Dental health-care service utilisation and its determinants in West Iran: a cross-sectional study

Dental service utilization in the general adult population in Bangladesh

OBJECTIVES

With the help of a national community-based survey, the analysis aimed to estimate the number of adults in Bangladesh who used dental services (DSU).

METHODS

The 8185 participants (18-69 years old) in the Bangladesh cross-sectional STEPS survey in 2018 provided national data for analysis. Predisposing, enabling, and need factors for DSU were included in the interview data, physical examinations, and biochemical analyses. To estimate the DSU (last 12 months) predictors, Poisson regression was employed.

RESULTS

Seven out of 10 participants (71.0%) had never DSU, 13.2% within the past 12 months, and 15.9% more than 12 months ago. In terms of predisposing factors, the final model showed a negative relationship between past 12-month DSU and living in the northern region (adjusted prevalence ratio-APR: 0.75, 95% CI: 0.59, 0.96). The enabling factors of living in an urban area (APR: 1.19, 95% CI: 1.01, 1.41) and seeing a doctor or other healthcare provider within the previous year (APR: 1.37, 95% CI: 1.08, 1.74) were positively correlated with DSU. In terms of need factors, dental pain (APR: 15.37, 95% CI: 9.68, 24.40), multimorbidity (APR: 1.26, 95% CI: 1.02, 1.55), oral health impact (OHI) speech problem (APR: 1.35, 95% CI: 1.13, 1.63), and OHI felt tense (APR: 1.34, 95% CI: 1.10, 1.64) were positively associated with DSU.

CONCLUSIONS

A low proportion of participants had DSU in the past 12 months and several associated factors were identified.

Utilization of dental care among adult populations: a scoping review of applied models

BACKGROUND

The timely and appropriate utilization of dental health care is essential to the prevention and accurate treatment of oral diseases. Therefore, it is crucial that managers, health professionals and healthcare providers be fully aware of the predictors encouraging the utilization of dental services and reduce social inequalities. In this scoping review, we aimed to analyze the published articles and reports to find out the factors associated with dental services utilization and the comprehensiveness of the applied models among general adult populations.

MATERIALS AND METHODS

This scoping study was based on the 5-steps of Arksey and O'Malley framework. Keywords were selected under two main concepts: determinants of dental care utilization and the concept of the applied models. Searches were conducted in some electronic databses including PubMed, Google Scholar and Scopus with variations, and a combination of the keywords under the two main afore-mentioned concepts. All the relevant articles reporting the utilization of dental care and its potential predictors among adult populations were chosen. No restrictions involving terms of study time, location or methodological aspects of oral health utilization were considered. Using tables and charts mapping, we tried to group the studies based on the year of their publication, geographic distribution, the range of included indices and the type of their measurement. Also, a directed content analysis method was used to investigate the comprehensiveness of the studies in regard to considering the determinant factors at different levels suggested by the Andesen model.

RESULTS

Fifty-two articles were included in the analysis. Thirty-six (69%) had been published between 2016 and 2020. The United States had conducted the most research in this scope. About 30% of studies had mentioned all three domains of demographics, social structure and beliefs, simultaneously. To evaluate the enabling factors, in 84.61% and 59.61% of studies, the income levels and insurance feature were assessed, respectively. 57.69% of the retrieved studies considered the perceived need features and 38.46% referred to the evaluated ones. The dental services utilization, in terms of the last visit during the "past 12 months", was assessed more commonly. Only 11.54% of studies did evaluate the contextual characteristics and about 71.15% of articles were relatively comprehensive.

CONCLUSION

Overall, it seems that in most of the studies, not all of the determinant factors at different levels of the Andersen model have been considered. In order to discover the conceptual linkages and feedback loops of the model, it is essential to conduct more comprehensive research in the future.

The Association Between Seeking Urgent Dental Care and the Prevalence of Root Caries Among Patients in the United States, National Health And Nutrition Examination Survey 2017-2020: A Cross-Sectional Study

OBJECTIVE

This cross-sectional study aimed to investigate the association between seeking urgent dental care and the prevalence of root caries among patients in the United States, utilizing data from the Nutritional Health and Examination Survey (NHANES) conducted between 2017 and 2020. Our hypothesis is that patients who are seeking urgent dental care due to pain will have a high prevalence of root caries.

METHODS

The study utilized a cross-sectional design, analyzing data from NHANES 2017-March 2020 pre-pandemic data, a nationally representative survey. The sub-sample consisted of 6,186 participants aged 20 years and older who underwent oral health assessments, including the examination of root caries. Information on seeking urgent dental care was obtained through self-reported data. Statistical analyses, using SAS 9.4 (SAS Institute Inc., Cary, NC), were performed to assess the association between urgent care seeking and root caries prevalence while controlling the potential confounding variables. Descriptive statistics and multivariable logistic regression were used.  Results: The study included a total of 6,186 participants. The mean age (SD) of the participants was 49.7 (17.2). Some 52% were females and 48% were males. Some 14% (849) of the samples had root caries and 28% (1739) of the participants were seeking urgent dental care due to pain. Findings indicated a significant association between seeking urgent dental care and the prevalence of root caries (odds ratio, OR = 2.72, 95% confidence interval, CI = 2.32-3.18). Individuals who reported seeking urgent care had a higher prevalence of root caries (26% vs. 9%) compared to those who did not seek urgent care. Socioeconomic factors such as poverty and education, and other factors such as age, gender, race, marital status, and alcohol intake were identified as potential confounders.

CONCLUSION

This study provides evidence of the association between seeking urgent dental care and the prevalence of root caries among patients in the United States. The findings underscore the importance of promoting regular dental visits, preventive measures, and early interventions to mitigate the risk of root caries among individuals seeking urgent dental care. Addressing socio-economic barriers, improving access to dental services, and enhancing oral health education are crucial steps toward reducing the burden of root caries in this population. Further, longitudinal studies are recommended to establish the temporal relationship between urgent care seeking and root caries development.

Clinical practice guideline adaptation for risk-based caries management in 18-55 year-old Iranian adults

PURPOSE

To adapt an evidence-based clinical practice guideline (CPG) for risk-based management of caries in 18-55 year-old Iranian adults.

METHODS

A multidisciplinary adaptation team reviewed evidence-based guidelines such as the NICE, SIGN, and ADA according to the defined clinical questions. In addition, databases such as the PubMed and Google Scholar were searched and CPGs were screened and appraised using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) tool. Clinical scenarios were developed and their level of evidence, clinical advantage and adaptability were assessed. Following a two-round ranking by experts, the final recommendations were selected using the RAND-UCLA appropriateness method.

RESULTS

Of 17 CPGs, 5 were selected as the source guidelines for adaptation. To assess the risk of caries in the adult population, reduced Cariogram (without saliva tests) and CAMBRA were suggested as diagnostic tools. In addition, 53 risk-based recommendations on the preventive care (including the use of fluoride toothpaste, fluoride, and chlorhexidine mouthwash, at home and in-office fluoride gel, fluoride varnish, mouth buffering, and sealant), operative intervention threshold, and follow-up interval were adapted for Iranian adults.

CONCLUSIONS

A guideline was adapted for risk-based management of dental caries in Iranian adults. This helps local dentists in decision making and promoting oral health of adults. Further research is needed to assess the external validity and feasibility of the adapted guideline in the Iranian population.

Moral Hazard and the Demand for Dental Treatment: Evidence from a Nationally Representative Survey in Thailand

Even though there are examples in the health economics literature of evidence investigating moral hazard in health insurance provided by general healthcare services, studies of moral hazard in dental care in developing countries are still scarce, especially when it comes to nationally representative data on dental care demand and expenditure. Using Thailand as a case study, we investigate here whether moral hazard in dental insurance exists and, if so, the extent to which it affects different dental insurance on the demand for dental care in developing countries. We use a nationally representative sample of 269,206 individuals to quantify the impacts of dental care insurance on four sets of dependent variables describing demand for dental care. They are: (i) dental care utilization, (ii) numbers of dental care visits, (iii) dental care expenditure, and (iv) each type of dental care. Our probit and tobit estimations show that there is no evidence of the existence of moral hazard in terms of dental care utilization and dental care expenditure. However, there is a moral hazard of dental insurance existence on the number of dental care visits and type of dental care. People with generous dental benefits coverage tend to use preventive dental treatments along with necessary treatment but also use costly restorative dental treatments more than do those with lower coverage. It can thus be concluded that, in the case of developing countries, dental care insurance is found to increase the use of dental care, especially for preventive care.

What makes inequality in the area of dental and oral health in developing countries? A scoping review

Background

Equity in health is an important consideration for policy makers particularly in low and middle income developing country. The area of oral and dental health is not an exception. This study is conducted to explore the main determinants that make inequality in oral and dental health area in developing countries.

Methods

This was a scoping review applying the framework enhanced by Levac et al. Four databases of Scopus, PubMed, WOS and ProQuest were systematically searched applying to related keywords up to 27.11.2020. There restriction was placed in the English language but not on the study design. All the related studies conducted in the low or middle income developing countries were included. A qualitative thematic analysis was applied for data analysis and a thematic map was presented.

Results

Among 436 articles after excluding duplications, 73 articles were included that the number of publications from Brazil was greater than other developing countries (33.33%). Thematic analysis of the evidence has led to 11 determinants that may result in inequality in oral and dental health services in developing countries including personal characteristics, health status, health needs and health behaviours, social, economic, cultural and environmental factors, as well as insurance, policies and practices and provided related factors.

Conclusion

The policymakers in the low and middle income developing countries should be both aware of the role of inequality determinants and also try to shift the resources to the policies and practises that can improve the condition of population access to oral and dental services the same as comprehensive insurance packages, national surveillance system and fair distribution of dentistry facilities. It is also important to improve the population’s health literacy and health behaviour through social media and other suitable mechanisms according to the countries’ local contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12962-021-00309-0.

Unmet dental care need in West of Iran: determinants and inequality

Purpose

The purpose of this study was to assess the self-perceived need, seeking and use of dental care and its main determinants in Kurdistan province, Iran.

Design/methodology/approach

A total of 1,056 adults in Kurdistan province were included in this cross-sectional study. Multistage sampling approach was used to select the samples. Data on sociodemographic characteristics, economic status, self-perceived need, seeking and use of dental care were collected using a self-administrated questionnaire. Multivariate logistic regression model was used to assess factors affecting the use of dental care. In addition, socioeconomic inequality relating to dental care needs and use of dental care were examined using concentration curve and concentration index.

Findings

In this study, unmet dental care need was 62.7%. There was a perceived need for dental care among 13.7% (n = 145) of the participants in the past month, with only 39.3% (n = 57) seeking the care. The most important reasons for unmet dental care need were “Could not afford the cost” and “Insurance did not cover the costs.” Multivariate logistic regression showed that supplementary insurance status and household economic status were identified as main determinants affecting dental care-seeking behavior. The result of concentration index revealed that seeking dental care was more concentrated among the rich, whereas the perceived dental care need is more prevalent among the poor.

Originality/value

This study demonstrated that the prevalence of unmet dental care needs is high in the study setting. Also, financial barrier was identified as the main determinant of unmet dental care needs.

Prevalence and Correlates of Dental Service Utilization among Adults in Solomon Islands

Aims and Objectives:

The aim of this study was to assess dental service utilization (DSU) among adults in a Pacific Island country.

Materials and Methods:

In a cross-sectional nationally representative survey in Solomon Islands, 2,533 individuals (18–69 years) responded to questions on DSU, sociodemographic and health information in 2015.

Results:

More than half of the participants (55.3%) never had DSU, 36.4% had more than 12 months DSU, and 8.3% had past 12 months DSU. In adjusted multinomial logistic regression analysis, older age, ever screened for blood pressure, using toothpaste, and having had pain in teeth, gum, or mouth in the past year were associated with both >12 months and past 12 months DSU. Higher education, ever screened for cholesterol, being divorced, separated, or widowed, poor self-rated oral health (SROH), and experienced difficulty in chewing foods in the past 12 months were associated with >12 months or past 12 months DSU. High physical activity was negatively associated with >12 months DSU.

Conclusion:

Less than one in ten participants had past 12 months DSU and several factors were found, which can be targeted in interventions.

Prevalence and correlates of dental service utilisation among a national general adult population sample in Sudan

BACKGROUND

Prompt dental service utilisation (DSU) is needed for the prevention and treatment of oral diseases, and it is therefore important to determine the facilitators and barriers of DSU. There is, however, scarce information available on DSU in Sudan. Therefore, this study aimed to investigate the prevalence and associated factors of DSU in a general population-based survey among 18-69 year-old persons in Sudan.

METHODS

Cross-sectional nationally representative data of 7,722 18-69 year-old persons (36 years median age) from the 2016 Sudan Stepwise approach to surveillance (STEPS) survey were analysed. Using questionnaire, anthropometric and biochemical measures, predisposing, enabling and health and lifestyle factors of DSU were assessed. Multinomial logistic regression was conducted to estimate the predictors of DSU (> 12 months and past 12 months, with never DSU as the reference category).

RESULTS

About two-thirds of the participants (64.6%) had never DSU, 22.0% had more than 12-month DSU, and 13.4% had past 12- month DSU. Among those who had ever DSU, the main reason for the last DSU was pain or trouble with teeth, gums, or mouth (66.9%), treatment or follow-up treatment 22.3%, and routine check-up treatment 5.0%. In adjusted multinomial logistic regression analysis, higher education (p < 0.001), urban residence (p < 0.001), screened for blood pressure (p < 0.001), raised total cholesterol (p < 0.05), poor SROH (p < 0.001), pain in teeth or mouth (p < 0.001), and not working because of teeth or mouth (p < 0.01) were positively and not knowing their household income (p < 0.01), high physical activity (p < 0.05), and having 20 or more teeth (p < 0.001), were negatively associated with both > 12 months and past 12 months DSU. Higher household income (p < 0.001), overweight/obesity (p < 0.05), using tooth paste (p < 0.001), and difficulty chewing (p < 0.001), were positively, and male sex (p < 0.01), and teeth cleaning twice or more times a day (p < 0.05), were negatively associated with > 12 months or past 12 months DSU.

CONCLUSION

More than one in ten participants had past 12 months DSU and several factors were detected which could be targeted in intervention activities. Study findings suggest to improve oral health awareness, in particular stressing the relevance of regular dental check-ups, by using different modalities of oral health promotion.

Demographic and socioeconomic inequalities in oral healthcare utilisation in Malaysia: evidence from a national survey

Background

Throughout the years, oral healthcare utilisation in Malaysia has been low despite various efforts by the Ministry of Health Malaysia for improvement. This study aimed to determine the prevalence of oral healthcare utilisation and identify factors associated with oral healthcare utilisation among adults in Malaysia.

Methods

Secondary data analysis of adults aged 18 years and over from the National Health and Morbidity Survey 2019 was conducted in this study. Characteristics of respondents and those who utilised oral healthcare were described using complex sample descriptive statistics. Logistic regression analysis was performed to examine the association between the dependent and independent variables. Dependent variable was oral healthcare utilisation in the last 12 months. Independent variables were demographic and socioeconomic factors (predisposing, enabling and need characteristics) based on Andersen’s Behavioural Model.

Results

A total of 11,308 respondents, estimated to represent 21.7 million adults aged 18 years and over in Malaysia were included in the analysis. Prevalence of oral healthcare utilisation in the last 12 months was 13.2%. Demographic factors of sex, age, marital status, and socioeconomic factors of education level and occupation as well as health belief such as medical check-up were significantly related to oral healthcare utilisation. Enabling factor of household income quintile had significant association with oral healthcare utilisation. Inequalities were observed; females (OR = 1.57, 95% CI = 1.25, 1.96), younger adults (OR = 1.64, 95% CI = 1.15, 2.33), those who were married (OR = 1.65, 95% CI = 1.23, 2.22), those with higher education (OR = 2.21, 95% CI = 1.23, 3.99), those who had medical check-up in the last 12 months (OR = 1.86, 95% CI = 1.53, 2.25) and those with higher income (OR = 1.43, 95% CI = 1.04, 1.96) were more likely to utilise oral healthcare.

Conclusion

Understanding factors associated with utilisation of oral healthcare could help in formulating effective interventions to improve oral healthcare utilisation. Demographic and socioeconomic factors are strong determinants of oral healthcare utilisation in Malaysia. Appropriate interventions to strengthen the existing programmes aimed to promote regular and timely oral health check-ups are needed to improve oral healthcare utilisation.

Decomposing socioeconomic inequality in dental caries in Iran: cross-sectional results from the PERSIAN cohort study

Background

The current study aimed to measure and decompose socioeconomic-related inequalities in DMFT (decayed, missing, and filled teeth) index among adults in Iran.

Methods

The study data were extracted from the adult component of Prospective Epidemiological Research Studies in IrAN (PERSIAN) from 17 centers in 14 different provinces of Iran. DMFT score was used as a measure of dental caries among adults in Iran. The concentration curve and relative concentration index (RC) was used to quantify and decompose socioeconomic-related inequalities in DMFT.

Results

A total of 128,813 adults aged 35 and older were included in the study. The mean (Standard Deviation [SD]) score of D, M, F and DMFT of the adults was 3.3 (4.6), 12.6 (10.5), 2.1 (3.4) and 18.0 (9.5), respectively. The findings suggested that DMFT was mainly concentrated among the socioeconomically disadvantaged adults (RC = - 0.064; 95% confidence interval [CI), - 0.066 to - 0.063). Socioeconomic status, being male, older age and being a widow or divorced were identified as the main factors contributing to the concentration of DMFT among the worse-off adults.

Conclusions

It is recommended to focus on the dental caries status of socioeconomically disadvantaged groups in order to reduce socioeconomic-related inequality in oral health among Iranian adults. Reducing socioeconomic-related inequalities in dental caries should be accompanied by appropriate health promotion policies that focus actions on the fundamental socioeconomic causes of dental disease.

Socioeconomic-Related Inequalities in Dental Care Utilization in Northwestern Iran

INTRODUCTION

There have been multiple studies on socioeconomic-related inequalities in the use of dental services in Iran, but the evidence is still limited. This study measured inequality in dental care utilization by socioeconomic status and examined factors explaining this inequality among households in Ardabil, Iran in 2019.

METHODS

A total of 436 household heads participated in this cross-sectional study. Using a validated questionnaire, face-to-face interviews were conducted to collect data on dental care utilization, unmet needs, sociodemographic characteristics, economic status, health insurance, and oral health status of the participants. We used the concentration curve and relative concentration index (RCI) to visualize and quantify the level of inequality in dental care utilization by income. Regression-based decomposition was also applied to understand the causes of inequality.

RESULTS

About 59.2% (95% CI 54.4%-63.7%) and 14.7% (95% CI 11.6%-18.4%) of participants had visited a dentist for dental treatment in the previous 12 months and for 6-month dental checkups, respectively. The RCI for the probability of visiting a dentist in the last 12 months was 0.243 (95% CI 0.140-0.346). This suggests that dental care utilization was more concentrated among the rich. The RCI for unmet dental care needs was negative, which indicates more prevalence among the poor. Monthly household income (20.9%), self-rated oral health (6.9%), regular brushing (3.2%), and dental health insurance (2.5%) were the main factors in socioeconomic inequality in dental care utilization.

CONCLUSION

This study reveals that dental care-service utilization did not match the need for dental care, due to differences in socioeconomic status in Ardabil, Iran. Policies could be implemented to increase the coverage of dental care services among socioeconomically disadvantaged groups to tackle socioeconomic-related inequality in dental care utilization.

Socioeconomic inequality in dental care utilization in Iran: a decomposition approach

PURPOSE

Socioeconomic inequalities in dental care utilization in Iran are rarely documented. This study aimed to provide insight into socioeconomic inequalities in dental care utilization and its main contributing factors among Iranian households.

DESIGN/METHODOLOGY/APPROACH

A total of 37,860 households from the 2017 Household Income and Expenditure Survey (HIES) were included in the study. Data on dental care utilization, age, gender and education attainment of the head of household, socioeconomic status of households, health insurance coverage, living areas and provinces were obtained for the survey. The concentration curve and the normalized concentration index (C_n) was used to illustrate and quantify socioeconomic inequalities in dental care utilization among Iranian households. The C_n was decomposed to identify the main determinants of the observed socioeconomic inequality in dental care utilization in Iran.

FINDINGS

The study indicated that the prevalence of dental care utilization among Iranian's households was 4.67% (95% confidence interval [CI]: 4.46 to 4.88%). The results suggested a higher concentration of dental care utilization among socioeconomically advantaged households (C_n = 0.2522; 95% CI: 0.2258 to 0.2791) in Iran. Pro-rich inequality in dental care utilization also found in rural (C_n = 0.2659; 95%CI: 0.2221 to 0.3098) and urban (C_n = 0.0.2504; 95% CI: 0.0.2159 to 0.2841) areas. The results revealed socioeconomic status of households, age and education status of head of households and residing provinces as the main contributing factors to the concentration of dental care utilization among the wealthy households.

ORIGINALITY/VALUE

This study revealed pro-rich inequalities in dental care utilization among households in Iran and its provinces. Thus, health policymakers should focus on designing effective evidence-based interventions to improve healthcare utilization among household with the older head of households, lower education status, and living in relatively poor provinces to reduce socioeconomic inequality in dental care utilization in Iran.

Eliciting Preferences for Health Insurance in Iran Using Discrete Choice Experiment Analysis

BACKGROUND

The preferences of Iranians concerning the attributes of health insurance benefit packages are not well studied. This study aimed to elicit health insurance preferences among insured people in Iran during 2016.

METHODS

A mixed methods study using a discrete choice experiment (DCE) approach was conducted to elicit health insurance preferences on a total sample of 600 insured Iranians residing in Tehran. The final design of the DCE included 8 health insurance attributes. Data were analyzed using conditional logistic regression models.

RESULTS

The final model of this DCE study included 8 attributes, and the findings indicated statistically significant (P<.001) increase in the odds ratio (OR) of choosing health insurance at all levels of cost coverage except for the rehabilitation and para-clinical benefits, where at 70% cost coverage there was insignificant (P=.485) disutility (OR=0.95). With the increase in cost coverage level, the probability of choosing health insurance was significantly (P<.001) the highest for the private hospitals' benefits (OR=2.82) followed by public hospitals' benefits (OR=2.02) and outpatient benefits (OR=1.75), and the premium revealed statistically significant (P<.001) disutility (OR=0.96).

CONCLUSION

Our findings revealed that participants would be willing to choose health insurance plans with higher cost coverage of healthcare services and with lower premiums. However, the demographic characteristics, income, and health status of the insured individuals affected their health insurance preferences. The findings can contribute to the design of better health insurance policies, improve the participation of individuals in health insurance, and increase the insured individuals' utility from the insurance benefits packages.