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Tuuliainen E, Nihtilä A, Komulainen K, Nykänen I, Hartikainen S, Tiihonen M, Suominen AL. Use of oral health care services among older home care clients in the context of an intervention study. Scand J Caring Sci 2024; 38:426-437. [PMID: 38389124 DOI: 10.1111/scs.13247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/10/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND An increasing number of care-dependent older people living at home need external support to receive regular dental care. OBJECTIVES To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition. MATERIALS AND METHODS This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up. RESULTS At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use. CONCLUSIONS In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.
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Affiliation(s)
| | - Annamari Nihtilä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Social and Health Services, Espoo, Finland
| | - Kaija Komulainen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Irma Nykänen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Miia Tiihonen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
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Chebib N, Holmes E, Maniewicz S, Abou-Ayash S, Srinivasan M, McKenna G, Kossioni A, Schimmel M, Müller F, Brocklehurst P. Exploring preferences of older adults for dental services: A pilot multi-national discrete choice experiment. Gerodontology 2024; 41:220-230. [PMID: 37309614 DOI: 10.1111/ger.12696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel. BACKGROUND The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge. MATERIALS AND METHODS Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model. RESULTS Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: β = 0.944, Switzerland: β = 0.260, UK β = 0.791), rather than a medical doctor (Greece: β = -0.556, Switzerland: β = -0.4690, UK: β = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: β = 0.220, UK: β = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (β = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (β = 0.365) in their home (β = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: β = -0.387; UK: β = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: β = 0.454, UK: β = 0.695). CONCLUSION Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.
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Affiliation(s)
- Najla Chebib
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, Bangor University, Bangor, UK
| | - Sabrina Maniewicz
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Samir Abou-Ayash
- Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Murali Srinivasan
- Clinic of General- Special care- and Geriatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Gerald McKenna
- Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Anastasia Kossioni
- Division of Gerodontology, Department of Prosthodontics, Dental School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, Bangor University, Bangor, UK
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Janssens B, Tsakos G, De Visschere L, Verté D, De Witte N. Frailty as a determinant of dental attendance among community-dwelling older adults. Gerodontology 2023; 40:363-371. [PMID: 36336964 DOI: 10.1111/ger.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/05/2022] [Accepted: 10/24/2022] [Indexed: 08/15/2023]
Abstract
OBJECTIVES The aim of this study was to assess the association between different levels of frailty and dental attendance among home-dwelling older adults, in Belgium. BACKGROUND While many determinants of dental attendance among older adults have been identified, no study has focused on the role of frailty. MATERIALS AND METHODS This was a cross-sectional study on a random sample of home-dwelling adults aged 60 and over from two Belgian cities. Data were collected with a structured questionnaire through a participatory peer-research method. Time since the last dental attendance was the dependent variable. The independent variable was frailty, assessed with the Comprehensive Frailty Assessment Instrument, including physical, psychological, social, and environmental subdomains. Covariates were age, gender, having a partner, educational level, and household income, as well as self-perceived oral health. Data analysis included descriptive, bivariate (Chi-Square, ANOVA, and Kruskal-Wallis), and binomial logistic regression analyses. RESULTS The sample consisted of 1329 older adults with a mean age of 72.5 years (SD 8.9, range 60-103). In the low frailty group, 73% attended the dentist in the previous 12 months, while it was 62% and 54% in the medium and high frailty groups, respectively. In the fully adjusted model, the initial gradient in the relationship between overall frailty and dental attendance remained; those in the medium and the high frailty groups were respectively 1.46 (95% CI: 1.09, 1.95) and 1.67 (95% CI: 1.15, 2.43) times more likely to report no dental attendance in the previous year than the low frailty group. Similar associations could be seen in the physical and environmental frailty subdomains. CONCLUSION Frailty is consistently associated with less favourable dental attendance, independent from age, gender, socioeconomic factors, family composition, and self-perceived oral health. Once frailty has been detected, good interprofessional communication and care are needed to avoid the drop-out of older adults from the oral healthcare system.
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Affiliation(s)
- Barbara Janssens
- Department of Oral Health Sciences, Gerodontology, ELOHA (Equal Lifelong Oral Health for All) research group, Ghent University, Gent, Belgium
| | - Georgios Tsakos
- UCL Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Luc De Visschere
- Department of Oral Health Sciences, Gerodontology, ELOHA (Equal Lifelong Oral Health for All) research group, Ghent University, Gent, Belgium
| | - Dominique Verté
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussel, Belgium
| | - Nico De Witte
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussel, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussels, Brussel, Belgium
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Ghanbari-Jahromi M, Bastani P, Jalali FS, Delavari S. Factors affecting oral and dental services` utilization among Elderly: a scoping review. BMC Oral Health 2023; 23:597. [PMID: 37635217 PMCID: PMC10464329 DOI: 10.1186/s12903-023-03285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Regular use of oral and dental services by the elderly is one of the important factors in reducing oral and dental diseases. This study aimed to identify the factors affecting oral and dental services` utilization among elderly. METHODS The published articles on the factors affecting oral and dental services` utilization among elderly were found through a scoping search and using related keywords in PubMed, Scopus, Embase, and Web of Science databases within January 2000 - December 2022 according to the PRISMA guidelines. The data were analyzed using the thematic analysis method. RESULTS Among the 2381 articles retrieved from the databases, forty-two were extracted. The factors affecting oral and dental services` utilization among elderly were classified into five main components as follows: access, demographic factors, social factors, health level, and mental factors. The results showed that income, education level, living area, number of teeth, and importance of care were the most frequent in the main components of access, demographic factors, social factors, health level, and mental factors, respectively. CONCLUSION Equitable utilization of oral and dental services is the right of all members of the society, especially the elderly. Therefore, it is necessary to provide the elderly with suitable conditions to utilize such services, which are mostly luxury items. Furthermore, increasing the elderly's awareness and encouraging them to use oral and dental services regularly can help reduce the burden of oral and dental diseases.
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Affiliation(s)
| | - Peivand Bastani
- College of Health and Human Sciences, Faculty of Health, Charles Darwin University, Darwin, Australia
| | - Faride Sadat Jalali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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de Oliveira Cunha R, Leite ICG. Factors associated with recent and regular non-use of dental services by students from a university in southeastern Brazil: a cross-sectional study. BMC Oral Health 2022; 22:612. [PMID: 36522707 PMCID: PMC9753854 DOI: 10.1186/s12903-022-02648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lack of use of dental services can be a risk factor for oral health. In addition to recent visits to dental services, it is important to assess the regularity of use of these services, as well as the motivations for visiting the dentist. There is a gap in literature studies on the patterns of use of oral health services by the young university students. The goal of this study was to assess the factors associated with recent and regular non-use of dental services by young university students, using the Andersen model as a reference. METHODS This was a cross-sectional study with 477 university students between 18 and 24 years old, carried out as a web survey, through which predisposing, enabling and need variables were collected, according to the model proposed by Andersen, to test the factors associated with recent and regular non-use of dental services. Bivariate analyses and robust Poisson regression were performed, with estimation of crude and adjusted prevalence ratios, using confidence intervals of 95%. The variables with p < 0.05 remained in the final model. RESULTS The prevalence of recent non-use was of 19.5% (95% CI 16.0-23.3%), and of regular non-use, of 53.5% (95% CI 48.9-58.0%). After the adjusted analysis, the following were found to be associated with the outcome of recent non-use: type of service used (PR = 0.91; 95% CI 0.85-0.98) and perceived need for dental treatment (PR = 0.98; 95% CI 0.97-0.99); and the following variables were associated with regular non-use: father's level of education (PR = 0.86; 95% CI 0.78-0.96), area of study (PR = 1.08; 95% CI 1.02-1.15), reason for last dental appointment (PR = 0.81; 95% CI 0.75-0.88), use of dental services throughout childhood (PR = 0.92; 95% CI 0.86-0.97), self-perceived oral health (PR = 0.86; 95% CI 0.76-0.88), and toothaches over the last 2 years (PR = 0.93; 95% CI 0.87-0.99). CONCLUSION The motivation for young university students to use dental services are curative treatment needs, not prevention. The results point to the need to implement health prevention and promotion policies in higher education institutions and to expand access to dental services for this young population.
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Affiliation(s)
- Rafaela de Oliveira Cunha
- grid.411198.40000 0001 2170 9332Postgraduate Program in Public Health, Federal University of Juiz de Fora, José Lourenço Kelmer, São Pedro, Juiz de Fora, Minas Gerais Brazil
| | - Isabel Cristina Gonçalves Leite
- grid.411198.40000 0001 2170 9332Postgraduate Program in Public Health, Federal University of Juiz de Fora, José Lourenço Kelmer, São Pedro, Juiz de Fora, Minas Gerais Brazil ,grid.411198.40000 0001 2170 9332School of Medicine, Federal University of Juiz de Fora, Eugênio do Nascimento, Dom Bosco, Juiz de Fora, Minas Gerais Brazil
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Kazemi-Karyani A, Yahyavi Dizaj J, Khoramrooz M, Soltani S, Soofi M, Irandoust K, Ramezani-Doroh V. Socio-economic inequality in reported dental self-care behavior among Iranian households: a national pooled study. Int J Dent Hyg 2022; 20:689-699. [PMID: 35080140 DOI: 10.1111/idh.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/27/2021] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Setting out effective prevention strategies in dental diseases needs recognition related factors of the prevention behaviors and targeting the most disadvantaged groups in the term of dental hygiene. This study aimed to investigate socio-economic inequality in the dental self-care status (DSS) of Iranian households and decompose the measured inequality into its contributors. METHOD In this cross-sectional study pooled data was extracted from Households Income and Expenditure Surveys (HIESs) conducted in Iran from 2012 to 2017. The index of socioeconomic status (SES) for each household was constructed using principal components analysis (PCA). We used Wagstaff normalized concentration index as a measure of socioeconomic inequality in dental self-care. Decomposition analysis was applied to determine the main factors contributed to the measured inequality. RESULTS The prevalence of dental self-care in the whole population was 40.56%. The total concentration index was 0.271 (CI: 0.266, 0.275). The results of decomposition analysis for the measured inequality showed that SES, was the highest positive contributors (90.19 %) followed by sex of household's head (12.15 %), place of residence (11.79 %), and education level of household's head (11.71 %). Furthermore, the province of residence had the highest negative contribution (-11.37) to the inequality. CONCLUSION The findings of this study showed that a huge portion of the observed inequality was explained by SES that might give us a policy recommendation: There is room for improving dental health and reducing inequality in dental self-care by paying more attention to SES-disadvantaged households.
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Affiliation(s)
- Ali Kazemi-Karyani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jafar Yahyavi Dizaj
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khoramrooz
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Irandoust
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajihe Ramezani-Doroh
- Department of Health Management and Economics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Provision of Oral Health Care by Dentists to Community-Dwelling Older Patients. Int Dent J 2021; 72:169-178. [PMID: 34281699 PMCID: PMC9275299 DOI: 10.1016/j.identj.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/18/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Research into oral health care for older people has shown that dental care in general decreases with increasing age and frailty and, therefore, oral health care provision may be complex. The aim of this study is to identify the oral health care dentists provide to community-dwelling older people and which barriers they experience in doing this. METHODS In this cross-sectional study, a representative sample of dentists in the Netherlands was asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to fill out a questionnaire. The relationship between experienced barriers in providing oral health care to older patients and characteristics of the dentists and the patients was studied by means univariate and multivariate logistic regression analysis. RESULTS In total, 923 dentists were asked to participate in the study. Data were available for 39.4% dentist-patient pairs. In most cases (87.4%), oral health care was focussed on conservation of the dentition. In all, 14.0% of the dentists experienced barriers in providing oral health care for older people. Some patient factors increase the risk of experiencing barriers, eg, the more difficult behaviour of older patients and the greater disease burden. CONCLUSIONS Oral health care was mostly focussed on conservation of the dentition, and dentists especially experience barriers in oral health provision to older patients if they are already frail.
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Bots-VantSpijker PC, van der Maarel-Wierink CD, Schols JMGA, Bruers JJM. Oral Health of Older Patients in Dental Practice: An Exploratory Study. Int Dent J 2021; 72:186-193. [PMID: 34238570 PMCID: PMC9275187 DOI: 10.1016/j.identj.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Some older people stop visiting the dentist when they get older. This study aims to identify the characteristics and oral health status of older people who do visit community dental practices. METHODS In this exploratory cross-sectional study, the oral health of Dutch community-dwelling older people was assessed. A random sample of general dental practitioners and older people who visit the dental practice was drawn. The dentists were asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to complete a questionnaire. Data were described for 3 distinct groups of older people. Statistical measures for distribution and dispersion were used to describe the oral health of community-dwelling older patients in relation to the age. RESULTS A total of 373 (40.4%) dentist registration forms and 372 (40.3%) patient questionnaires were returned. Data were available for 364 (39.4%) dentist-patient couples. Amongst the patients, 52.8% were female and most had a high socioeconomic status. About 65.7% had one or more problems related to general health, and 75.2% used medication. Regarding the overall oral health status, the average number of teeth was 20, 3.5% were edentulous. Oral health problems were more common in the older patient group (aged 75+), in whom frailty was also most common. CONCLUSIONS Older people who visit community dental practices are still relatively healthy, non-frail, and highly educated. Even in this group, there is a turning point in both general and oral health from the age of 75.
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Affiliation(s)
- Pieternella C Bots-VantSpijker
- Flemish-Netherlands Geriatric Oral Research Group (BENECOMO), Dutch Association for Gerodontology (NVGd), Bunnik, The Netherlands; Department Oral Public Health (OPH), Acadamic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
| | - Claar D van der Maarel-Wierink
- Flemish-Netherlands Geriatric Oral Research Group (BENECOMO), Dutch Association for Gerodontology (NVGd), Bunnik, The Netherlands; Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Jos M G A Schols
- Flemish-Netherlands Geriatric Oral Research Group (BENECOMO), Dutch Association for Gerodontology (NVGd), Bunnik, The Netherlands; Caphri/Department Oral Public Health (OPH) and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Josef J M Bruers
- Flemish-Netherlands Geriatric Oral Research Group (BENECOMO), Dutch Association for Gerodontology (NVGd), Bunnik, The Netherlands; Department Oral Public Health (OPH), Acadamic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands; Royal Dutch Dental Association (KNMT), Utrecht, The Netherlands
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Wu YY, Zhang W, Wu B. Disparities in Dental Service Use among Adult Populations in the United States. JDR Clin Trans Res 2021; 7:182-188. [PMID: 33938303 DOI: 10.1177/23800844211012660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This article aims to examine the disparities in dental service utilization among 3 age groups: younger adults (20-49 y), middle-aged adults (50-64 y), and older adults (65+ y), among Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives (AIAN), and Native Hawaiian or other Pacific Islanders (NHOPI). METHODS Weighted logistic regression models were conducted to analyze 9 waves of cross-sectional survey data (2002-2018) from the Behavioral Risk Factor Surveillance System. We estimated age group- and race/ethnic-specific prevalences of dental service utilization adjusting sociodemographics and self-rated health for each wave and compared with crude analysis. Next, we performed linear regression analysis of the trend of adjusted prevalences over time and the average level by race/ethnicity and age groups. RESULTS Racial/ethnic disparities increased with age, even though the adjusted prevalences of dental service utilization were less apparent than the crude analysis. The all-wave average prevalence was 71%. Black older adults had the lowest level of dental service utilization (65%) as compared with the 2 highest groups: White older adults (79%) and Asian older adults (76%). The general younger adult populations had low prevalences, with the lowest among Asian younger adults (65%). AIAN and NHOPI individuals from all age groups tended to have average or below average prevalences. In addition, a decreasing trend of dental service utilization was observed among White individuals of all age groups (0.2%-0.3% lower per year, P < 0.01) and AIAN younger adults (0.5% lower per year, P < 0.01). CONCLUSION Health policy, federal funding, and community-based programs should address the needs of dental service utilization for racial/ethnic minorities including Blacks, AIANs, and NHOPIs. KNOWLEDGE TRANSFER STATEMENT Our study offers insights into our understanding of disparities in dental service utilization among minority racial/ethnic groups. As health policy, federal funding, and community-based programs seek to improve oral health, there is a need to address access to and utilization of dental service for Blacks, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders.
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Affiliation(s)
- Y Y Wu
- Thompson School of Social Work & Public Health, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - W Zhang
- Department of Sociology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - B Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Åstrøm AN, Lie SA, Mastrovito B, Sannevik J. Avoidance of dental appointment due to cost and consequences for oral health-related quality of life: 25-yr follow-up of Swedish adults. Eur J Oral Sci 2021; 129:e12778. [PMID: 33667033 DOI: 10.1111/eos.12778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Abstract
We explored how socio-demographic and personal characteristics contribute to avoidance of dental appointment due to cost over time from age 55 (in 1997) to 75 (in 2017) and assessed the implications for oral health-related quality of life. In 1992, 6346 residents born in 1942 consented to participate in a prospective questionnaire survey, and 3060 (48.2%) of them completed postal follow-ups every fifth year until 2017. Oral health-related quality of life was assessed using the Oral Impact on Daily Performance inventory. The frequency of avoidance of dental appointment due to cost declined from 7.0% (in 1997) to 5.4% (in 2017), whereas the frequency of oral impacts declined from 26.0% in 2007 to 24.0% in 2017. Generalized Estimating Equation models revealed that avoidance of dental appointments due to cost was more likely reported in 1997 (OR: 1.5: 1.2-1.8) than in 2017, more likely in low educated people, and less likely in those using private dental care services. Avoidance of dental appointment due to cost was associated with impaired oral health-related quality of life. Social inequalities in avoidance of dental appointment due to cost and oral impacts did not vary across time but persisted into older ages despite the dental health care reforms that had been implemented.
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Affiliation(s)
- Anne Nordrehaug Åstrøm
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
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Factors Associated with Dental Service Use Based on the Andersen Model: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052491. [PMID: 33802430 PMCID: PMC7967618 DOI: 10.3390/ijerph18052491] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 02/07/2023]
Abstract
Background: A systematic review synthesizing studies examining the determinants of dental service use drawing on the (extended) Andersen model is lacking. Hence, our purpose was to fill this knowledge gap; Methods: Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies focusing on the determinants of dental service use drawing on the Andersen model were included; Results: In sum, 41 studies have been included (ten studies investigating children/adolescents and 31 studies investigating adults). Among children, particularly higher age (predisposing characteristic), higher income (enabling resource) and more oral health problems (need factor) were associated with increased dental service use. Among adults, findings are, in general, less consistent. However, it should be noted that one half of the studies found an association between increased education (predisposing characteristic) and increased dental service. In general, study quality was rather high. However, it should be noted that most studies did not report how they dealt with missing data; Conclusions: Our systematic review revealed that all components (i.e., predisposing characteristics, enabling resources and need factors) of the Andersen model tend to be associated with dental service use among children, whereas the findings are more mixed among adults. In conclusion, beyond need factors, dental service use also tend to be driven by other factors. This may indicate over—or, more likely—underuse of dental services and could enrich the inequality discussion in dental services research.
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Singh KA, Brennan DS. Use of dental services among middle-aged adults: predisposing, enabling and need variables. Aust Dent J 2021; 66:270-277. [PMID: 33521979 DOI: 10.1111/adj.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine if making a visit, number of visits and services varied by predisposing (gender, perceived health competence, education, previous relief of pain visit), enabling (dental anxiety, income, social support) and need (perceived need, number of teeth and oral pain) characteristics. METHODS Dental visiting and services data from a sample of middle-aged South Australian adults were collected from 61% of participants at 12-months (n = 603) and 59% after 24-months (n = 583). Visiting over 2-years, mean visits and mean services were analysed by log binomial and Poison regression using the Andersen and Newman model. RESULTS The percentage having a dental visit over 2-years was lower for males than females, prevalence ratio (PR, 95% CI) 0.91 (0.84, 0.99), and for higher than lower dental anxiety, PR = 0.78 (0.62, 0.98). Number of visits was associated with higher than lower income, rate ratio (RR, 95%CI) 1.20 (1.02, 1.41) but lower for those with higher social support, RR = 0.86 (0.74, 0.99). Services were lower for those with higher perceived health competence, RR = 0.72 (0.56, 0.92) but higher for those with perceived needs, RR = 1.22 (1.01, 1.46). CONCLUSIONS While need and cost factors predict dental service use, psychosocial variables such as health competence and social support also need to be considered.
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Affiliation(s)
- K A Singh
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - D S Brennan
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Soares GH, Ortiz-Rosa E, Alves CP, Paz D, An KS, Pereira AC, Biazevic MGH, Frias AC, Michel-Crosato E. Factors associated with utilisation of dental services by the elders from São Paulo, Brazil. Gerodontology 2020; 38:216-227. [PMID: 33354806 DOI: 10.1111/ger.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Population ageing in Brazil is rapid and is likely to place additional pressure over the Brazilian public health system. OBJECTIVE This study aims to examine the factors associated with utilisation of dental services in the previous year among a representative sample of older adults from São Paulo, Brazil. METHODS The sample included 5951 older adults who participated in the SBSP-15 study, an epidemiological survey conducted in 2015 in the State of São Paulo, Brazil. The outcome "utilisation of dental services" was defined as having visited a dentist in the previous year. Chi-square tests were employed in the bivariate analyses and Poisson regressions with robust variance in the multilevel analysis. RESULTS Only 30.5% of the participants had their last dental appointment within the previous year. Number of teeth and dental pain presented the strongest effects on the investigated outcome. Education, income, age, ethnicity, living alone, higher Family Health Strategy coverage and the Metropolitan area were associated with having visited a dentist in the previous year. Older adults who rated their oral health as positive did not report treatment need nor prosthodontic need, presented negative oral health-related quality of life, had their last dental appointment in the public health system and sought treatment due to pain or extraction also were more likely to report the utilisation of dental services in the previous year. CONCLUSION Regional, sociodemographic and subjective factors are associated with utilisation of dental services in the previous year among the elders from the State of São Paulo, Brazil.
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Affiliation(s)
- Gustavo Hermes Soares
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Ezequiel Ortiz-Rosa
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Caroline Paula Alves
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | | | - Ki Sung An
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Pereira
- Community Dentistry Department, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Maria Gabriela Haye Biazevic
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Antônio Carlos Frias
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Edgard Michel-Crosato
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
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14
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Torppa-Saarinen E, Tolvanen M, Lahti S, Suominen AL. Changes and determinants of unmet oral health treatment need. Community Dent Oral Epidemiol 2020; 49:158-165. [PMID: 33104256 DOI: 10.1111/cdoe.12587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 09/19/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our aim was to describe the nature and determinants of the changes in unmet treatment need between the years 2000 and 2011 after a major oral healthcare reform and a wider supply of subsidized care. METHODS The study used a longitudinal sample (n = 3838) of adults who had participated in both the Health 2000 and 2011 surveys (BRIF 8901). Those reporting self-assessed treatment need without having visited a dentist in the previous 12 months were categorized as having unmet treatment need. Two logistic regression models were applied to determine the effects of predisposing and enabling factors on change in unmet treatment need. Model 1 was conducted among those who reported unmet treatment need in 2000 and evaluated the determinants for improvement. Model 2 was conducted among those who did not have unmet treatment need in 2000 to evaluate the risk factors for having unmet treatment need by 2011. RESULTS Unmet treatment need was reported by 25% of the participants in 2000 and by 20% in 2011. Those with unmet treatment need in 2000 were less likely to report improvement by 2011 if they had poor subjective oral health, basic or intermediate education level, or poor perceived economic situation in 2000. Those who did not have unmet treatment need in 2000 were more likely to have it in 2011 if they were males or from northern Finland and less likely to if they came from central Finland or were older. CONCLUSIONS The wider supply of subsidized oral health care during the study years did not lead to complete elimination of treatment need. The determinants of unmet treatment need, such as low or intermediate education level and perceived economic difficulties, should be used in targeting the services at those with treatment need to achieve better oral health outcomes.
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Affiliation(s)
| | - Mimmi Tolvanen
- Institute of Dentistry, University of Turku, Turku, Finland.,Institute of Medicine, Center for Life Course Health Research, University of Oulu, Turku, Finland
| | - Satu Lahti
- Department of Community Dentistry, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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15
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Al-Nasser L, Lamster IB. Prevention and management of periodontal diseases and dental caries in the older adults. Periodontol 2000 2020; 84:69-83. [PMID: 32844424 DOI: 10.1111/prd.12338] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As a result of aging populations, in the future, dental practitioners will be caring for more older adults than ever before. These older adults, especially in developed countries, will demand a greater number of dental services, driven by increased tooth retention and an expectation of excellent oral healthcare throughout the life course. Further, the global rise in the prevalence and incidence of chronic diseases will increase the risk and/or severity of oral diseases and add a layer of complexity to the management of oral diseases in older adults. More older adults will be at a higher risk of periodontal disease and root caries as a result of reduced tooth loss and edentulism. This article reviews information on periodontitis and root caries, oral diseases which reflect the cumulative risk of the individual, and which are best addressed through prevention. Oral healthcare providers must embrace the concept of lifelong emphasis on prevention, as well as participation as active members of a healthcare team which provides healthcare for older adults in various settings (eg, hospital/clinic-based care, community-based settings, and long-term care facilities). National guidelines that address oral health are being considered by some countries, and if these are implemented they will increase the accessibility to oral health for older adults. In parallel to this, revisions of existing older adult insurance schemes (eg, the inclusion of routine oral healthcare in the US Medicare program) would promote the maintenance of a functional dentition that is pain-free and conducive to general health. The opportunity exists to implement a holistic approach to oral health that will align oral health with general health and emphasize that true health can only be achieved with the inclusion of oral health.
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Affiliation(s)
- Lubna Al-Nasser
- Mailman School of Public Health, Columbia University, New York City, New York, USA.,Population Health Research Section, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ira B Lamster
- School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA.,College of Dental Medicine, Columbia University, New York City, New York, USA
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Schroeder FMM, Mendoza-Sassi RA, Meucci RD. Condição de saúde bucal e utilização de serviços odontológicos entre idosos em área rural no sul do Brasil. CIENCIA & SAUDE COLETIVA 2020; 25:2093-2102. [DOI: 10.1590/1413-81232020256.25422018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo Este artigo objetiva avaliar a saúde bucal, a utilização de serviços odontológicos e os fatores associados entre indivíduos com 60 anos, ou mais, residentes em área rural. Estudo transversal, de base populacional, realizado na zona rural de um município de porte médio do extremo sul do Brasil. O desfecho foi ter utilizado serviços odontológicos nos 12 meses anteriores à data da entrevista. A análise abrangeu descrição da amostra, prevalência da utilização de serviços odontológicos para cada categoria das variáveis independentes e análise multivariada através da Regressão de Poisson. Foram entrevistados 1.030 idosos, sendo 49,9% edêntulos totais e tendo 13,9% consultado com dentista no último ano. A probabilidade de consultar foi maior em idosos do sexo feminino, com companheiros(as), com maior escolaridade, pertencentes aos melhores níveis econômicos e que referiram ter algum problema de saúde bucal. Por sua vez, idosos que relataram ser ex-fumantes ou fumantes consultaram menos. Planejamentos em saúde devem ser reorganizados com o intuito de priorizar grupos populacionais com maiores dificuldades na utilização dos serviços odontológicos.
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Fujii K, Kosaka T, Hasegawa Y, Kida M, Hashimoto S, Fushida S, Nokubi T, Kokubo Y, Watanabe M, Higashiyama A, Miyamoto Y, Ikebe K, Ono T. Periodical utilization of dental services is an effective breakthrough for declining masticatory performance: the Suita study. Odontology 2020; 108:715-722. [DOI: 10.1007/s10266-020-00501-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
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Zhang W, Wu YY, Wu B. Racial/Ethnic Disparities in Dental Service Utilization for Foreign-Born and U.S.-Born Middle-Aged and Older Adults. Res Aging 2019; 41:845-867. [PMID: 31272288 DOI: 10.1177/0164027519860268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study examines racial/ethnic disparities of dental service utilization for foreign-born and U.S.-born dentate residents aged 50 years and older. Generalized linear mixed-effects models (GLMM) were used to perform longitudinal analyses of five-wave data of dental service utilization from the Health and Retirement Study (HRS). We used stratified analyses for the foreign-born and U.S.-born and assessed the nonlinear trend in rates of dental service utilization for different racial/ethnic groups. Findings indicate that Whites had higher rates of service utilization than Blacks and Hispanics regardless of birthplace. For all groups, the rates of service utilization decreased around age 80, and the rates of decline for Whites were slower than others. The U.S.-born showed the trend of higher rates of service utilization than the foreign-born for all racial/ethnic groups. These findings suggest the importance of developing culturally competent programs to meet the dental needs of the increasingly diverse populations in the United States.
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Affiliation(s)
- Wei Zhang
- 1 Department of Sociology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Yan Yan Wu
- 2 Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Bei Wu
- 3 Rory Meyers College of Nursing, New York University, New York, NY, USA
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19
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Souza JGS, Sampaio AA, Costa Oliveira BE, Jones KM, Martins AMEDBL. Socioeconomic inequalities in the use of dental care services during early childhood: an epidemiological survey. Int J Paediatr Dent 2018; 28:400-409. [PMID: 29726042 DOI: 10.1111/ipd.12368] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of dental care services contributes to the improvement of children's healthy behaviors, reducing the prevalence of future dental problems. In this way, the purpose of this study was to describe the use of dental care service during early childhood and the possible socioeconomic inequalities in this use. DESIGN Data from the Brazilian Oral Health Survey (SB Brasil, 2010) were used. Interviews with the children's parents and clinical examinations with the children were conducted in a 5-year-old representative sample. Descriptive, bivariate and multiple hierarchical statistical analyses were applied. RESULTS Of the 7241 children included, 3812 (53.2%) had used dental care services at least once in their lifetimes, and 1872 (48.8%) had used services for check-up/prevention. The use of dental services was greater among children with a higher family income (P < 0.05). The use of check-ups was lower among children with non-White skin color (Black and Browns) and among those who did not live in state capitals (P < 0.05). Clinical conditions and self-perception were also associated with the use (P < 0.05). CONCLUSION Socioeconomic differences in the general use of dental care and in its use for check-ups were identified during early childhood, indicating the presence of inequalities.
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Affiliation(s)
- João Gabriel Silva Souza
- Department of Periodontology and Prosthodontics, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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20
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Herkrath FJ, Vettore MV, Werneck GL. Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis. PLoS One 2018; 13:e0192771. [PMID: 29420660 PMCID: PMC5805334 DOI: 10.1371/journal.pone.0192771] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.
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Affiliation(s)
- Fernando José Herkrath
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- * E-mail:
| | - Mario Vianna Vettore
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Guilherme Loureiro Werneck
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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21
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Åstrøm AN, Ekbäck G, Ordell S, Lie SA, Gulcan F. Dental hygienist attendance and its covariates in an ageing Swedish cohort. Eur J Oral Sci 2017; 125:487-494. [PMID: 29083073 DOI: 10.1111/eos.12385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Delegation of tasks between professional groups is important to make health-care services accessible and effective for ageing people. Focussing on a Swedish 1942 birth cohort and guided by Andersen's Behavioral Model, this study assessed dental hygienist attendance from age 50 to age 70 and identified covariates at the population-averaged and person-specific levels. In 1992, a census of 50-yr-old subjects was invited to participate in a questionnaire survey. Of the 6,346 respondents, 3,585 completed follow-ups in 1997, 2002, 2007, and 2012. Multiple logistic regression analysis was conducted using a marginal model and a random intercept model. Cochran's Q test revealed that significantly more respondents confirmed dental hygienist attendance in 2012 than in 1992 (57.2% in 2012 vs. 26.0% in 1992). Population-averaged ORs for dental hygienist attendance across time were 3.5 at age 70 yr compared with age 50 yr (baseline); 2.0 if being a regular rather than an irregular dental attendee; and 0.7 if being of non-native origin compared with native origin. The corresponding person-specific ORs were 8.9, 3.2, and 0.5. Consistent with Andersen's Behavioral Model, predisposing, enabling, and need-related factors were associated with dental hygienist attendance at population-averaged and person-specific levels. This has implications for promoting dental hygienist attendance among ageing people.
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Affiliation(s)
- Anne N Åstrøm
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Gunnar Ekbäck
- Örebro County Council, Örebro, Sweden.,School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Sven Ordell
- Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden
| | - Stein A Lie
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Ferda Gulcan
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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22
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Hakeberg M, Wide Boman U. Dental care attendance and refrainment from dental care among adults. Acta Odontol Scand 2017; 75:366-371. [PMID: 28420315 DOI: 10.1080/00016357.2017.1317105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to analyse dental care utilization, refrainment from self-perceived needed dental care and the association with socioeconomic indicators among adult individuals. MATERIALS AND METHODS This cross-sectional survey included 3500 randomly selected adult individuals. Telephone interviews were conducted and the participants answered a battery of questions regarding dental visiting habits, health, socioeconomic position (SEP), behavioural factors and lifestyle indicators. RESULTS The outcome 'dental visits' was significantly correlated with SEP, especially with monetary dimensions, such as income and economic resources for unforeseen expenditures. However, educational level was not a significant predictor in the tested statistical models. Furthermore, other covariates that contributed significantly to the models were ethnicity, dental anxiety and lifestyle factors, albeit with a different pattern of impact on the two outcome dimensions. Important features of the SEP variables were the stepwise gradient relative to the outcomes, implicating that the lower the SEP status, the greater the risk of reporting irregular dental visiting habits and refraining from dental care due to financial problems. CONCLUSIONS Dental care utilization and refraining from dental care for financial reasons clearly reveal associations with socioeconomic positions among adult individuals.
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Affiliation(s)
- Magnus Hakeberg
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulla Wide Boman
- Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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23
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Niesten D, Witter DJ, Bronkhorst EM, Creugers NH. Oral health care behavior and frailty-related factors in a care-dependent older population. J Dent 2017; 61:39-47. [DOI: 10.1016/j.jdent.2017.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/31/2017] [Accepted: 04/01/2017] [Indexed: 11/29/2022] Open
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Gaewkhiew P, Bernabé E, Gallagher JE, Klass C, Delgado-Angulo EK. Oral impacts on quality of life and problem-oriented attendance among South East London adults. Health Qual Life Outcomes 2017; 15:82. [PMID: 28446237 PMCID: PMC5405499 DOI: 10.1186/s12955-017-0663-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental care seeking behaviour is often driven by symptoms. The value of oral health related quality of life (OHRQoL) measures to predict utilisation of dental services is unknown. This study aims to explore the association between OHRQoL and problem-oriented dental attendance among adults. METHODS We analysed cross-sectional data for 705 adults, aged 16 years and above, living in three boroughs of Inner South East London. Data were collected during structured interviews at home. The short form of the Oral Health Impact Profile (OHIP-14) was used to assess the frequency of oral impacts on daily life in the last year. Problem-oriented attendance was defined based on time elapsed since last visit (last 6 months) and reason for that visit (trouble with teeth). The association between OHIP-14 (total and domain) scores and problem-oriented attendance was tested in logistic regression models adjusting for participants' sociodemographic characteristics. RESULTS Problem-oriented attenders had a higher OHIP-14 total score than regular attenders (6.73 and 3.73, respectively). In regression models, there was a positive association between OHIP-14 total score and problem-oriented attendance. The odds of visiting the dentist for trouble with teeth were 1.07 greater (95% Confidence Interval: 1.04-1.10) per unit increase in the OHIP-14 total score, after adjustment for participants' sociodemographic characteristics. In subsequent analysis by OHIP-14 domains, greater scores in all domains but handicap were significantly associated with problem-oriented attendance. CONCLUSION This study shows that oral impacts on quality of life are associated with recent problem-oriented dental attendance among London adults. Six of the seven domains in the OHIP-14 questionnaire were also associated with dental visits for trouble with teeth.
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Affiliation(s)
- Piyada Gaewkhiew
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Eduardo Bernabé
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK.
| | - Jennifer E Gallagher
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
| | - Charlotte Klass
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
- Public Health England - London Region, London, UK
| | - Elsa K Delgado-Angulo
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
- Departamento Académico de Odontología Social, Universidad Peruana Cayetano Heredia, Lima, Peru
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25
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Khabra KK, Compton SM, Keenan LP. Independent older adults perspectives on oral health. Int J Dent Hyg 2016; 15:295-305. [PMID: 27862993 DOI: 10.1111/idh.12259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to explore oral health experiences from the perspective of older adults' living in community dwellings. The two objectives of this study were to identify facilitators and barriers to oral health care, and to determine how utilization of oral health services compares to utilization of other healthcare services. METHODOLOGY An interpretive descriptive methodology was employed with a purposive sample of 12 adults, aged 70 years or older. The inclusion criterion was English-speaking seniors residing in community dwellings. Community dwellings were defined as any housing outside of long-term care or other supportive living facilities. Semi-structured interviews were 30-80 min, audio-recorded and transcribed verbatim. Three researchers participated in the comparative analysis process to develop codes, generate categories, interpret patterns and construct themes. RESULTS Three central themes surfacing from the data were as follows: life course influences on oral health, transparency in delivery of oral health services and interrelationships between oral health and overall health. CONCLUSIONS Older adults in this study emphasized the value of establishing collaborative and trusting relationships between oral health practitioners and older adults. Oral health practitioners should be clear and transparent when communicating information about oral health costs and be cognizant of different circumstances from childhood to older adulthood that inhibit or promote routine utilization of oral health services. Including oral health services as part of interdisciplinary care teams could help promote understandings of the reciprocal relationship between oral health and general health and improve oral health status for older adults.
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Affiliation(s)
- K K Khabra
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - S M Compton
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - L P Keenan
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Gülcan F, Ekbäck G, Ordell S, Lie SA, Åstrøm AN. Social predictors of less frequent dental attendance over time among older people: population-averaged and person-specific estimates. Community Dent Oral Epidemiol 2016; 44:263-73. [DOI: 10.1111/cdoe.12214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/08/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ferda Gülcan
- Department of Clinical Dentistry; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
| | - Gunnar Ekbäck
- Örebro County Council; Örebro Sweden
- School of Health and Medical Sciences; Örebro University; Örebro Sweden
| | - Sven Ordell
- Dental Commissioning Unit; Östergötland County Council; Linköping University; Linköping Sweden
| | - Stein Atle Lie
- Department of Clinical Dentistry; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
| | - Anne Nordrehaug Åstrøm
- Department of Clinical Dentistry; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
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Kikui M, Ono T, Kida M, Kosaka T, Yamamoto M, Yoshimuta Y, Yasui S, Nokubi T, Maeda Y, Kokubo Y, Watanabe M, Miyamoto Y. Does the utilization of dental services associate with masticatory performance in a Japanese urban population?: the Suita study. Clin Exp Dent Res 2015; 1:57-62. [PMID: 29744141 PMCID: PMC5839175 DOI: 10.1002/cre2.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 12/03/2022] Open
Abstract
There are numerous reports on the relationship between regular utilization of dental care services and oral health, but most are based on questionnaires and subjective evaluation. Few have objectively evaluated masticatory performance and its relationship to utilization of dental care services. The purpose of this study was to identify the effect of regular utilization of dental services on masticatory performance. The subjects consisted of 1804 general residents of Suita City, Osaka Prefecture (760 men and 1044 women, mean age 66.5 ± 7.9 years). Regular utilization of dental services and oral hygiene habits (frequency of toothbrushing and use of interdental aids) was surveyed, and periodontal status, occlusal support, and masticatory performance were measured. Masticatory performance was evaluated by a chewing test using gummy jelly. The correlation between age, sex, regular dental utilization, oral hygiene habits, periodontal status or occlusal support, and masticatory performance was analyzed using Spearman's correlation test and t-test. In addition, multiple linear regression analysis was carried out to investigate the relationship of regular dental utilization with masticatory performance after controlling for other factors. Masticatory performance was significantly correlated to age when using Spearman's correlation test, and to regular dental utilization, periodontal status, or occlusal support with t-test. Multiple linear regression analysis showed that regular utilization of dental services was significantly related to masticatory performance even after adjusting for age, sex, oral hygiene habits, periodontal status, and occlusal support (standardized partial regression coefficient β = 0.055). These findings suggested that the regular utilization of dental care services is an important factor influencing masticatory performance in a Japanese urban population.
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Affiliation(s)
- Miki Kikui
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry1‐8 Yamada‐OkaSuitaOsaka565‐0871Japan
| | - Takahiro Ono
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry1‐8 Yamada‐OkaSuitaOsaka565‐0871Japan
- Division of Comprehensive ProsthodonticsNiigata University Graduate School of Medical and Dental Sciences8050, Ikarashi 2‐no‐choNiigata950‐2181Japan
| | - Momoyo Kida
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry1‐8 Yamada‐OkaSuitaOsaka565‐0871Japan
| | - Takayuki Kosaka
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry1‐8 Yamada‐OkaSuitaOsaka565‐0871Japan
| | - Masaaki Yamamoto
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry1‐8 Yamada‐OkaSuitaOsaka565‐0871Japan
| | - Yoko Yoshimuta
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry1‐8 Yamada‐OkaSuitaOsaka565‐0871Japan
| | - Sakae Yasui
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry1‐8 Yamada‐OkaSuitaOsaka565‐0871Japan
| | | | - Yoshinobu Maeda
- Department of Prosthodontics, Gerodontology and Oral RehabilitationOsaka University Graduate School of Dentistry1‐8 Yamada‐OkaSuitaOsaka565‐0871Japan
| | - Yoshihiro Kokubo
- Department of Preventive CardiologyNational Cerebral and Cardiovascular Center5‐7‐1, Fujishiro‐daiSuitaOsaka565‐8565Japan
| | - Makoto Watanabe
- Department of Preventive CardiologyNational Cerebral and Cardiovascular Center5‐7‐1, Fujishiro‐daiSuitaOsaka565‐8565Japan
| | - Yoshihiro Miyamoto
- Department of Preventive CardiologyNational Cerebral and Cardiovascular Center5‐7‐1, Fujishiro‐daiSuitaOsaka565‐8565Japan
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Manski R, Moeller J, Chen H, Widström E, Listl S. Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA. Int Dent J 2015; 66:36-48. [PMID: 26465093 DOI: 10.1111/idj.12190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries. METHOD The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents≥51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use. RESULTS We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance. CONCLUSIONS The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.
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Affiliation(s)
- Richard Manski
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - John Moeller
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Haiyan Chen
- Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Eeva Widström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Stefan Listl
- Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany.,Munich Center for the Economics of Aging, Max-Planck-Institute for Social Law and Social Policy, Munich, Germany
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da Mata C, Allen PF, McKenna G, Cronin M, O'Mahony D, Woods N. Two-year survival of ART restorations placed in elderly patients: A randomised controlled clinical trial. J Dent 2015; 43:405-11. [PMID: 25597266 DOI: 10.1016/j.jdent.2015.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/01/2015] [Accepted: 01/07/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Older dentate adults are a high caries risk group who could potentially benefit from the use of the atraumatic restorative treatment (ART). This study aimed to compare the survival of ART and a conventional restorative technique (CT) using rotary instruments and a resin-modified glass-ionomer for restoring carious lesions as part of a preventive and restorative programme for older adults after 2 years. METHODS In this randomised controlled clinical trial, 99 independently living adults (65-90 years) with carious lesions were randomly allocated to receive either ART or conventional restorations. The survival of restorations was assessed by an independent and blinded examiner 6 months, 1 year and 2 years after restoration placement. RESULTS Ninety-six (67.6%) and 121 (76.6%) restorations were assessed in the ART and CT groups, respectively, after 2 years. The cumulative restoration survival percentages after 2 years were 85.4% in the ART and 90.9% in the CT group. No statistically significant between group differences were detected (p=0.2050, logistic regression analysis). CONCLUSIONS In terms of restoration survival, ART was as effective as a conventional restorative approach to treat older adults after 2 years. This technique could be a useful tool to provide dental care for older adults particularly in the non-clinical setting. ( TRIAL REGISTRATION NUMBER ISRCTN 76299321). CLINICAL SIGNIFICANCE The results of this study show that ART presented survival rates similar to conventional restorations in older adults. ART appears to be a cost-effective way to provide dental care to elderly patients, particularly in out of surgery facilities, such as nursing homes.
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Affiliation(s)
- Cristiane da Mata
- Cork University Dental School and Hospital, University College Cork, Ireland.
| | - P Finbarr Allen
- Cork University Dental School and Hospital, University College Cork, Ireland
| | - Gerald McKenna
- Centre for Dentistry, Queens University Belfast, Northern Ireland, United Kingdom
| | - Michael Cronin
- School of Mathematical Sciences, University College Cork, Ireland
| | | | - Noel Woods
- Centre for Policy Studies, University College Cork, Ireland
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Åstrøm AN, Ekback G, Ordell S, Nasir E. Long-term routine dental attendance: influence on tooth loss and oral health-related quality of life in Swedish older adults. Community Dent Oral Epidemiol 2014; 42:460-9. [PMID: 24712734 DOI: 10.1111/cdoe.12105] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/10/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Few studies have investigated the effect of long-term routine dental attendance on oral health between middle-aged and older adults, using a prospective cohort design. This study aimed to assess routine dental attendance (attending dentist in the previous 12 months for dental checkups) from age 50 to 65 years. Moreover, this study examined whether long-term routine dental attendance contributes to oral health-related quality of life, OHRQoL, and major tooth loss independent of social factors and the type of treatment sector utilized. Whether oral health impacts of long-term routine attendance varied with type of treatment sector utilized was also investigated. METHOD In 1992, a census of the 1942 cohort in two counties of Sweden participated in a longitudinal questionnaire survey conducted at age 50 and again after 5, 10, and 15 years. Information was collected on a wide range of health- and oral health-related aspects. Of the 6346 subjects who completed the 1992 survey, 4143 (65%) completed postal follow-ups in 1997, 2002, and 2007. RESULTS Routine dental attendance decreased from 69.1% at age 50-64.2% at age 65. Adjusted logistic regression analyses revealed that individuals reporting long-term routine attendance (routine attendance in both 1992 and 2007) were 0.3 (95% CI 0.2-0.5) times less likely than their counterparts who were nonroutine attenders to report oral impacts. According to generalized estimating equations (GEE), individuals who reported long-term routine attendance were 0.6 (95% CI 0.4-0.7) times less likely than nonroutine attenders to have major tooth loss across the survey years. The effect of long-term routine attendance on OHRQoL was stronger in public than in private dental healthcare attenders. CONCLUSION Routine attendance decreased from age 50-65 years. Long-term routine attendance had positive impact on major tooth loss and OHRQoL supporting the principle of encouraging annual dental attendance for preventive checkups among older people.
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Affiliation(s)
- Anne N Åstrøm
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Christensen LB, Rosing K, Lempert SM, Hede B. Patterns of dental services and factors that influence dental services among 64-65-year-old regular users of dental care in Denmark. Gerodontology 2014; 33:79-88. [DOI: 10.1111/ger.12122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa B. Christensen
- Department for Community Dentistry; School of Dentistry; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Kasper Rosing
- Department for Community Dentistry; School of Dentistry; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Susanne M. Lempert
- National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
| | - Børge Hede
- Department for Community Dentistry; School of Dentistry; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- Department of Special Care Dentistry; City of Copenhagen; Copenhagen Denmark
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Listl S, Moeller J, Manski R. A multi-country comparison of reasons for dental non-attendance. Eur J Oral Sci 2013; 122:62-9. [PMID: 24147428 DOI: 10.1111/eos.12096] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2013] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to describe differences across countries with respect to the reasons for dental non-attendance by Europeans currently 50 yr of age and older. The analyses were based on retrospective life-history data from the Survey of Health, Ageing, and Retirement in Europe and included information on various reasons why respondents from 13 European countries had never had regular dental visits in their lifetime. A series of logistic regression models was estimated to identify reasons for dental non-attendance across different welfare-state regimes. The highest proportion of respondents without any regular dental attendance throughout their lifetime was found for the Southern welfare-state regime, followed by the Eastern, the Bismarckian, and the Scandinavian welfare-state regimes. Factors such as patients' perception that regular dental treatment is 'not necessary' or 'not usual' appear to be the predominant reason for non-attendance in all welfare-state regimes. The health system-level factor 'no place to receive this type of care close to home' and the perception of regular dental treatment as 'not necessary' were more often referred to within the Southern, Eastern, and Bismarckian welfare-state regimes than in Scandinavia. This could be relevant information for health-care decision makers in order to prioritize interventions towards increasing rates of regular dental attendance.
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Affiliation(s)
- Stefan Listl
- Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany; Munich Center for the Economics of Aging, Max-Planck-Institute for Social Law and Social Policy, Munich, Germany
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Nihtilä A, Widström E, Elonheimo O. Heavy consumption of dental services; a longitudinal cohort study among Finnish adults. BMC Oral Health 2013; 13:18. [PMID: 23617730 PMCID: PMC3659074 DOI: 10.1186/1472-6831-13-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 04/22/2013] [Indexed: 11/17/2022] Open
Abstract
Background A reform to Dental Care legislation in 2002 abolished age limits restricting adults’ use of public dental services in Finland. In the Public Dental Service (PDS) unit of Espoo, the proportion of adult patients rose from 36% to 57%. The aim of this study was to investigate heavy use of dental services by adults and its determinants. Methods A longitudinal cohort study was undertaken based on a PDS patient register. Of all adults who attended the PDS in Espoo in 2004, those who had six or more visits (n=3,173) were assigned to the heavy user group and a comparison group of low users (n=22,820) had three or fewer dental visits. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and type of visit, oral health status and treatment provided was collected from treatment records. Each group was followed-up for five years and information on the number and types of visit was recorded for each year from 2005 to 2009. Results Most heavy users (61.6%) became low users and only 11.2% remained chronic heavy users. Most low users (91.0%) remained low users. For heavy users, the mean number of dental visits per year (3.0) during the follow-up period was significantly lower than initially in 2004 (8.3) (p<0.001) but 74.8% of heavy users had had emergency visits compared with 21.6% of the low users (p<0.001). A third (33%) of the visitors in each group had no proper examination and treatment planning during the 5-year follow-up period and two or more examinations were provided to fewer than half of the heavy (46.1%) or low (46.5%) users. The mean number of treating dentists was 5.7 for heavy users and 3.8 for low users (p<0.001). Conclusions Frequent emergency visits were characteristic of heavy users of dental services. Treatment planning was inadequate, probably partly due to the many dentists involved and too many patients requesting care. Better local management and continuous education are needed to ensure good quality adult dental care and to reduce heavy consumption.
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Affiliation(s)
- Annamari Nihtilä
- Helsinki Health Centre and Institute of Dentistry, University of Helsinki, Helsinki, Finland.
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