information on tooth loss was obtained from general practitioners. Patients were divided into 3 groups based on appointment adherence. A total of 1,886 teeth were lost in 1,400 patients. The mean number of teeth lost in men was 2.2±2.6 per patient over 10 yr in POAs, 1.2±1.7 in IRAs, and 1.5±1.5 in RAs. This number was significantly lower in IRAs (p = 0.011) or RAs (p=0.012) than in POAs. When the dependent variable was defined as "a patient with at least 2 or more extracted teeth", the independent variables showed the following correlations with tooth loss: IRAs (OR: 0.54; 95%CI: 0.35-0.84), RAs (OR: 0.65; 95%CI: 0.47-0.89), man (OR: 1.43; 95%CI: 1.11-1.83), hypertension (OR: 1.38; 95%CI: 1.04-1.85), 20-25 present teeth (OR: 2.41; 95%CI: 1.81-3.22), and 1-19 present teeth (OR: 3.75; 95%CI: 2.73-5.16). The risk of tooth loss showed a 0.65-fold increase in RAs undergoing maintenance compared with POAs. Motivating patients to visit the dentist more regularly and undergo maintenance is important. The present results may be of use to dental professionals in providing patients with detailed information on potential tooth loss and associated risk factors with the aim of achieving such a change in behavior.

Exploring the association of dental care utilization with oral impacts on daily performances (OIDP) - a prospective study of ageing people in Norway and Sweden

OBJECTIVES

To explore the association of dental health care utilization with oral impacts on daily performances (OIDP) across time focusing ageing Norwegian and Swedish adults adjusting for predisposing, enabling, and need related-factors as defined by Andersen's model.

METHODS

Data were based on Norwegian and Swedish 1942 birth-cohorts conducted in 2007 (age 65) and 2012 (age 70). In Norway, the response rates ranged from 54% to 58%. Corresponding figures in Sweden were from 72% to 73%. Self-administered questionnaires assessed OIDP, dental care utilization and predisposing, enabling and need related factors. Logistic regression with robust variance estimation was used to adjust for clustering in repeated data.

RESULTS

Significant covariates of OIDP were satisfaction with dental services, dental care avoidance due to financial constraints, frightening experience with dental care during childhood and patient initiated dental visiting. Frequency and regularity of dental attendance were associated with OIDP in the Swedish cohort, only.

CONCLUSIONS

In spite of country differences in the public co-financing of dental care, dental care utilization indicators were associated with OIDP across time in both cohorts. Encouraging regular and dentist initiated visiting patterns and strengthening beliefs in keeping own teeth could be useful in attempts to reduce poor oral health related quality of life in ageing people.

Dental care use in Ontario: the Canadian community health survey (CCHS)

BACKGROUND

Oral health is a significant measure of overall health, and regular dental visits are recommended for the maintenance of oral health. The purpose of this study is to determine the pattern (amount and type) of, and factors associated with dental care use among Ontarians.

METHODS

Data from the 2014 cycle of the Canadian Community Health Survey was used and analysis was restricted to individuals aged 12 and above residing in Ontario. Dental care use was defined by two distinct outcomes: not visiting a dentist within the past year and visiting a dentist only for emergencies. Multivariable logistic regression was performed to examine the association between socio-demographic, health behavior, oral health, and other health-related factors and the two outcomes.

RESULTS

More than a quarter of participants reported not visiting the dentist in the last year, and 19% reported usually visiting a dentist only for emergencies. Multivariable logistic regression analysis suggested that males, individuals of Aboriginal status, those with low educational attainment, low household income, no dental insurance, who smoked, less frequent teeth brushing, poor health of teeth and mouth, or had diabetes were at a significant increased likelihood of not visiting the dentist within the past year, and only visiting a dentist for emergency care.

CONCLUSIONS

Socioeconomic status, self-reported oral health, and general health behaviors were associated with dental care use. These findings highlight the need for focusing efforts toward improving dental care use among Ontarians.

Factors influencing Patients' Utilization of Dental Health Services in Jazan, Kingdom of Saudi Arabia

Introduction

One way of prevention and early detection of oral diseases is by utilizing the dental health care services on a regular basis. The current study aims to know the factors that play a role in influencing the dental service utilization in Jazan, Kingdom of Saudi Arabia.

Materials and methods

A cross-sectional survey using a self-administered questionnaire was designed and implemented. Study subjects comprised of patients visiting the dental clinics at Jazan University and the primary dental centers of five different suburbs in Jazan region of Kingdom of Saudi Arabia. Items in the questionnaire were grouped into three sections; “demographic details,” “self-reported dental visits,” and “potential factors” contributing to dental visits. Chi-square p-value of 0.05 or less was considered as significant and logistic regression with 95% confidence interval (CI) was performed to get more precise results.

Results

The sample size was 395 (N) of which 44.8% were males and 53.4% were females. Less than half (45.8%) of the studied sample reported that their last visit to a dentist was within a span of one year and 33% of them think that a dentist should only be visited if they experience pain. Patients following instructions given by a dentist were 7 times [odds ratio (OR) = 0.13; CI = 0.04, 0.40] less likely to miss their regular dental appointments. Following this, patients receiving knowledge on their dental problems were seen to be twice (OR = 0.50; CI = 0.25, 0.98) less likely to be irregular with their dental visits. Finally, the patients who are better educated and literate were also 2 times (OR = 2.21; CI = 1.14, 4.28) more likely to be regular with their dental appointments in comparison with the patients who completed just their primary level education.

Conclusion

Findings of this study will facilitate future oral health prevention programs to be more focused, thereby reducing the gap between high and low educated sectors of the population residing in Jazan.

How to cite this article: Quadri FA, Jafari FAM, Albeshri ATS, Zailai AM. Factors influencing Patients’ Utilization of Dental Health Services in Jazan, Kingdom of Saudi Arabia. Int J Clin Pediatr Dent 2018;11(1):29-33.

Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

OBJECTIVE

Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature.

METHODS

We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP.

RESULT

16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP.

CONCLUSIONS

The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.

Monitoring of caries disease by risk assessments and activity

ABSTRACT Dental caries is a non-communicable disease and is considered a public health problem. For diagnosis and correct treatment, the study of risk assessment and caries activity is necessary. The caries risk assessment is a way to formalize the balance and imbalance of predictably disease to diagnose dental caries. Therefore, the caries risk assessment is performed through different evaluation systems. Another parameter of great importance to be studied is the activity of caries, because through it is done the correct treatment decision for the patient. The objective of this article is to inform the reader about: the concepts and caries risk factors; the different caries risk assessment systems described in the literature; and which systems are validated. In addition, this literature review provides for identification and evaluation of risk factors and activity of caries lesions in order to enable greater objectivity in the diagnosis and facilitate the decisions of a successful treatment.

Long-term regular dental attendance and periodontal disease in the 1998 adult dental health survey

AIM

The aim of this study was to explore the association between long-term pattern of dental attendance and periodontal disease among British adults.

METHODS

We used data from 3272 adults who participated in the 1998 Adult Dental Health Survey in the UK. Participants were classified into four trajectories (current, always, former and never regular attenders) based on their responses to three questions on lifetime dental attendance patterns. The numbers of teeth with pocket depth (PD) ≥4 mm and loss of attachment (LOA) ≥4 mm were the outcome measures. The association between dental attendance patterns and each periodontal measure was assessed in crude and adjusted models using negative binomial regression.

RESULTS

Never and former regular attenders had more teeth with PD ≥4 mm (Rate Ratios with 95% Confidence Interval: 1.58 [1.28-1.95] and 1.34 [1.12-1.60] respectively) and LOA ≥4 mm (1.34 [1.04-1.72] and 1.37 [1.07-1.75] respectively) than always regular attenders, after adjustments for demographic (sex, age and country of residence) and socioeconomic factors (education and social class). However, no differences in periodontal measures were found between always and current regular attenders.

CONCLUSION

This analysis of national cross-sectional data shows that adults with different long-term patterns of dental attendance have different periodontal health status.

Associations between adult attachment and: oral health-related quality of life, oral health behaviour, and self-rated oral health

PURPOSE

Although adult attachment theory has been revealed as a useful theoretical framework for understanding a range of health parameters, the associations between adult attachment patterns and a range of oral health parameters have not yet been examined. The aim of this study was to examine potential associations between attachment insecurity and: (1) oral health-related quality of life (OHRQoL), (2) oral health behaviours, and (3) self-rated oral health. In association with this aim, sample characteristics were compared with normative data.

METHODS

The sample in this cross-sectional study was comprised of 265 healthy adults, recruited via convenience sampling. Data were collected on attachment patterns (Experiences in Close Relationships Scale-Short Form, ECR-S), OHRQoL (Oral Health Impact Profile-14, OHIP-14), oral health behaviours (modified Dental Neglect Scale, m-DNS), and self-rated oral health (one-item global rating of oral health). Multivariate regression models were performed.

RESULTS

Both dimensions of attachment insecurity were associated with lowered use of favourable dental visiting behaviours, as well as decreased OHRQoL for both overall well-being and specific aspects of OHRQoL. Attachment avoidance was linked with diminished self-rated oral health.

CONCLUSIONS

This study supports the potential value of an adult attachment framework for understanding a range of oral health parameters. The assessment of a client's attachment pattern may assist in the identification of people who are at risk of diminished OHRQoL, less adaptive dental visiting behaviours, or poorer oral health. Further research in this field may inform ways in which attachment approaches can enhance oral health-related interventions.

A systematic map of systematic reviews in pediatric dentistry--what do we really know?

OBJECTIVES

To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry.

METHODS

A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps.

RESULTS

Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low.

CONCLUSION

There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.

Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform

OBJECTIVES

In Finland, a major oral healthcare reform (OHCR), implemented during 2001-2002, opened the public dental services (PDS) and extended subsidies for private dental services to entire adult population. Before the reform, adults born earlier than 1956 were not entitled to use PDS nor did they receive any reimbursements for their private dental costs. We aimed to examine changes in the income-related inequality and inequity in the use of dental services among the adult Finns after the reform.

METHODS

Representative data from Finnish adults born in 1970 or earlier were gathered from three identical postal surveys concerning the use of dental services and subjective perceptions of oral health. Those surveys were conducted before the OHCR in 2001 (n = 1907) and after the OHCR in 2004 (n = 1629) and 2007 (n = 1509). We used concentration index and its decomposition to analyse income-related inequality and inequity in the use of dental services and factors associated with them.

RESULTS

Results showed that pro-rich inequality and inequity in the overall use of dental services narrowed from 2001 to 2004. However, between 2004 and 2007, pro-rich inequality and inequity widened, so it returned to a rather similar level in 2007 as it had been in 2001. Most of the pro-rich inequality and inequity were related to regular dental visiting habit and income level. While there was pro-poor inequality and inequity in the use of PDS, there was pro-rich inequality and inequity in the use of private dental services throughout the study years.

CONCLUSION

It seems that income-related inequality and inequity in the use of dental services narrowed only temporarily after the reform.

The effectiveness of regionalization of perinatal care services--a systematic review

BACKGROUND

Several reports recommend the implementation of perinatal regionalization for improvements in maternal and neonatal outcomes, while research evidence on the effectiveness of perinatal regionalization has been limited. The interventional studies have been assessed for robust evidence on the effectiveness of perinatal regionalization on improving maternal and neonatal health outcomes.

METHODS

Bibliographic databases of Medline, EMbase, EconLit, HMIC have been searched using sensitive search terms for interventional studies that reported important patient or process outcomes. At least two authors assessed eligibility for inclusion and the risk of biases and extracted data from the included studies. As meta-analysis was not possible, a narrative analysis as well as a 'vote-counting' analysis has been conducted for important outcomes.

RESULTS

After initial screenings 53 full text papers were retrieved. Eight studies were included in the review from the USA, Canada and France. Studies varied in their designs, and in the specifications of the intervention and setting. Only three interrupted time series studies had a low risk of bias, of which only one study reported significant reductions in neonatal and infant mortality. Studies of higher risk of bias were more likely to report improvements in outcomes.

CONCLUSIONS

Implementing perinatal regionalization programs is correlated with improvements in perinatal outcomes, but it is not possible to establish a causal link. Despite several high profile policy statements, evidence of effect is weak. It is necessary to assess the effectiveness of perinatal regionalization using robust research designs in a more diverse range of countries.

Patient perceptions regarding benefits of single visit scale and polish: a randomised controlled trial

BACKGROUND

Single visit scale and polish is frequently carried out in dental practices however there is little evidence to support (or refute) its clinical effectiveness. The purpose of this research was to compare patient-reported outcomes between groups receiving a scale and polish at 6-, 12-, and 24-month intervals. Outcomes recorded included participants' subjective assessment of their oral cleanliness; the perceived importance of scale and polish for oral health and aesthetics; and frequency at which this treatment is required.

METHODS

A practice-based randomised control trial was undertaken, with a 24-month follow-up period. Participants were healthy adults with no significant periodontal disease (BPE codes <3) randomly allocated to three groups to receive scale and polish at 6-, 12-, or 24-month intervals. Patient-reported outcomes were recorded at baseline and follow-up. Oral cleanliness was reported using a 5-point scale and recorded by examiners blinded to trial group allocation. A self-completed questionnaire enabled participants to report perceived importance of scale and polish (5-point scale), and required frequency of treatment (6-point scale). The main hypothesis was that participants receiving 6-monthly scale and polish would report higher levels of oral cleanliness compared to participants receiving scale and polish at 12- and 24-month intervals.

RESULTS

369 participants were randomised: 125 to the 6-month group; 122 to the 12-month group; and 122 to the 24-month group. Complete data set analysis was carried out to include 107 (6-month group), 100 (12-month group) and 100 (24-month group) participants. Multiple imputation analyses were conducted where follow-up data was missing. The difference in the proportions of participants reporting a 'high' level of oral cleanliness at follow-up was significant (Chi-squared P = 0.003): 52.3% (6-month group), 47.0% (12-month group) and 30.0% (24-month group). Scale and polish was thought to be important by the majority in each group for keeping mouths clean and gums healthy, whitening teeth, and preventing bad breath and tooth decay; there were no statistically significant differences between groups at follow-up. Most participants at follow-up thought that the frequency of scale and polish should be "every 6 months" or more frequently: 77.9% (6-month group), 64.6% (12-month group), 71.7% (24-month group); differences between groups were not statistically significant (Chi squared P = 0.126). The results suggest that participants in the 24-month trial group were more likely to choose a scale and polish interval of "once a year" or less frequently (OR 2.89; 95% CI 1.36, 6.13).

CONCLUSIONS

The majority of healthy adults regarded 6-monthly single-visit scale and polish as being beneficial for their oral health. Receiving the treatment at different frequencies did not alter this belief; and those with the longest interval between scale and polish provision perceived that their mouth was less clean. In the absence of a strong evidence base to support (or refute) the effectiveness of single-visit scale and polish, the beliefs and preferences of patients regarding scale and polish may be influential drivers for maintaining provision of this treatment.

Periodicity of dental recall visits for young children first seen in community health centers

OBJECTIVES

To study the factors associated with young children who had their first dental visit (FDV) at a Federally Qualified Health Center (FQHC) and returned within 12 months for a second dental episode.

METHODS

Two hundred Medicaid-enrolled children who were less than 6 years old were randomly selected from five Iowa FQHCs. Dental utilization was followed for 36 months using dental charts and Medicaid medical and dental claims data, regardless of provider. Child's birth certificate data were also used as covariates. Multivariable logistic regression, using backward elimination, was used to identify variables that were associated with whether a child returned for a dental recall visit within 1 year of the initial dental episode.

RESULTS

About 56% of the children returned for dental care within 1 year of their initial episode. The number of children in the household had a positive impact on children returning for a second dental episode. However, an increase in the frequency of medical well-child visits at the FQHC prior to the FDV had a negative influence. Unadjusted analysis demonstrated that children with dental caries at the FDV were less likely to return within 12 months; however, this variable failed to make the final regression model. Moreover, age at FDV did not make a difference in regard to returning for a second episode within 12 months.

CONCLUSIONS

The experience gained from having other Medicaid-enrolled children in the household appears to be important for younger children entering into continuous and comprehensive dental care.

Retention of people living with HIV/AIDS in oral health care

OBJECTIVE

We identified factors associated with retention in oral health care for people living with HIV/AIDS (PLWHA) and the impact of care retention on oral health-related outcomes.

METHODS

We collected interview, laboratory value, clinic visit, and service utilization data from 1,237 HIV-positive patients entering dental care from May 2007 to August 2009, with at least an 18-month observation period. Retention in care was defined as two or more dental visits at least 12 months apart. We conducted multivariate regression using generalized estimating equations to explore factors associated with retention in care.

RESULTS

In multivariate analysis, patients who received oral health education were 5.91 times as likely (95% confidence interval 3.73, 9.39) as those who did not receive this education to be retained in oral health care. Other factors associated with care retention included older age, taking antiretroviral medications, better physical health status, and having had a dental visit in the past two years. Patients retained in care were more likely to complete their treatment plans and attend a recall visit. Those retained in care experienced fewer oral health symptoms and less pain, and better overall health of teeth and gums.

CONCLUSIONS

Retention in oral health care was associated with positive oral health outcomes for this sample of PLWHA. The strongest predictor of retention was the receipt of oral health education, suggesting that training in oral health education is an important factor when considering competencies for new dental professionals, and that patient education is central to the development of dental homes, which are designed to engage and retain people in oral health care over the long term.

A systematic review of dental recall intervals and incidence of dental caries

BACKGROUND

Dental recall interval protocols are used to prevent dental disease through regular maintenance evaluations and preventive procedures. In this systematic review, the authors examined the evidence for the rationale behind a "one-recall-interval-fits-all" protocol, such as a six-month recall interval on caries incidence.

METHODS

The authors searched the PubMed database and reviewed titles, abstracts and full reports. They also searched the references of each full report and used the "Related articles" feature. They used a checklist validated for randomized and nonrandomized studies to conduct a quality assessment for each article.

RESULTS

The authors found seven articles representing six studies that met their inclusion criteria. The results of a randomized controlled trial showed no significant differences in oral health between patients recalled every 12 months and those recalled every 24 months. The investigators of one nonrandomized controlled trial reported that a two- to three-month recall interval significantly reduced the incidence and recurrence of caries. The investigators of an additional longitudinal non-randomized controlled study that compared three-, six- and 12-month recall intervals reported caries increments of 4.4, 4.0 and 4.9, respectively. The results of two retrospective studies showed that a specific recall interval did not alter caries incidence significantly. The results from a cross-sectional study suggested that a six-month recall interval was associated with more restored teeth but less active caries.

CONCLUSIONS

The authors conclude that the evidence for using a one-recall-interval-fits-all protocol to reduce caries incidence was weak. Studies that addressed the impact of recall interval on caries incidence were methodologically weak. The evidence was not strong enough to support using any specific one-recall-interval-fits-all protocol for all patients.

CLINICAL IMPLICATIONS

Using a one-recall-interval-fits-all protocol for caries prevention should be re-evaluated. On the basis of evidence from the randomized controlled trial, recall intervals could be extended to every two years. Evidence from the other studies revealed conflicting results for the efficacy of using any specific recall interval protocol. Because all of these studies had serious threats to validity, clinicians may wish to consider assigning recall intervals to patients on the basis of the patients' risk of developing caries. However, a discussion of a caries risk assessment is beyond the scope of this review.

What is an appropriate caries diagnosis?

This aim of this paper is to spur a discussion of the direction of caries-lesion detection activities in clinical dental practice. It is argued that since the dental clinician's caries-related decision making is a script-matching enterprise in which clinical decisions are made on the basis of 'this-lesion-needs-this-kind-of-treatment' reasoning, the methods and strategies employed for caries lesion detection should accommodate this fact. This may be done by employing a clinical visual-tactile method for caries lesion detection that evaluates the two aspects that are crucial for appropriate caries management: lesion activity and surface integrity. The use of diagnostic methods that do not assess these features directly but involve assumptions about activity status and surface integrity should be avoided. This includes the use of bite-wing radiography for the detection of approximal caries lesions, as it may be shown that plain reliance on radiographs leads to considerable overtreatment. If clinical dentistry is to retain its status as a profession committed to doing good, changes in diagnostic practices along these lines are warranted.

Long-term dental visiting patterns and adult oral health

To date, the evidence supporting the benefits of dental visiting comes from cross-sectional studies. We investigated whether long-term routine dental visiting was associated with lower experience of dental caries and missing teeth, and better self-rated oral health, by age 32. A prospective cohort study in New Zealand examined 932 participants' use of dentistry at ages 15, 18, 26, and 32. At each age, routine attenders (RAs) were identified as those who (a) usually visited for a check-up, and (b) had made a dental visit during the previous 12 months. Routine attending prevalence fell from 82% at age 15 to 28% by 32. At any given age, routine attenders had better-than-average oral health, fewer had teeth missing due to caries, and they had lower mean DS and DMFS scores. By age 32, routine attenders had better self-reported oral health and less tooth loss and caries. The longer routine attendance was maintained, the stronger the effect. Routine dental attendance is associated with better oral health.

What a difference a place makes: dental attendance and self-rated oral health among adults in three counties in Norway

Through a multilevel approach, the study explores the relationships of dental attendance and self-rated oral health (SROH) to individual and structural factors among adults in Norway. The individual factors include various socio-demographic characteristics. The structural ones are population density and dentist density. The sample was recruited from three counties that represent three different combinations of population density and dentist density. There were significant differences in both dental attendance and SROH between the counties. The findings support the theory of a structural explanation of the observed differences and indicate evidence of supplier-suppressed demand. Access to dental services could be improved either by regulating the supply side of dentistry or by compensating patients for travel costs incurred in accessing dental services.

The impact of dental neglect on oral health: a population based study in Hong Kong

OBJECTIVE

The aim of this study was to assess dental neglect (DN) among Hong Kong citizens, to identify socio-demographic variations in DN and to determine the association between DN and oral health (self-reported).

DESIGN

Cross sectional population based study involving a random sample of 800 Hong Kong Chinese adults.

METHOD

Telephone interview incorporating the dental neglect scale, assessment of self-reported oral health including an oral health related quality of life measure.

RESULTS

The response rate was 70% (556/800). Mean dental neglect score of the population was 14.81 (S.D. 3.62) [possible range 6 to 30]. Most commonly, people were neglectful of using professional dental health care. Socio-demographic disparities in DN were apparent, in relation to age (P < 0.05), income (P < 0.05) and educational attainment (P < 0.05). DN was associated with self-reported oral health: denture status (P < 0.05), number of teeth possessed (P < 0.05) and oral health related quality of life (P < 0.05).

CONCLUSION

Dental neglect is widespread in Hong Kong, particularly neglect of professional dental care. Socio-demographic disparities in dental neglect were apparent. Dental neglect is associated with self-reported oral health status including how oral health impacts on life quality. These findings have implications in understanding the impact of dental neglect.

Is regular visiting associated with lower costs? Analyzing service utilization patterns in the first nations population in Canada

OBJECTIVES

Using an administrative database of dental service records from the Non-Insured Health Benefits (NIHB) program of Health Canada for 1994-2001, the authors set out to test whether regular visitors had lower program expenditures.

METHODS

The age-specific mean expenditures per client were compared among those with regular examinations in 8, 7 and fewer years. The study further examined the effect of regular visiting over the first 6 years on expenditures in the last 2 years. "Continuity of care" was measured by the numbers of consecutive years prior to 2000 in which clients had a regular examination. In a "gap analysis" individuals were classified according to the number of years prior to 2000 since they last had an initial or recall examination. Mean expenditures per client were analyzed by age group and type of service.

FINDINGS

Over the 8-year period, clients with regular visits had the highest expenditures. In both the continuity of care and gap analyses, the findings were generally consistent; the more that clients visited over the first 6 years, the higher the expenditures in the final 2 years. Clients with more "regular" (initial and recall) examinations received a relatively standard, age-specific, pattern of service but incurred greater expenditures compared to clients with fewer regular, or longer gaps in, examinations.

CONCLUSION

The observations of the authors in this client group do not support the thesis that regular visiting is associated with lower expenditures on dental care.

Four-year follow-up of oral health surveillance in renal transplant children

To outline the specific oral surveillance needs of renal transplant children, we report the 4-year follow-up data of 106 children examined routinely on a 6-month basis and upon request from the medical team or the parents in the interval. Data were recorded for hard and soft dental tissues, including enamel defects carious lesions, gingival status, orthodontic treatment needs, and wisdom teeth eruption. Hard-tissue lesions were noted in 34.9% of the children, caries lesions on the permanent teeth were seen in 15.0% of cases, 18.86% of the patients had orthodontic treatment. Spontaneous examination, upon request for medical reasons, was given for 26 children. Twenty-one demands originated from the parents. Over a 4-year period the attendance of a dental specialist resulted in a significant improvement in the oral health of the renal transplant children.