1
|
Alhozgi A, Feine JS, Tanwir F, Shrivastava R, Galarneau C, Emami E. Rural-urban disparities in patient satisfaction with oral health care: a provincial survey. BMC Oral Health 2021; 21:261. [PMID: 33992110 PMCID: PMC8122552 DOI: 10.1186/s12903-021-01613-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Identifying spatial variation in patient satisfaction is essential to improve the quality of care. Thus, the objective of this study was to investigate rural–urban disparities in patient satisfaction and to determine the factors that could influence satisfaction with oral health care. Methods Data from 1788 parents/caregivers of children who participated in the Quebec Ministry of Health clinical study were subject to secondary analysis. The Perneger model of patient satisfaction was used as the conceptual framework for the study. Satisfaction with oral health care was measured using the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II). Explanatory variables included predisposing factors and enabling resources. Statistical analyses included descriptive statistics, as well as bivariate and linear regression models. Results Individuals with higher income, dental insurance coverage, having a family dentist, reporting ease in finding a dentist, and having access to a private dental clinic were more satisfied with oral health care (p < 0.001). There were statistically significant differences between rural and urban Quebec residents in their ratings of patient satisfaction on four items, including dental office location (p = 0.013), dental equipment (p = 0.016), cost of dental treatment (p < 0.001), and cleanliness of dental office (p = 0.004), with greater satisfaction for urban dwellers. The multiple linear regression model showed that major determinants of patient satisfaction were being born in Canada, income ≥ 40,000$ CAD, having a family dentist, and having visited the dentist in the last year for regular checkups. However, ethnicity, having difficulty finding a dentist, and being in need of dental treatment negatively influenced patient satisfaction with oral health care. Conclusions These findings suggest that Quebec rural–urban disparity exists in patient satisfaction with care and that determinants of health influence this outcome. Intensive and powerful knowledge dissemination activities are needed to mobilize policymakers in implementing public health strategies to reduce this disparity.
Collapse
Affiliation(s)
- Abdalgader Alhozgi
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500, Montreal, QC, H3A 1G1, Canada
| | - Jocelyne S Feine
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500, Montreal, QC, H3A 1G1, Canada
| | - Farzeen Tanwir
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500, Montreal, QC, H3A 1G1, Canada
| | - Richa Shrivastava
- Sri Aurobindo College of Dentistry, Sanwer Road, Indore, India.,Faculty of Dentistry, Université de Montréal, C.P. 6128, succursale centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Chantal Galarneau
- Institut National de Santé Publique du Québec, 190 Boul Crémazie E, Montreal, QC, H2P 1E2, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500, Montreal, QC, H3A 1G1, Canada.
| |
Collapse
|
2
|
Exploring the Intersection between Social Determinants of Health and Unmet Dental Care Needs Using Deep Learning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197286. [PMID: 33036152 PMCID: PMC7579108 DOI: 10.3390/ijerph17197286] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/21/2022]
Abstract
The goals of this study were to develop a risk prediction model in unmet dental care needs and to explore the intersection between social determinants of health and unmet dental care needs in the United States. Data from the 2016 Medical Expenditure Panel Survey were used for this study. A chi-squared test was used to examine the difference in social determinants of health between those with and without unmet dental needs. Machine learning was used to determine top predictors of unmet dental care needs and to build a risk prediction model to identify those with unmet dental care needs. Age was the most important predictor of unmet dental care needs. Other important predictors included income, family size, educational level, unmet medical needs, and emergency room visit charges. The risk prediction model of unmet dental care needs attained an accuracy of 82.6%, sensitivity of 77.8%, specificity of 87.4%, precision of 82.9%, and area under the curve of 0.918. Social determinants of health have a strong relationship with unmet dental care needs. The application of deep learning in artificial intelligence represents a significant innovation in dentistry and enables a major advancement in our understanding of unmet dental care needs on an individual level that has never been done before. This study presents promising findings and the results are expected to be useful in risk assessment of unmet dental care needs and can guide targeted intervention in the general population of the United States.
Collapse
|
3
|
Luo H, Wu Q, Bell RA, Wright WG, Garcia RI, Quandt SA. Trends in use of dental care provider types and services in the United States in 2000-2016: Rural-urban comparisons. J Am Dent Assoc 2020; 151:596-606. [PMID: 32718489 DOI: 10.1016/j.adaj.2020.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities. METHODS Data were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix. RESULTS A decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values < .001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37). CONCLUSIONS Although preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents. PRACTICAL IMPLICATIONS These results of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients' oral health needs.
Collapse
|
4
|
Wright WG, Rafferty AP, Winterbauer N, Locklear K, Tucker-McLaughlin M. Geofencing: Mobile Technology as a Health Promotion Tool to Raise Awareness of a Dental Clinic in Rural North Carolina. J Rural Health 2020; 37:667-674. [PMID: 32761672 DOI: 10.1111/jrh.12501] [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: 11/30/2022]
Abstract
PURPOSE The purpose of the study was to assess the use of geofence technology to raise awareness of a dental clinic in rural North Carolina. METHODS The catchment area of the dental clinic was defined by ZIP Codes. A geofence was identified, and cell phones within the perimeter were targeted for oral health message drops to occur over 3 months from April to June 2017. Surveys conducted twice, pre- and postintervention (message drop), evaluated change in community awareness of services available at the dental clinic. A cross-sectional analysis was used to measure the effect of the exposure to the geofence technology in survey respondents. FINDINGS The survey included 200 participants (100 pre- and 100 postintervention). There were no significant differences in race or age for pre- and postintervention survey groups. The majority of respondents were American Indians (47.0% pre, 58.6% post) or black (28.8% pre, 25.5% post). There was a statistically significant improvement in awareness of the dental clinic (P = .045) from pre- to postintervention. A significant increase was also observed in the question related to dental visits by the respondent or family member of the respondent (from 6.5% to 15.0%, P = .04). A more modest improvement was found in questions related to the cost of dental care, type of insurance accepted, and services provided. CONCLUSION Geofencing has the potential to increase awareness of health care services and ultimately increase the number of patients receiving care.
Collapse
Affiliation(s)
- Wanda G Wright
- Department of Foundational Sciences, Division of Dental Public Health, School of Dental Medicine, East Carolina University, Greenville, North Carolina
| | - Ann P Rafferty
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Nancy Winterbauer
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Kayla Locklear
- Department of Foundational Sciences, Division of Dental Public Health, School of Dental Medicine, East Carolina University, Greenville, North Carolina
| | | |
Collapse
|
5
|
Meyerhoefer CD, Zuvekas SH, Farkhad BF, Moeller JF, Manski RJ. The demand for preventive and restorative dental services among older adults. HEALTH ECONOMICS 2019; 28:1151-1158. [PMID: 31264323 PMCID: PMC6706303 DOI: 10.1002/hec.3921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 06/09/2023]
Abstract
Many older Americans have poor access to dental care, resulting in a high prevalence of oral health problems. Because traditional Medicare does not include dental care benefits, only older Americans who are employed, have post-retirement dental benefits or spousal coverage, or enroll in certain Medicare Advantage plans are able to obtain dental care coverage. We seek to determine the extent to which poor access to dental insurance and high out-of-pocket costs affect dental service use by the elderly. Using the 2007-2015 Medical Expenditure Panel Survey and supplemental data on dental care prices, we estimate a demand system for preventive dental services and basic and major restorative services. Selection into dental and medical insurance is addressed using a correlated random effects panel data specification. Consistent with prior studies of the nonelderly population, dental service use was not sensitive to out-of-pocket prices. However, private dental insurance increased preventive service use by 25%, and dental coverage through Medicaid increased basic and major service use by 23% and 36%, respectively. The use of services was more responsive to dental insurance for women than men. These estimates suggest that a Medicare dental benefit could significantly increase dental service use by older Americans.
Collapse
Affiliation(s)
- Chad D Meyerhoefer
- Department of Economics, Lehigh University, National Bureau of Economic Research, Cambridge, Massachusetts
| | - Samuel H Zuvekas
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - John F Moeller
- University of Maryland School of Dentistry, Baltimore, Maryland
| | | |
Collapse
|
6
|
Lutfiyya MN, Gross AJ, Soffe B, Lipsky MS. Dental care utilization: examining the associations between health services deficits and not having a dental visit in past 12 months. BMC Public Health 2019; 19:265. [PMID: 30836954 PMCID: PMC6402128 DOI: 10.1186/s12889-019-6590-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A growing literature supports the contention that closing the divide between dental and medical care can improve access to and coordination of patient care. Health service deficits (HSDs) entail: no routine medical exam, no personal healthcare provider (HCP), no health insurance, and/or delaying medical care because of cost all within the last 12 months. Examining the associations between HSDs and dental care utilization could inform strategies and interventions aimed at narrowing the gap between the medical and dental professions. This study explored whether HSDs are associated with not having a dental care visit within the last 12 months. In addition, the study sought to provide an updated analysis of the characteristics and factors associated with dental care utilization. METHODS Two thousand sixteen Behavioral Risk Factor Surveillance System survey data were analyzed using bivariate and multivariable techniques. The outcome variable for this study was: last dental visit was longer than 12 months ago. RESULTS US adults without healthcare insurance, without a personal HCP, who had delayed medical care because of cost, and who had their last routine medical visit longer than 12 months ago had greater odds of not having a dental visit within the last 12 months. Further, this study identified disparities in dental care utilization among males, rural residents, those earning less than $50,000 per year, Non-Hispanic Blacks and Non-Hispanic other races. Individuals with six or more and/or all of their permanent teeth removed and current smokers also had greater odds of not having had a dental care visit in the past 12 months. CONCLUSIONS Findings suggest that a stronger integration of medical and dental care might increase dental care utilization. In addition, persistent disparities in dental care utilization remain for several demographic groups. Targeted interventions offer the promise of helping achieve HP 2020 goals for improved oral health.
Collapse
Affiliation(s)
- M. Nawal Lutfiyya
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Minneapolis, MN USA
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Andrew J. Gross
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Burke Soffe
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| | - Martin S. Lipsky
- College of Dental Medicine, Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, Utah 84095 USA
| |
Collapse
|
7
|
Kailembo A, Quiñonez C, Lopez Mitnik GV, Weintraub JA, Stewart Williams J, Preet R, Iafolla T, Dye BA. Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011-2014. BMC Oral Health 2018; 18:147. [PMID: 30139349 PMCID: PMC6108097 DOI: 10.1186/s12903-018-0613-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies in the United States (US) have used income and education as socioeconomic indicators but there is limited information on other indicators, such as wealth. We aimed to assess how two socioeconomic status measures, income and wealth, compare as correlates of socioeconomic disparity in dentist visits among adults in the US. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were used to calculate self-reported dental visit prevalence for adults aged 20 years and over living in the US. Prevalence ratios using Poisson regressions were conducted separately with income and wealth as independent variables. The dependent variable was not having a dentist visit in the past 12 months. Covariates included sociodemographic factors and untreated dental caries. Parsimonious models, including only statistically significant (p < 0.05) covariates, were derived. The Akaike Information Criterion (AIC) measured the relative statistical quality of the income and wealth models. Analyses were additionally stratified by race/ethnicity in response to statistically significant interactions. RESULTS The prevalence of not having a dentist visit in the past 12 months among adults aged 20 years and over was 39%. Prevalence was highest in the poorest (58%) and lowest wealth (57%) groups. In the parsimonious models, adults in the poorest and lowest wealth groups were close to twice as likely to not have a dentist visit (RR 1.69; 95%CI: 1.51-1.90) and (RR 1.68; 95%CI: 1.52-1.85) respectively. In the income model the risk of not having a dentist visit were 16% higher in the age group 20-44 years compared with the 65+ year age group (RR 1.16; 95%CI: 1.04-1.30) but age was not statistically significant in the wealth model. The AIC scores were lower (better) for the income model. After stratifying by race/ethnicity, age remained a significant indicator for dentist visits for non-Hispanic whites, blacks, and Asians whereas age was not associated with dentist visits in the wealth model. CONCLUSIONS Income and wealth are both indicators of socioeconomic disparities in dentist visits in the US, but both do not have the same impact in some populations in the US.
Collapse
Affiliation(s)
- Alexander Kailembo
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA.
| | | | - Gabriela V Lopez Mitnik
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
| | | | - Jennifer Stewart Williams
- Umeå University, Umea, Sweden.,Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
| | | | - Timothy Iafolla
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
| | - Bruce A Dye
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
| |
Collapse
|
8
|
Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers. J Ambul Care Manage 2018; 40:204-213. [PMID: 27218701 PMCID: PMC5585172 DOI: 10.1097/jac.0000000000000151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is Available in the Text. Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.
Collapse
|
9
|
Gaber A, Galarneau C, Feine JS, Emami E. Rural-urban disparity in oral health-related quality of life. Community Dent Oral Epidemiol 2017; 46:132-142. [PMID: 28940682 DOI: 10.1111/cdoe.12344] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 08/22/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The objective of this population-based cross-sectional study was to estimate rural-urban disparity in the oral health-related quality of life (OHRQoL) of the Quebec adult population. METHODS A 2-stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)-14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression. RESULTS The prevalence of poor oral health-related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily-life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural-urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1-2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7-15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8-15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8-3.9; P < .001). CONCLUSION The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes, specifically for rural residents. Further studies are needed to confirm these results.
Collapse
Affiliation(s)
- Amal Gaber
- Faculty of Dentistry, McGill University, Montréal, QC, Canada.,Faculty of Dentistry, Université de Montréal, Montréal, QC, Canada
| | | | | | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, QC, Canada.,Faculty of Dentistry, Université de Montréal, Montréal, QC, Canada.,School of Public Health, Public Health Research Institute, CRCHUM, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
10
|
Visits to US emergency departments by 20- to 29-year-olds with toothache during 2001-2010. J Am Dent Assoc 2016; 146:295-302.e2. [PMID: 25925521 DOI: 10.1016/j.adaj.2015.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/02/2015] [Accepted: 01/11/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Visits to emergency departments (EDs) for dental symptoms are on the rise, yet reliance on EDs for dental care is far from ideal. ED toothache visits represent opportunities to improve access to professional dental care. METHODS This research focuses on 20- to 29-year-olds, who account for more ED toothache visits than do other age groups. The authors analyzed publicly available ED visit data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 through 2010. They assessed trends in ED toothache visit rates compared with back pain and all cause ED visits during the past decade. The authors used NHAMCS data for years 2009 and 2010 to characterize the more recent magnitude, relative frequency, and independent risk factors for ED toothache visits. Statistical analyses accounted for the complex sampling design. RESULTS The average annual increase in ED visit rates among 20- to 29-year-olds during 2001-2010 was 6.1% for toothache, 0.3% for back pain, and 0.8% for all causes of ED visits. In 2009 and 2010, 20- to 29-year-olds made an estimated 1.27 million ED visits for toothaches and accounted for 42% of all ED toothache visits. Toothache was the fifth most common reason for any ED visit and third most common for uninsured ED visits by 20- to 29-year-olds. Independent risk factors for ED toothache visits were being uninsured or Medicaid-insured. CONCLUSIONS Younger adults increasingly rely on EDs for toothaches-likely because of barriers to accessing professional dental care. Expanding dental coverage and access to affordable dental care could increase options for timely dental care and decrease ED use for dental symptoms. PRACTICAL IMPLICATIONS Though additional research is needed to better understand why younger adults disproportionately use the ED for toothaches, findings from this study suggest the importance of maintaining access to a dental home from childhood through adolescence and subsequently into early adulthood.
Collapse
|
11
|
Pradeep Y, Chakravarty KK, Simhadri K, Ghenam A, Naidu GM, Vundavalli S. Gaps in need, demand, and effective demand for dental care utilization among residents of Krishna district, Andhra Pradesh, India. J Int Soc Prev Community Dent 2016; 6:S116-21. [PMID: 27652242 PMCID: PMC5022387 DOI: 10.4103/2231-0762.189737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS To identify the relation between need, demand, and effective demand for dental services in Andhra Pradesh, India. MATERIALS AND METHODS This is a cross-sectional study performed among populations residing in the rural and urban areas of Krishna district, Andhra Pradesh, India. Data were collected from 3102 individuals who were selected through multiphase random sampling. Data regarding self-perceived dental need, dental service utilization, and barriers for utilization were collected through s pretested questionnaire followed by type-III clinical examination to assess the normative need of the individuals. Chi-square test was used to compare independent and dependent variables, and further comparison was done with multivariate logistic regression analysis for significant variables. RESULTS Less than half (40%) of the participants perceived a need for dental care. Among the people who perceived need for care, only 21.4% utilized dental care and 78.6% of them had unmet dental needs. The two main reasons for not seeking dental care was lack of money, i.e., unaffordable dental treatment (48%) and having the perception that they do not have any dental problem (19.4%). CONCLUSIONS There is an enormous difference between normative need, demand, and actual utilization rates in dental care, and hindrances for effective demand need to be addressed to improve dental care delivery system.
Collapse
Affiliation(s)
- Y Pradeep
- Department of Public Health Dentistry, R. V. S. Dental College, Kannampalayam, Coimbatore, Tamil Nadu, India
| | | | - Kavya Simhadri
- Department of Prosthodontics, St. Joseph Dental College, Eluru, India
| | - Alexis Ghenam
- Department of General Dentistry, Eastman Institute of Oral Health, Rochester, New York, USA
| | - Guntipalli M Naidu
- Department of Public Health Dentistry, Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Cinaoutpally, Gannavarm, Andhra Pradesh, India
| | - Sudhakar Vundavalli
- Department of Public Health Dentistry, Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Cinaoutpally, Gannavarm, Andhra Pradesh, India
| |
Collapse
|
12
|
McNeil DW, Hayes SE, Randall CL, Polk DE, Neiswanger K, Shaffer JR, Weyant RJ, Foxman B, Kao E, Crout RJ, Chapman S, Brown LJ, Maurer JL, Marazita ML. Depression and Rural Environment are Associated With Poor Oral Health Among Pregnant Women in Northern Appalachia. Behav Modif 2015; 40:325-40. [PMID: 26643277 DOI: 10.1177/0145445515615353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Both oral health problems and depression among pregnant women contribute to maternal-infant health outcomes. Little is known, however, about the potential effects of clinically significant depression on the oral health status of pregnant women. The purpose of the present study was to determine the influence of clinically significant depression and rural- or urban-dwelling status on oral health outcomes among pregnant women. Pregnant women (N = 685) in rural (i.e., West Virginia) and urban (i.e., Pittsburgh, PA) areas of northern Appalachia were assessed by calibrated examiners regarding gingivitis, oral hygiene, and DMFT (decayed, missing, and filled teeth), completed the Center for Epidemiologic Studies-Depression Scale (CES-D) and provided demographics. Participants were categorized based on clinically significant depressive symptoms (CES-D ≥ 16) and rural/urban domicile. Women with depression and those living in rural areas had worse oral health on all three indices than their non-depressed and urban counterparts. Depression, particularly among women in rural areas, affects certain oral health indices and represents a modifiable target for intervention. Moreover, treatments designed specifically for rural populations may be of particular utility. Women who are pregnant or planning to become pregnant may benefit from regular depression screenings from their dental and medical health care providers.
Collapse
Affiliation(s)
- Daniel W McNeil
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Sarah E Hayes
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Cameron L Randall
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Deborah E Polk
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - Kathy Neiswanger
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - John R Shaffer
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - Robert J Weyant
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - Betsy Foxman
- Center for Oral Health Research in Appalachia University of Michigan, Ann Arbor, USA
| | - Elizabeth Kao
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Richard J Crout
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Stella Chapman
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Linda J Brown
- West Virginia University, Morgantown, USA Center for Oral Health Research in Appalachia
| | - Jennifer L Maurer
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| | - Mary L Marazita
- Center for Oral Health Research in Appalachia University of Pittsburgh, PA, USA
| |
Collapse
|
13
|
Guo Y, Logan HL, Dodd VJ, Muller KE, Marks JG, Riley JL. Health literacy: a pathway to better oral health. Am J Public Health 2014; 104:e85-91. [PMID: 24832423 DOI: 10.2105/ajph.2014.301930] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We examined whether health literacy was associated with self-rated oral health status and whether the relationship was mediated by patient-dentist communication and dental care patterns. METHODS We tested a path model with data collected from 2 waves of telephone surveys (baseline, 2009-2010; follow-up, 2011) of individuals residing in 36 rural census tracts in northern Florida (final sample size n = 1799). RESULTS Higher levels of health literacy were associated with better self-rated oral health status (B = 0.091; P < .001). In addition, higher levels of health literacy were associated with better patient-dentist communication, which in turn corresponded with patterns of regular dental care and better self-rated oral health (B = 0.003; P = .01). CONCLUSIONS Our study showed that, beyond the often-reported effects of gender, race, education, financial status, and access to dental care, it is also important to consider the influence of health literacy and quality of patient-dentist communication on oral health status. Improved patient-dentist communication is needed as an initial step in improving the population's oral health.
Collapse
Affiliation(s)
- Yi Guo
- Yi Guo and Keith E. Muller are with the Department of Health Outcomes and Policy, College of Medicine, and Henrietta L. Logan, Virginia J. Dodd, John G. Marks, and Joseph L. Riley III are with the Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville
| | | | | | | | | | | |
Collapse
|
14
|
Saman DM, Lemieux A, Arevalo O, Lutfiyya MN. A population-based study of edentulism in the US: does depression and rural residency matter after controlling for potential confounders? BMC Public Health 2014; 14:65. [PMID: 24450754 PMCID: PMC3905917 DOI: 10.1186/1471-2458-14-65] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/16/2014] [Indexed: 11/23/2022] Open
Abstract
Background Oral health is an integral component of general health and well-being. While edentulism has been examined in relation to socioeconomic status, rural residency, chronic disease and mental health, no study that we know of has examined edentulism and these factors together. The objective of this study was to determine whether depression and rural residency were significantly associated with partial and full edentulism in US adults after controlling for potential confounders. Methods 2006 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify factors associated with increased odds of partial or full edentulism. This year of BRFSS data was chosen for analysis because in this year the standardized and validated Personal Health Questionnaire-8 (PHQ-8) was used to measure current depression. This measure was part of the optional questions BRFSS asks, and in 2006 33 states and/or territories included them in their annual surveillance data collection. Bivariate and logistic regression analyses were performed on weighted BRFSS data. Results Logistic regression analysis using either full or partial edentulism as the dependent variable yielded that rural residency or living in a rural locale, low and/or middle socioeconomic status (SES), depression as measured by the PHQ-8, and African American race/ethnicity were all independent risk factors when controlling for these and a number of additional covariates. Conclusions This study adds to the epidemiological literature by assessing partial and full edentulism in the US utilizing data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Examining data collected through a large national surveillance system such as BRFSS allows for an analysis that incorporates an array of covariates not available from clinically-based data alone. This study demonstrated that current depression and rural residency are important factors related to partial and full edentulism after controlling for potential confounders.
Collapse
Affiliation(s)
| | | | | | - May Nawal Lutfiyya
- University of Minnesota, National Center for Interprofessional Practice and Education, Academic Health Center, Minneapolis, MN 55845, USA.
| |
Collapse
|
15
|
McKernan SC, Kuthy RA, Kavand G. General Dentist Characteristics Associated With Rural Practice Location. J Rural Health 2013; 29 Suppl 1:s89-95. [DOI: 10.1111/jrh.12004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Susan C. McKernan
- Public Policy Center; The University of Iowa; Iowa City Iowa
- Preventive and Community Dentistry; College of Dentistry, The University of Iowa; Iowa City Iowa
| | - Raymond A. Kuthy
- Public Policy Center; The University of Iowa; Iowa City Iowa
- Preventive and Community Dentistry; College of Dentistry, The University of Iowa; Iowa City Iowa
| | - Golnaz Kavand
- Public Policy Center; The University of Iowa; Iowa City Iowa
- Preventive and Community Dentistry; College of Dentistry, The University of Iowa; Iowa City Iowa
| |
Collapse
|
16
|
Bhagavatula P, Xiang Q, Szabo A, Eichmiller F, Kuthy RA, Okunseri CE. Rural-urban differences in dental service use among children enrolled in a private dental insurance plan in Wisconsin: analysis of administrative data. BMC Oral Health 2012; 12:58. [PMID: 23259637 PMCID: PMC3548684 DOI: 10.1186/1472-6831-12-58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 12/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies on rural-urban differences in dental care have primarily focused on differences in utilization rates and preventive dental services. Little is known about rural-urban differences in the use of wider range of dental procedures. This study examined patterns of preventive, restorative, endodontic, and extraction procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI). METHODS We analyzed DDWI enrollment and claims data for children aged 0-18 years from 2002 to 2008. We modified and used a rural and urban classification based on ZIP codes developed by the Wisconsin Area Health Education Center (AHEC). We categorized the ZIP codes into 6 AHEC categories (3 rural and 3 urban). Descriptive and multivariable analysis using generalized linear mixed models (GLMM) were used to examine the patterns of dental procedures provided to children. Tukey-Kramer adjustment was used to control for multiple comparisons. RESULTS Approximately, 50%, 67% and 68% of enrollees in inner-city Milwaukee, Rural 1 (less than 2500 people), and suburban-Milwaukee had at least one annual dental visit, respectively. Children in inner city-Milwaukee had the lowest utilization rates for all procedures examined, except for endodontic procedures. Compared to children from inner-city Milwaukee, children in other locations had significantly more preventive procedures. Children in Rural 1-ZIP codes had more restorative, endodontic and extraction procedures, compared to children from all other regions. CONCLUSIONS We found significant geographic variation in dental procedures received by children enrolled in DDWI.
Collapse
Affiliation(s)
- Pradeep Bhagavatula
- Department of Clinical Services, Marquette University School of Dentistry, Milwaukee, WI 53201-1881, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Kengne Talla P, Gagnon MP, Dramaix M, Leveque A. Barriers to dental visits in Belgium: a secondary analysis of the 2004 National Health Interview Survey. J Public Health Dent 2012; 73:32-40. [PMID: 23215822 DOI: 10.1111/jphd.12003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 10/07/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The study aims to identify barriers to annual dental visits in the Belgian population. METHODS We conducted a secondary analysis of data collected through the 2004 National Health Interview Survey in Belgium. Only respondents aged 15 years and older with complete information on dental consultations and the independent variables (n = 5940) were considered in this analysis. The associations between the lack of dental visits during the 12 months preceding the survey and covariates of interest were examined using a multivariable logistic regression analysis. RESULTS Almost one-half of the respondents (49.7 percent) did not visit a dentist in the 12 months prior to the survey. Region of residence was significantly the common variable for the three age categories. In the 15- to 34-year-old category, males and two-person households were significantly less likely to report a dental visit during the 12 months preceding the survey. For the 35- to 54-year-old category, a low level of education was the covariate associated with the lack of dental visit. In the 55 years or older category, the factors associated with the lack of a dental visit in the 12 months prior to the survey were: male gender, low level of education, low household income, low weekly alcohol consumption, current smoker, and body mass index of ≥ 25 mg/kg(2). CONCLUSION Barriers to dental visits in Belgium differ among age groups and are linked to personal and environmental factors. The findings confirm the existence of social health inequalities in dental visits among Belgian people.
Collapse
Affiliation(s)
- Pascaline Kengne Talla
- Department of Social and Preventive Medicine, Université Laval, Rue de l'Espinay, Quebec, Canada.
| | | | | | | |
Collapse
|
18
|
Arcury TA, Savoca MR, Anderson AM, Chen H, Gilbert GH, Bell RA, Leng X, Reynolds T, Quandt SA. Dental care utilization among North Carolina rural older adults. J Public Health Dent 2012; 72:190-7. [PMID: 22536828 DOI: 10.1111/j.1752-7325.2012.00329.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This analysis delineates the predisposing, need, and enabling factors that are associated with regular and recent dental care in a multiethnic sample of rural older adults. METHODS A cross-sectional, comprehensive, oral-health survey conducted with a random, multiethnic (African American, American Indian, white) sample of 635 community-dwelling adults aged 60 years and older was completed in two rural southern counties. Logistic regression models assessed the simultaneous associations of dental care with predisposing, enabling, and need factors. RESULTS Almost no edentulous rural older adults received dental care; 27.1 percent of dentate rural older adults had received regular dental care, and 36.7 percent had received recent dental care. Predisposing (less than high-school education, dental anxiety), enabling (no regular place for dental care), and need factors (no filled teeth) reduced the odds of regular dental, while predisposing (dental anxiety), enabling (no regular place for dental care), and need factors (no filled teeth) reduced the odds of recent dental care. Having excellent, very good, or good self-rated oral health increased the odds of receiving regular and recent dental care. CONCLUSIONS Regular and recent dental care are infrequent among rural older adults. Contrary to expectations, those not receiving dental care are those who most need care; this has been referred to as the Paradox of Dental Need. Community access to dental care and the ability of older adults to pay for dental care must be addressed by public-health policy to improve the health and quality of life of older adults in rural communities.
Collapse
Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157-1084, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
dos Santos CM, Martins AB, de Marchi RJ, Hilgert JB, Hugo FN, Padilha DMP. Assessing changes in oral health-related quality of life and its factors in community-dwelling older Brazilians. Gerodontology 2012; 30:176-86. [DOI: 10.1111/j.1741-2358.2012.00656.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
20
|
Bell RA, Arcury TA, Anderson AM, Chen H, Savoca MR, Gilbert GH, Quandt SA. Dental anxiety and oral health outcomes among rural older adults. J Public Health Dent 2011; 72:53-9. [PMID: 22316247 DOI: 10.1111/j.1752-7325.2011.00283.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The objective of this study is to determine the degree to which rural older adults are able to complete a measure of dental anxiety and to assess the prevalence, as well as the demographic and oral health characteristics, of individuals reporting high dental anxiety. METHODS A population-based sample of 635 African American, American Indian and White older adults (age ≥ 60 years) completed an in-home survey, and 362 dentate participants completed an oral examination. Dental anxiety was measured using the four-item Corah's Dental Anxiety Scale (DAS). Gender, ethnicity, age, education, and oral health outcomes were compared between those who completed all four DAS questions (completers) and those who did not (noncompleters) as well as, among completers, those with high versus low DAS scores. RESULTS There were 94 (14.8%) noncompleters. Noncompletion was associated with older age, lower education, being edentulous, and having gingival recession. 12.4% of DAS completers had high DAS scores, which was more common among those aged 60-70 years, women, and those with oral pain and sore or bleeding gums. In logistic regression analysis, only sore and bleeding gums had a significant association with a high DAS score (odds ratio = 2.40, 95% confidence interval 1.09-5.26). CONCLUSIONS About one in eight rural older adults have high dental anxiety, which is associated with poor oral health outcomes. Identifying new approaches to measure dental anxiety among a population with limited interaction with dental care providers is needed.
Collapse
Affiliation(s)
- Ronny A Bell
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | | | | | | | | | | | | |
Collapse
|
21
|
Arcury TA, Chen H, Savoca MR, Anderson AM, Leng X, Bell RA, Quandt SA. Ethnic variation in oral health and social integration among older rural adults. J Appl Gerontol 2011; 32:302-23. [PMID: 23788829 DOI: 10.1177/0733464811420428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, White) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do White older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, whereas the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian, and White elders. More research on the ways oral health affects the lives of older adults is warranted.
Collapse
Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, NC, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Morarend QA, Spector ML, Dawson DV, Clark SH, Holmes DC. The use of a respiratory rate biofeedback device to reduce dental anxiety: an exploratory investigation. Appl Psychophysiol Biofeedback 2011; 36:63-70. [PMID: 21365307 DOI: 10.1007/s10484-011-9148-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Anxiety experienced by individuals visiting the dental office to receive treatment is common. Evidence has shown biofeedback to be a useful modality of treatment for numerous maladies associated with anxiety. The purpose of the current pilot study was to investigate the use of a novel biofeedback device (RESPeRATE™) to reduce patients' pre-operative general anxiety levels and consequently reduce the pain associated with dental injections. Eighty-one subjects participated in this study, forty in the experimental group and forty-one in the control group. Subjects in the experimental group used the biofeedback technique, while those in the control group were not exposed to any biofeedback. All subjects filled out a pre-injection anxiety survey, then received an inferior alveolar injection of local anesthetic. Post-injection, both groups were given an anxiety survey and asked to respond to four questions regarding the injection experience using a Visual Analog Scale (VAS). With the use of the respiratory rate biofeedback device, there was a significant reduction of negative feelings regarding the overall injection experience, as measured by a VAS. Our findings demonstrate that this novel biofeedback technique may be helpful in the amelioration of dental anxiety, and may help produce a more pleasant overall experience for the patient.
Collapse
|
23
|
|
24
|
Skillman SM, Doescher MP, Mouradian WE, Brunson DK. The challenge to delivering oral health services in rural America. J Public Health Dent 2010; 70 Suppl 1:S49-57. [PMID: 20806475 DOI: 10.1111/j.1752-7325.2010.00178.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This review identifies the challenges to oral health in rural America and describes areas of innovation in prevention, delivery of dental services, and workforce development that may improve oral health for rural populations. METHODS This descriptive article is based on literature reviews and personal communications. RESULTS Rural populations have lower dental care utilization, higher rates of dental caries, lower rates of insurance, higher rates of poverty, less water fluoridation, fewer dentists per population, and greater distances to travel to access care than urban populations. Improving the oral health of rural populations requires practical and flexible approaches to expand and better distribute the rural oral health workforce, including approaches tailored to remote areas. Solutions that involve mass prevention/public health interventions include increasing water fluoridation, providing timely oral health education, caries risk assessment and referral, preventive services, and offering behavioral interventions such as smoking and tobacco cessation programs. Solutions that train more providers prepared to work in rural areas include recruiting students from rural areas, training students in rural locations, and providing loan repayment and scholarships. Increasing the flexibility and capacity of the oral health workforce for rural areas could be achieved by creating new roles for and new types of providers. Solutions that overcome distance barriers include mobile clinics and telehealth technology. CONCLUSIONS Rural areas need flexibility and resources to develop innovative solutions that meet their specific needs. Prevention needs to be at the front line of rural oral health care, with systematic approaches that cross health professions and health sectors.
Collapse
|
25
|
Wu B, Goedereis EA, Crout RJ, Plassman BL, DiNapoli EA, McNeil DW, Wiener M, Boone ML, Wiener RC, Kao E, Bai L. Recruitment of rural and cognitively impaired older adults for dental research. SPECIAL CARE IN DENTISTRY 2010; 30:193-9. [PMID: 20831737 DOI: 10.1111/j.1754-4505.2010.00150.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The recruitment of community-dwelling older adults, particularly those with cognitive impairment and those residing in rural areas, has been consistently challenging for researchers, especially in the dental field. This study reports on recruitment experiences from an ongoing study investigating the association between oral health and cognitive status in later life. Multiple recruitment strategies, including educational presentations and traveling to participants' homes, were used to enroll rural elderly participants with various levels of cognitive function. In general, multipronged, proactive recruitment strategies were more effective than traditional, passive methods in reaching participants with varying degrees of cognitive impairment. The outcome of this study suggests that successful recruitment of such populations involves gaining the support of staff at relevant community organizations, informing community members (including older adults and their family members) of the project and the importance of oral health, and making data collection sites accessible for older adults.
Collapse
Affiliation(s)
- Bei Wu
- The University of North Carolina Greensboro, Gerontology Program, Greensboro, North Carolina, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Beil HA, Rozier RG. Primary health care providers' advice for a dental checkup and dental use in children. Pediatrics 2010; 126:e435-41. [PMID: 20660547 DOI: 10.1542/peds.2009-2311] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In this study we estimated factors associated with children being advised to see the dentist by a doctor or other health provider; tested for an association between the advisement on the likelihood that the child would visit the dentist; and estimated the effect of the advisement on dental costs. METHODS We identified a sample of 5268 children aged 2 to 11 years in the 2004 Medical Expenditures Panel Survey. A cross-sectional analysis with logistic regression models was conducted to estimate the likelihood of the child receiving a recommendation for a dental checkup, and to determine its effect on the likelihood of having a dental visit. Differences in cost for children who received a recommendation were assessed by using a linear regression model. All analyses were conducted separately on children aged 2 to 5 (n = 2031) and aged 6 to 11 (n = 3237) years. RESULTS Forty-seven percent of 2- to 5-year-olds and 37% of 6- to 11-year-olds had been advised to see the dentist. Children aged 2 to 5 who received a recommendation were more likely to have a dental visit (odds ratio: 2.89 [95% confidence interval: 2.16-3.87]), but no difference was observed among older children. Advice had no effect on dental costs in either age group. CONCLUSIONS Health providers' recommendation that pediatric patients visit the dentist was associated with an increase in dental visits among young children. Providers have the potential to play an important role in establishing a dental home for children at an early age. Future research should examine potential interventions to increase effective dental referrals by health providers.
Collapse
Affiliation(s)
- Heather A Beil
- Department of Health Policy and Management, UNC Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC 27599, USA.
| | | |
Collapse
|
27
|
Unmet dental needs in rural primary care: a clinic-, community-, and practice-based research network collaborative. J Am Board Fam Med 2010; 23:514-22. [PMID: 20616294 PMCID: PMC2989533 DOI: 10.3122/jabfm.2010.04.090080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Oral health is an essential component of general health and well-being, yet barriers to the access of dental care and unmet needs are pronounced, particularly in rural areas. Despite associations with systemic health, few studies have assessed unmet dental needs across the lifespan as they present in primary care. This study describes the prevalence of oral health conditions and unmet dental needs among patients presenting for routine care in a rural Oregon family medicine practice. METHODS Eight primary care clinicians were trained to conduct basic oral health screenings for 7 dental conditions associated with International Statistical Classification of Diseases and Related Health Problems 9-Clinical Modification codes. During the 6-week study period, patients older than 12 months of age who presented to the practice for a regularly scheduled appointment received the screening and completed a brief dental access survey. RESULTS Of 1655 eligible patients, 40.7% (n = 674) received the screening and 66.9% (n = 1108) completed the survey. Half of the patients who were screened (46.0%, n = 310) had oral health conditions detected, including partial edentulism (24.5%), dental caries (12.9%), complete edentulism (9.9%), and cracked teeth (8.9%). Twenty-eight percent of the patients reported experiencing unmet dental needs. Patients with dental insurance were significantly more likely to report better oral and general health outcomes as compared with those who had no insurance or health insurance only. CONCLUSIONS Oral health diseases and unmet dental needs presented substantially in patients with ages ranging across the lifespan from one rural primary care practice. Primary care settings may present opportune environments for reaching patients who are unable to obtain regular dental care.
Collapse
|
28
|
Quandt SA, Chen H, Bell RA, Anderson AM, Savoca MR, Kohrman T, Gilbert GH, Arcury TA. Disparities in oral health status between older adults in a multiethnic rural community: the rural nutrition and oral health study. J Am Geriatr Soc 2009; 57:1369-75. [PMID: 19563519 PMCID: PMC3400086 DOI: 10.1111/j.1532-5415.2009.02367.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare oral health status according to ethnicity and socioeconomic status in African-American, American-Indian, and white dentate and edentulous community-dwelling older adults. DESIGN Cross-sectional study; data from self-reports and oral examinations. PARTICIPANTS A multistage cluster sampling design was used to recruit 635 participants aged 60 and older from rural North Carolina counties with substantial African-American and American-Indian populations. MEASUREMENTS Participants completed in-home interviews and oral examinations. Self-reported data included sociodemographic indicators; self-rated oral health status; presence or absence of periodontal disease, bleeding gums, oral pain, dry mouth; and fit of prostheses. Oral examination data included number of teeth and numbers of anterior and posterior functional occlusal units. RESULTS African Americans and American Indians had significantly lower incomes and educational attainment than whites. Self-rated oral health was significantly better in whites than in African Americans and American Indians. Prevalence of self-reported periodontal disease and bleeding gums was lower in whites. Of dentate participants, African Americans were significantly more likely than whites to have 11 to 20 teeth and one or two posterior occlusal contacts. Oral health deficits remained associated with ethnicity when adjusted for socioeconomic variables. CONCLUSION Oral health disparities in older adults in a multiethnic rural area were largely associated with ethnicity and not socioeconomic status. Clinicians should be aware of these health disparities in oral health status and their possible role in disparities in chronic disease. Further research is necessary to understand whether these oral health disparities reflect current or lifetime access to care, diet, or attitudes toward oral health care.
Collapse
Affiliation(s)
- Sara A Quandt
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Use of Emergency Departments for Conditions Related to Poor Oral Healthcare. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2009; 15:238-45. [DOI: 10.1097/phh.0b013e3181a1179f] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Jablonski RA, Swecker T, Munro C, Grap MJ, Ligon M. Measuring the Oral Health of Nursing Home Elders. Clin Nurs Res 2009; 18:200-17. [DOI: 10.1177/1054773809335306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The primary purposes of this descriptive and prospective pilot study was to test the feasibility of a nursing and dental hygiene team to measure specific oral health indices in a sample of older adults residing in nursing homes (NHs). The secondary purpose was to determine the relationship between plaque and dentate status. Oral health indicators, functional status scores, and behavioral scores were collected and analyzed from 38 female NH residents from two geographically, organizationally, and economically diverse NHs. Persons with dentures had significantly lower plaque scores than those with natural dentition. Rural NH residents and African American NH residents had fewer filled teeth, indicating a potential lack of access to dental care. Oral health indicators were collected safely and efficiently from NH residents using a nursing and dental hygiene collaborative approach. Nursing and dental hygiene collaborations hold promise for improving the oral health in institutionalized elders.
Collapse
|
31
|
Maharani DA. Perceived need for and utilization of dental care in Indonesia in 2006 and 2007: a secondary analysis. J Oral Sci 2009; 51:545-50. [DOI: 10.2334/josnusd.51.545] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
32
|
Arcury TA, Bell RA, Anderson AM, Chen H, Savoca MR, Kohrman T, Quandt SA. Oral health self-care behaviors of rural older adults. J Public Health Dent 2009; 69:182-9. [PMID: 19486460 PMCID: PMC2784128 DOI: 10.1111/j.1752-7325.2009.00121.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This analysis describes the dental self-care behaviors used by a multiethnic sample of older adults and delineates the associations of self-care behaviors with personal characteristics and oral health problems. METHODS A cross-sectional comprehensive oral health survey conducted with a random, multiethnic (African-American, American Indian, white) sample of 635 community-dwelling rural adults aged 60 years and older was completed in two rural southern counties. RESULTS Rural older adults engage in a variety of self-care behaviors, including the use of over-the-counter (OTC) medicine (12.1 percent), OTC dental products (84.0 percent), salt (50.9 percent), prayer (6.1 percent), and complementary therapies (18.2 percent). Some gender and ethnic class differences are apparent, with greater use by women of OTC medicine and salt and greater use by African-Americans and American Indians of OTC medicine and OTC dental products. The use of dental self-care behaviors appears to be driven by need. Those reporting oral pain, bleeding gums, and dry mouth have greater odds of engaging in most of the dental self-care behaviors, including the use of complementary therapies. CONCLUSIONS The major factor leading to the use of self-care behaviors is need. Although oral pain does increase the use of self-care behaviors, so do bleeding gums and dry mouth. Research and practice should address self-care behaviors used for oral health problems in addition to pain. Investigators should expand analysis of dental self-care behavior and the relationship of self-care behavior to the use of professional services. Further research also should explore the use of complementary therapies in dental self-care.
Collapse
Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1084, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Meng X, Gilbert GH, Litaker MS. Dynamics of satisfaction with dental appearance among dentate adults: 24-month incidence. Community Dent Oral Epidemiol 2008; 36:370-81. [DOI: 10.1111/j.1600-0528.2007.00409.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Skinner AC, Slifkin RT. Rural/urban differences in barriers to and burden of care for children with special health care needs. J Rural Health 2007; 23:150-7. [PMID: 17397371 DOI: 10.1111/j.1748-0361.2007.00082.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine the barriers and difficulties experienced by rural families of children with special health care needs (CSHCN) in caring for their children. METHODS The National Survey of Children with Special Health Care Needs was used to examine rural-urban differences in types of providers used, reasons CSHCN had unmet health care needs, insurance and financial difficulties encountered, and the family burden of providing the child's medical care. We present both unadjusted and adjusted results to allow consideration of the causes of rural-urban differences. FINDINGS Rural CSHCN are less likely to be seen by a pediatrician than urban children. They are more likely to have unmet health care needs due to transportation difficulties or because care was not available in the area; there were minimal other differences in barriers to care. Families of rural CSHCN are more likely to report financial difficulties associated with their children's medical needs and more likely to provide care at home for their children. CONCLUSIONS Examining results from both unadjusted and adjusted odds ratios shows that the burden of care for families of rural CSHCN stems both from socioeconomic differences and health system differences. Policies aimed at achieving equity for rural children will require focusing on both individual factors and the health care infrastructure, including increasing insurance coverage to lessen financial difficulties and addressing the availability of providers in rural areas.
Collapse
Affiliation(s)
- Asheley Cockrell Skinner
- North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
| | | |
Collapse
|
35
|
Harrison JP, Daniel RC, Nemecek V. The growing importance of dental services in rural America. Health Care Manag (Frederick) 2007; 26:34-42. [PMID: 17314625 DOI: 10.1097/00126450-200701000-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As the science of medicine progresses, associations between good oral health and improved health status are being documented. However, the data would suggest that individuals in America's rural communities are experiencing dramatic health problems because they are not receiving dental treatment. This article addresses the importance of dental services in rural communities and highlights the importance of cooperation among hospitals, individual clinical providers, community health care organizations, and governmental entities. It will also discuss why there is a shortage in these rural areas and how the shortage is affecting rural communities and will address some strategies for solving this crisis. This research on the availability of dental care in rural communities will provide a framework for community leaders, elected officials, and health care providers to collect and analyze data to support future decision making in response to community health care needs. Such decisions increase the quality and efficiency of health care services, thereby safeguarding the health status of the population. This study found that the capability for hospital-based dental care services is greater in urban communities, whereas rural communities have significantly less capability for hospital dental care. This would support the premise that the availability of dental services is inconsistent across the United States and that dental care resources could be allocated to provide a consistent level of services across the population. It also emphasizes the importance of building innovative partnerships among local, state, and national organizations to ensure that an appropriate level of dental care is available in rural America. The study has managerial implications on meeting the demand for dental care in rural communities and policy implications on future resource allocation.
Collapse
Affiliation(s)
- Jeffrey P Harrison
- Department of Public Health, University of North Florida, Jacksonville 32224, USA.
| | | | | |
Collapse
|
36
|
Skinner AC, Slifkin RT, Mayer ML. The Effect of Rural Residence on Dental Unmet Need for Children With Special Health Care Needs. J Rural Health 2006; 22:36-42. [PMID: 16441334 DOI: 10.1111/j.1748-0361.2006.00008.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. OBJECTIVE To examine the effects of rural residence on unmet dental need for CSHCN. METHODS We use the nationally representative National Survey of CSHCN Needs. We performed logistic regression to estimate the independent effects of rural residence on the likelihood of having an unmet dental need, using a measure of unmet need based on professional society recommendations and a measure based on parental report. RESULTS Using either of the measures, a substantial percentage of CSHCN do not receive all needed dental care. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Our results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need. CONCLUSION Traditional access barriers for rural children, such as inadequate provider supply and lack of insurance, may increase unmet needs both directly and indirectly, through their effects on parents' perceptions of need. Reducing unmet needs for dental care in rural children with special needs will require addressing both access issues and parents' understanding of dental care need.
Collapse
Affiliation(s)
- Asheley Cockrell Skinner
- Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | | | | |
Collapse
|
37
|
Abstract
Self-report is an efficient and accepted means of assessing many population characteristics, risk factors, and diseases, but has rarely been used for periodontal disease (chronic periodontitis). The availability of valid self-reported measures of periodontal disease would facilitate epidemiologic studies on a much larger scale, allow for integration of new studies of periodontal disease within large ongoing studies, and facilitate lower-cost population surveillance of periodontitis. Several studies have been conducted to validate self-reported measures for periodontal disease, but results have been inconsistent. In this report, we conducted a systematic review of the validation studies. We reviewed the 16 studies that assessed the validity of self-reported periodontal and gingivitis measures against clinical gold standards. Seven of the studies included self-reported measures specific to gingivitis, four included measures only for periodontitis, and five included both gingivitis and periodontal measures. Three of the studies used a self-assessment method where they provided the patient with a detailed manual for performing a self-exam. The remaining 13 studies asked participants to self-report symptoms, presence of periodontal disease itself, or their recollection of a dental health professional diagnosing them or providing treatment for periodontal disease. The review indicates that some measures showed promise, but results varied across populations and self-reported measures. One example of a good measure is, "Has any dentist/hygienist told you that you have deep pockets?", which had a sensitivity of 55%, a specificity of 90%, positive predictive value of 77%, and negative predictive value of 75% against clinical pocket depth. Higher validity could be potentially obtained by the use of combinations of several self-reported questions and other predictors of periodontal disease.
Collapse
Affiliation(s)
- B Blicher
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | | | | |
Collapse
|
38
|
Wu B, Tran TV, Khatutsky G. Comparison of utilization of dental care services among Chinese- and Russian-speaking immigrant elders. J Public Health Dent 2005; 65:97-103. [PMID: 15929547 DOI: 10.1111/j.1752-7325.2005.tb02793.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of the study was to identify factors predictive of use of dental services among Chinese- and Russian-speaking immigrant elders. METHODS The data for this analysis were collected from the 1997 survey "Assessing public health and health care needs of Russian-speaking elderly immigrants." A similar survey was replicated among Chinese-speaking elderly immigrants in 2000. Community-based samples of 300 Russian elders and 177 Chinese elders were recruited for the study. RESULTS Chinese elders used dental care services at lower rates than Russian elders. Education, length of stay in the U.S., social support, and smoking behavior were significant predictors for the use of dental services among Chinese. However, among Russian elders, age, income, and denture use predicted utilization of dental services. CONCLUSIONS Although Chinese- and Russian-speaking elders have similar immigrant experiences and share the same geographic location and urban setting, the two groups have different patterns of dental service use. These differences may be due to differences in socio-demographic characteristics, values, attitudes and knowledge of oral health and dental care, and unique cultural backgrounds.
Collapse
Affiliation(s)
- Bei Wu
- Center on Aging and Department of Community Medicine, West Virginia University, P.O. Box 9127, Morgantown, WV 26506, USA.
| | | | | |
Collapse
|