Evaluation of a dental benefit plan for children conducted in Auvergne, France, since 1992

Caries management decision: influence of dentist and patient factors in the provision of dental services

OBJECTIVES

Little is known about how dentists implement caries management and provide restorative dental services in everyday practice. This study explored whether or not recent concepts in caries management were implemented in practice by private practitioners. The influence of patient and practitioner characteristics on the provision of restorative dental services was also investigated through multidimensional analyses.

METHODS

A sample of French general private dental practitioners was asked to record the characteristics of 35 preventive or restorative treatments made on vital permanent teeth. The data collection form was designed to explore dentists' attitudes towards caries management and their use of minimally invasive therapies.

RESULTS

Twenty-six practitioners recorded the characteristics of 921 treatments performed on 457 patients. Results indicate that participants rarely performed non-invasive treatments. They used an inappropriate detection tool, as most of decisions to treat were based on visual inspection frequently associated with probing. Multidimensional analysis showed that dentists provided different restorative treatments depending on patient characteristics, with minimally invasive, esthetic restorations preferentially performed for healthy, young and well-insured patients. Restorative treatments and detection tools also varied markedly among practitioners. These variations in service patterns were not related to a specific patient profile in each dental practice.

CONCLUSIONS

Results indicate that recent concepts in caries management have not yet been adopted in everyday practice. Patient and dentist characteristics influence the provision of restorative dental services. Decision-making in caries management not only depends on pathophysiology but also seems to be influenced by many other factors.

Dental status and oral health quality of life in economically disadvantaged French adults

Expansion of French health insurance coverage has increased funding for dental care for economically disadvantaged adults. This study aimed to measure clinical and self-perceived oral health, behaviors, and use of dental services by adults who were eligible for such coverage. The regional agency that gives administrative services for the health insurance funds provided a sample of 900 adults aged 35-44 years, insured through this program. We reached 805 of these adults by mail; of these 18% were surveyed and clinically examined. Self-perceived oral health was measured by the Global Oral Health Assessment Index (GOHAI) and participants' attitudes to dental health, by questionnaire. Decayed and Missing teeth constituted 40% of the DMFT. Participants reported poor oral health (63%), and 79% perceived a need for care, although they used dental services infrequently and had poor knowledge of available services. Cost of care and number of carious teeth were important predictors of the GOHAI.

[Utilization of preventive dental services by recent immigrants in Quebec]

OBJECTIVES

Studies conducted in Canada show that recent immigrants tend to under-utilize preventive services provided by the health care system. The objective of our study was to learn whether this phenomenon also applies to dental care.

METHODS

Our sample was composed of 5,795 women who live in Quebec and are between 30 and 44 years old. These women filled out a self-administered questionnaire regarding their immigration status and their habits concerning dental visits. In our analyses, we compared the use of dental services of recent immigrants (10 years or less in Canada), long-term immigrants (more than 10 years), and non-immigrants (Canadians of origin).

RESULTS

55% of recent immigrants are preventive service users compared to 69% of long-term immigrants and 76% of non-immigrants. The financial barrier partly explains this result: immigrants often have a modest income and rarely benefit from dental coverage. However, having private dental insurance does not in itself explain the gap between these groups. This suggests that there is a cultural barrier in dental services access.

CONCLUSIONS

Under-use of preventive services by immigrants is not limited to the medical field, it extends to dental services as well. In order to facilitate immigrants' adaptation to the health system, we recommend that the government provide them with free dental services that respect their culture.

Inégalités sociales dans le recours aux soins dentaires

BACKGROUND

Despite excellent general health indices, Quebec is in a difficult situation concerning oral health: tooth loss remains at a high level in adults and reveals important social inequalities. The objective of this research was to show that dental health inequalities reflect inequalities in the demand for dental care.

METHODS

For the Dental Health Survey of Quebec 1998-1999, 9930 parents of children aged 5 to 8 years were randomly selected across Quebec and received a questionnaire at their home on the demand for dental care. Among them, 8430 adults completed and sent back the questionnaire (responses rate: 85%). After excluding edentulous persons, the sample was reduced to 6585 parents aged 30 to 44 years.

RESULTS

The majority of respondents (76.4% of women and 72.8% of men) visit the dentist in a preventive manner rather than wait until dental problems occur. However, our study shows important disparities: the proportion of preventive attenders increases as income increases. A multiple logistic regression model suggests that there are financial as well as cultural barriers in dental care access.

CONCLUSION

The proportion of preventive attenders is high in Quebec and allows practitioners to adopt a preventive management of dental caries. Social disparities are high however, and are associated with financial as well as cultural barriers that need to be reduced.

[Oral health screening: evaluation of implementation of a national programme]

BACKGROUND

The first national French oral health screening was implemented in 1998 toward young people aged from 15 to 18 Years. These adolescents were invited every year to a free dental check up performed by their dentist. The aim of this study, carried out for self-employed persons insured by compulsory national health insurance, was to measure the rate of dental checks during years 1998-1999-2000, to estimate the oral health status, to assess the factors related to the dental care consumption in 1998, and the predictive factors for a successive dental check.

METHODS

We included seventy four French counties. Every teenager born in 1983 (23.874) was invited. We collected data from both the health insurance databases and the form filled in by the consulted dental surgeons. We selected four variables: gender, residence place, social, and occupational group to study the consumption in 1998.

RESULTS

In 1998, 10% (2462) of teenagers have got a dental check up (EXP1). Only 0,7% participated in the three screenings (1998-1999-2000). We noted a higher female consumption and disparities between the main categories of self-employed persons. Participation by boys was higher than girls. The lowest participation rates concerned the Ile of France area and adolescents living with single parents. In 1998 (EXP1), 57% of teenagers had at least one decayed tooth. Only 69% of them received appropriate curative dental treatments in the following six-Months period. However, among teenagers followed during the three years, higher rates of care reaching 90% were observed on the second and third EXP.

CONCLUSION

This small participation rate may be related to the recent implementation of screening. It should lead to optimize screening and to associate other partners in particular the state education system. It should also be helpful in focusing the oral health prevention policy toward the population with a high risk of decay.

Evaluation of a long-term oral health program by carers of children and adults with intellectual disabilities

The oral health program presented here was undertaken in three French centers for persons with special needs. The program aimed to educate the carers about dental disease, to motivate them with regard to prevention, and to improve the oral hygiene and oral health of the residents. This study evaluated the impact of the program in terms of change in attitudes and behavior expressed by the carers by means of a questionnaire. Following demonstration of oral hygiene techniques on an individual basis, the number of residents who had their teeth cleaned more than once a day rose from 24% to 52% (p < 0.05). The percentage of carers able to clean both posterior and anterior teeth of their key residents increased from 24% to 60% (p < 0.05), and the percentage finding tooth cleaning easy increased from 36% to 60% (non-significant). The intervention was thus deemed moderately successful, although the carers continued to take better care of their own oral health than that of the residents. The need for ongoing training is emphasized, both for the carers of those with special needs and for the dental profession. The lack of a validated means of measuring the impact of such interventions on care providers for this population is discussed.

Dental care access among individuals with Down syndrome in France

The aim of this study was to compare levels of dental care utilization, receipt of dental services, and oral hygiene habits between a sample of individuals with Down syndrome (DS) and their siblings. Data were collected by means of a recently validated, French-language, questionnaire measured of oral health and its related problems for individuals with DS. A cross-sectional survey was undertaken of parents of children with DS attending a national meeting for families and carers of individuals with DS in France. Older individuals with DS were significantly more likely to visit a dentist regularly than their older non-DS siblings, but the group with DS was significantly less likely to have received any dental treatment. The group with DS was significantly more likely to have difficulty finding both medical and dental services. Parents were nearly twice as likely to report problems finding dental services for their child with DS as they were medical services. In a multiple logistic regression analysis within the DS group, it was found that older age, regular speech therapy and ophthalmology consultations, and reports of no difficulty finding a dentist were independently associated with increased odds for regular dental consultations. Analysis of the findings suggests that the parents of children with DS in France frequently encounter problems of access to oral health care and that individuals with DS are less likely to receive dental services than are their non-DS siblings.