Underutilization of Dental Care When It Is Freely Available: A Prospective Study of the New England Children's Amalgam Trial

Exploring the state and influential factors of dental caries in preschool children aged 3-6 years in Xingtai City

OBJECTIVE

To explore the main factors affecting early dental caries among preschool children aged 3-6 years in Xingtai City to formulate effective preventive measures.

METHODS

A cross-sectional study was conducted on 570 preschool children aged 3-6 years in Xingtai City through questionnaire surveys and oral examinations to understand their dental caries situation. Multifactorial logistic regression analysis was used to analyse the main influencing factors for the occurrence of dental caries in preschool children.

RESULTS

Univariate analysis showed statistically significant differences in age (χ2 = 2.636, p = 0.008), father's education level (χ2 = 4.207, p < 0.001), mother's education level (χ2 = 4.217, p < 0.001), daily tooth brushing frequency (χ2 = 3.160, p = 0.002), age of starting tooth brushing (χ2 = 8.756, p < 0.001), mouth rinsing after meals (χ2 = 89.401, p < 0.001), Streptococcus mutans positivity (χ2 = 133.503, p < 0.001), non-sweet snack consumption frequency (χ2 = 5.962, p < 0.001), snack flavour preference (χ2 = 116.119, p < 0.001), use of fluoridated toothpaste (χ2 = 75.639, p < 0.001), regular oral examinations (χ2 = 98.711, p < 0.001), sugary drink consumption frequency (χ2 = 10.370, p < 0.001) and sweet food consumption frequency (χ2 = 9.261, p < 0.001) between the caries and non-caries groups. Multifactorial analysis revealed that older age (odds ratio [OR] = 5.342, 95% confidence interval [CI]: 1.434-6.631), later initiation of tooth brushing (OR = 3.244, 95% CI: 2.413-5.424), S. mutans positivity (OR = 5.357, 95% CI: 4.529-8.563), high snack consumption frequency (OR = 3.452, 95% CI: 2.634-5.442), high sugary drink consumption frequency (OR = 4.414, 95% CI: 2.534-6.451) and high sweet food consumption frequency (OR = 4.531, 95% CI: 3.421-6.354) were risk factors for dental caries. Higher father's educational level (OR = 0.724, 95% CI: 0.564-0.891), higher mother's educational level (OR = 0.641, 95% CI: 0.601-0.813), high daily tooth brushing frequency (OR = 0.572, 95% CI: 0.423-0.864), mouth rinsing after meals (OR = 0.743, 95% CI: 0.643-0.813), use of fluoridated toothpaste (OR = 0.657, 95% CI: 0.553-0.931) and regular oral examinations (OR = 0.443, 95% CI: 0.352-0.747) were protective factors against dental caries (all p < 0.05).

CONCLUSION

Multiple factors result in early dental caries in preschool children aged 3-6 years; however, the most influential factors are older age and high snack consumption, as well as high sugary and sweet food/drink consumption.

Navigating Barriers to Oral Health Challenges Faced by Children With Autism Spectrum Disorder: A Scoping Review

This article identifies the multifaceted challenges that hinder optimal oral health among children diagnosed with autism spectrum disorder (ASD). While dental care is a fundamental aspect of overall well-being, children with ASD encounter unique obstacles that often go unnoticed. Drawing from a comprehensive review of existing literature and insights from healthcare professionals, this article explores the sensory sensitivities, communication difficulties, and behavioral issues that contribute to suboptimal oral hygiene in this demographic. We also discuss the critical role of caregivers, dentists, and educators in addressing these challenges, emphasizing the importance of early intervention and tailored strategies to improve the oral health of children with ASD. By shedding light on these obstacles, this article aims to foster a more inclusive and holistic approach to oral healthcare for children with ASD, ultimately enhancing their overall quality of life.

Impact of health insurance on the use of oral health services in the Peruvian population 2015-2019

BACKGROUND

The high treatment cost of oral diseases is a barrier for accessing oral health services (OHS), particularly in low-income countries. Therefore, this study aimed to evaluate the impact of health insurance on the use of OHS in the Peruvian population from 2015 to 2019.

METHODS

We conducted a prospective, longitudinal study of secondary data using the National Household Survey (ENAHO) 2015-2019 panel databases, which collected information from the same participants during each of the five years. The dependent variable was the use of OHS in the three months prior to the survey (yes/no). The independent variable was health insurance affiliation (four years or less/all five years). Both were measured by survey questions. Generalized estimating equation (GEE) Poisson regression models with robust standard errors were used to estimate the relative risk (RR) associated with use of OHS.

RESULTS

We included 4064 individuals distributed in 1847 households, who responded to the survey during each of the five years. The adjusted GEE model showed that those who had health insurance during all five years without interruption were more likely to attend OHS than those who had insurance for four years or less (adjusted relative risk [aRR]: 1.30; 95%CI: 1.13-1.50). In addition, we carried out a sensitivity analysis by recategorizing the independent variable into three categories (never/some years/ all five years), which also showed (aRR: 1.45; 95%CI: 1.11-1.89) that participants with health insurance during all five years were more likely to have used OHS than those who never had insurance.

CONCLUSION

Therefore, in the Peruvian context, health insurance affiliation was associated with greater use of OHS. The panel data used derives from a subsample of consecutive nationally representative samples, which may have led to a loss of representativeness. Furthermore, the data was collected between 2015 and 2019, prior to the onset of the COVID-19 pandemic, and insurance conditions may have changed.

Two years outcome of an individualized oral health preventive program for preschool children with neurodevelopmental disorders

AIMS

Limited data exist on the effectiveness of oral health preventive programs in children with Neurodevelopmental Disorders (NDD). The aim of this study was to evaluate the effectiveness of an individualized preventive oral health program for preschool children with NDD at a rehabilitation center, over a two years period.

METHODS AND RESULTS

In this study, 102 preschool children with NDD were assessed for caries (dmft), oral hygiene status (Green & Vermillion Index) and presence of developmental dental defects. An individualized preventive program was applied based on caries risk and children were followed for two years. Effectiveness of the program was assessed for caries and dental plaque change and explanatory individual factors were used in multivariate models. After two years prospective, dmft increased significantly from 1.1 (SD = 2.7) to 2.04 (SD = 3.6), while GVPI was reduced significantly from 1.8 (SD = 0.9) to 1.4 (SD = 0.9). Children in the moderate and high-risk groups missed significantly more follow-ups compared to the low caries risk group (p < .001) while older maternal age (OR = 1.38, 95%CI = 1.057-1.808) and consumption of more than three sugary snacks/day (OR = 0.005, 95%CI = 0-0.0794) were significantly correlated with dental caries.

CONCLUSION

The individualized preventive program for preschool children with NDD was effective in improving oral hygiene but not dental caries status.

Dental care utilization among developmentally disabled adolescents experiencing difficulty with decayed teeth: A population-level study

AIMS

To determine if adolescents with developmental disabilities (DDs) who experienced difficulty with dental caries differed by dental visits in the past 12 months and receipt of preventive services (fluoride treatment and dental sealants) during those visits compared to adolescents with no DDs or difficulty with dental caries.

METHODS AND RESULTS

A cross-sectional study was conducted using data of 91 196 adolescents aged 10-17 years from the 2016-2020 National Survey of Children's Health. Descriptive and bivariate statistics and multivariable regression models were conducted. We derived the odds ratio for visiting a dental office (OR: 0.76, 95% CI: 0.57-1.03, p = .07), receiving fluoride treatments (OR: 1.20, 95% CI: 1.01-1.43, p = .04), and dental sealants (OR: 1.44, 95% CI: 1.19-1.75, p < .001) for DD adolescents who experienced difficulty with dental caries compared to adolescents with no DDs or difficulty with dental caries.

CONCLUSIONS

DD adolescents who experienced difficulty with dental caries were more likely to receive fluoride treatments and sealants during dental visits but were equally likely to have a dental visit in the past 12 months than adolescents with no DDs or difficulty with dental caries.

Non-utilization of oral health services and associated factors among children and adolescents: an integrative review

OBJECTIVE

To review publications exploring non-utilization of oral health services and to identify factors associated with non-utilization of oral health services among children and adolescents.

MATERIALS AND METHODS

An integrative review design was adopted. A search was conducted for research articles published during the period from 2000 to April 2021 in five databases, Medline via Ovid, Scopus, CINAHL, Cochrane Library and Web of Science. Inclusion criteria were original articles examining non-utilization of oral health services among 0-19 years old and studies published in peer-reviewed journals in English. Thematic analysis was undertaken to identify common themes. The Newcastle-Ottawa scale was used to evaluate the quality of the studies.

RESULTS

Twenty-one geographically diverse articles were included. Nineteen studies were cross-sectional, one was a prospective cohort and one a case-control study. Non-utilization of dental health services tended to be higher in children than adolescents. There were predisposing (age, gender, ethnicity, parent's level of education), enabling (family income, dental insurance) and need factors (subjective and objective oral health related parameters) that had been shown to be associated with non-utilization of dental services among children and adolescents.

CONCLUSIONS

This integrative review found predisposing, enabling and need factors to be associated with dental health service non-utilization.

The impact of dental care programs on healthcare system and societal outcomes: a scoping review

BACKGROUND

Dental diseases have detrimental effects on healthcare systems and societies at large. Providing access to dental care can arguably improve health outcomes, reduce healthcare utilization costs, and improve several societal outcomes.

OBJECTIVES

Our objective was to review the literature to assess the impacts of dental care programs on healthcare and societal outcomes. Specifically, to identify the nature of such programs, including the type of services delivered, who was targeted, where services were delivered, and how access to dental care was enabled. Also, what kind of societal and healthcare outcomes have been attempted to be addressed through these programs were identified.

METHODS

We conducted a scoping review by searching four databases, MEDLINE, EMBASE, CINAHL, and Sociological Abstracts. Relevant articles published in English language from January 2000 to February 2022 were screened by four reviewers to determine eligibility for inclusion.

RESULTS

The search resulted in 29,468 original articles, of which 25 were included in the data synthesis. We found minimal evidence that answers our proposed research question. The majority of identified programs have demonstrated effectiveness in reducing medical and dental healthcare utilization (especially for non-preventive services) and avert more invasive treatments, and to a lesser degree, resulting in cost-savings. Moreover, some promising but limited evidence about program impacts on societal outcomes such as reducing homelessness and improving employability was reported.

CONCLUSION

Despite the well-known societal and economic consequences of dental problem, there is a paucity of studies that address the impacts of dental care programs from the societal and healthcare system perspectives.

MESH TERMS

Delivery of Health Care, Dental Care, Outcome assessment, Patient acceptance of Health Care.

Barriers and facilitators to attending dental care appointments among adults in low- and middle-income countries: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify the barriers and facilitators to attending dental care appointments among adults in low- and middle-income countries.

INTRODUCTION

Missed dental appointments are a well-recognized problem in dental care, widely contributing to adverse health care outcomes. Patients' adherence to dental appointments plays a vital role in improving and maintaining oral health. This scoping review will identify and synthesize barriers and facilitators that influence adults in keeping dental appointments.

INCLUSION CRITERIA

Studies focusing on barriers and facilitators to dental appointment attendance among adults will be included. The study will include public, private, and university-based dental clinical settings and will be limited to low- and middle-income countries. There will be no restrictions on the source of evidence (primary studies or text/opinion studies) or study design (qualitative or quantitative studies).

METHODS

The review will follow the JBI methodology for scoping reviews. Studies will be searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Dentistry and Oral Sciences Source, and Scopus. Databases will be searched from inception until the present. ProQuest Dissertations and Theses, OAIster, International Association for Dental Research conference abstracts, and Google Scholar will be searched for unpublished studies. Study screening will be performed by two reviewers, and data extraction will be done using a customized data extraction form. Barriers and facilitators will be categorized based on the Theoretical Domains Framework. The tabulated data and figures will be accompanied by a narrative summary of barriers and facilitators to attending dental care appointments, which may be used to guide further research.

SCOPING REVIEW PROTOCOL REGISTRATION

Open Science Framework osf.io/mny8h.

Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis

Background

Underutilization of health services among chronic non-communicable disease sufferers, especially for hypertension (HBP) and diabetes mellitus (DM), was considered as a significant contributing factor to substantial cases in terms of both avoidable morbidity and mortality. However, evidence on health services underutilization and its associated factors in poverty-stricken areas remain scarce based on previous literature. This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which are expected to provide practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner.

Methods

Data were collected from a cross-sectional survey conducted through face-to-face interviews among 2413 patients from six counties in rural central China in 2019. The Anderson behavioral model was adopted to explore the associated factors. A two-level logistic model was employed to investigate the association strengths reflected by adjusted odds ratios (AOR) and 95% confidence intervals in forest plots.

Results

On average, 17.58% of the respondents with HBP and 14.87% with DM had experienced health services underutilization during 1 month before the survey. Multilevel logistic regression indicated that predisposing factors (age), enabling factors (income and a regular source of care), and need factors (self-reported health score) were the common predictors of health service underutilization both for hypertensive and diabetic patients in impoverished areas, among which obtaining a regular source of care was found to be relatively determinant as a protective factor for health services underutilization after controlling for other covariates.

Conclusions

Our results suggested that the implementation of a series of comprehensive strategies should be addressed throughout policy-making procedures to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Our findings are expected to provide practical implications for other developing countries confronted with similar challenges resulting from underdeveloped healthcare systems and aging population structures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06725-5.

The Association of Social Determinants of Health with Somali Refugee Mother-Child Caries

Minnesota has the largest population of Somali refugees with the majority depending on public insurance for dental care. The social determinants of health (SDOH) framework is helpful to identify factors that may be related to oral health, and subsequently plan for public health initiatives. The purpose of this study was to measure the correlation between Somali refugee mother-child caries experience, and to identify associations between SDOH factors and child caries. The study was conducted in day care facilities where oral screenings and surveys identified SDOH factors at the individual, provider, community and environmental levels. A positive correlation was found between mother-child caries experience. Factors associated with child caries (p ≤ 0.05) were found at all SDOH levels except the provider level though only individual level factors for mothers and children yielded the expected results. SDOH affecting child caries were limited to individual demographic, behavioral and attitudinal factors.

Test of an organizational change model to reduce no-shows in dental care settings

OBJECTIVES

To test the feasibility and preliminary effectiveness of the NIATx model for organizational change to reduce appointment no-shows in dental care settings.

METHODS

The NIATx Dental Pilot Study used a clustered prepost interventional design and a mixed-methods approach. Five independent dental clinics serving Medicaid enrollees were recruited. Quantitative data on the impact of the NIATx model were complemented by qualitative assessment information collected from dental staff. The NIATx model was applied through a multisite learning collaborative that engaged participating organizations in adopting targeted no-show best practices. The primary outcome measure was no-show data collected at the preintervention phase (5 months), intervention phase (7 months), and postintervention phase (3 months).

RESULTS

Female patients were in the majority (median 54.5 percent). Mean age ranged from 8 to 50 (median 35.2) years. The median percentage for Hispanics was 11.0 percent, and the proportion of uninsured patients was 25 percent. Preintervention no-show rates ranged from 14 percent (clinic B) to 38 percent (clinic E). All clinics had lower no-show rates during the postintervention period, with decreases ranging from 1 percent (clinic B) to 13 percent (clinic E). Overall, the no-show rates decreased in the study.

CONCLUSIONS

The study demonstrated the feasibility of applying the NIATx model to reduce no-show rates, with some difficulty observed with sustainability across dental practices during the postintervention period.

Increase in dental caries and change in the socioeconomic profile of families in a child cohort of the primary health care in Northeast Brazil

Background

Factors associated with increases in dental caries and changes in the family socioeconomic profile were investigated in a paediatric primary health care (PHC) cohort in Northeast Brazil during the implementation of social and income transfer programmes.

Method

A prospective analytical study compared data from two surveys on caries in primary dentition conducted in 2006 (age: 18–36 months, n = 1045) and 2010 (age: 5–7 years). Data from the sample recruited and re-examined in 2010 (n = 469) were analysed. Prevalences (P) and the mean primary decayed, missing and filled teeth (dmft) index, cumulative incidence and mean increase were calculated. Differences (p ≤ 0.05 and 95% CI) in dmft ≥1 were identified via McNemar’s test. Differences in the mean dmft were evaluated according to socioeconomic variables (Kruskal-Wallis test and p ≤ 0.05). Multivariate analysis with a negative binomial model was used for the risk factors associated with increasing dmft. In the univariate analyses, nonparametric methods (Kruskal-Wallis test) were used to compare subsamples. Variables with p ≤ 0.20 were included in the multivariate model and retained when p ≤ 0.05.

Results

The prevalence and mean dmft (18–36 months and 5–7 years: p = 28.6 and 68.9%, mean = 1.01 and 3.46, respectively) and variation in mean dmft changed significantly (p < 0.005) with the education level and occupation of the mother; the prevalence and mean dmft were lower for higher maternal education level and maternal participation in the labour market. The cumulative incidence and mean increase in dmft were 8.71% and 2.45, respectively. Common risk predictors for increases in caries were consumption of sweets (RR = 1.53, 95% CI 1.09–2.14) and attendance at public schools (RR = 1.49, 95% CI: 1.81–1.89). Use of private clinical services was a protective factor (RR = 0.68, 95% CI 0.54–0.87).

Conclusion

Increases in caries were observed despite positive changes in the distribution of socioeconomic indicators for the analysed children’s families. The risk factors identified for the increase in caries suggest ongoing problems regarding the effectiveness of intersectoral and health measures for controlling caries in populations exposed to PHC programmes.

Research Evidence Use in Early and Periodic Screening, Diagnostic, and Treatment Dental Medicaid Class Action Lawsuits

Little is known about research evidence use in dental Medicaid class action lawsuits. This qualitative study develops a conceptual model to understand the role of dentists and how research evidence was used. Archival analyses were conducted and 15 key informants interviewed. Dentists had key roles requiring scientific expertise or clinical experience serving vulnerable populations. Most evidence was newly generated, not based on existing sources. Dentists were involved in all phases of the lawsuits. Future research should identify conditions fostering research evidence use in dental Medicaid lawsuits and whether high-quality research evidence use improves child health outcomes.

The association between oral health literacy and missed dental appointments

BACKGROUND

In this study, the author identified associations among demographic characteristics, dental risk factors, health-seeking behaviors, oral health literacy level, and failure to keep dental appointments.

METHODS

The author conducted an unmatched 1:2 case-control study at a university-based dental clinic from February through April 2015. The author used the Comprehensive Measure of Oral Health Knowledge questionnaire to record the oral health literacy of the respondents. The author obtained additional information about the various covariates using a questionnaire and checking the patients' electronic medical records. The author used a multivariate logistic regression analysis to test the associations between missed appointments and other risk factors in addition to oral health literacy.

RESULTS

Data from 150 (50 case patients and 100 control patients) respondents were included in the analysis. The case and control patients were comparable in terms of sociodemographic characteristics and dental risk factors. The Comprehensive Measure of Oral Health Knowledge score was used to categorize the sample into low (≤ 18) and high (> 18) oral health literacy groups. Low oral health literacy was associated with a 2-fold increase in the risk of having missed appointments (adjusted odds ratio, 2.38; 95% confidence interval, 1.05-5.40). Age was also independently associated with missed appointments (adjusted odds ratio, 1.03; 95% confidence interval, 1.01-1.06).

CONCLUSIONS

After adjusting for the various demographic and dental risk factors, poor oral health literacy was found to be independently associated with missed dental appointments. Insights into the role of oral health literacy and clinic attendance could play an important role in addressing the problem of missed dental appointments.

PRACTICAL IMPLICATIONS

Considering the effects of missed appointments on treatment outcomes, predictors of patient compliance behaviors may be useful in circumventing cancellations and no shows.

A Pilot Study of Reasons and Risk Factors for "No-Shows" in a Pediatric Neurology Clinic

Missed clinic appointments lead to decreased patient access, worse patient outcomes, and increased healthcare costs. The goal of this pilot study was to identify reasons for and risk factors associated with missed pediatric neurology outpatient appointments ("no-shows"). This was a prospective cohort study of patients scheduled for 1 week of clinic. Data on patient clinical and demographic information were collected by record review; data on reasons for missed appointments were collected by phone interviews. Univariate and multivariate analyses were conducted using chi-square tests and multiple logistic regression to assess risk factors for missed appointments. Fifty-nine (25%) of 236 scheduled patients were no-shows. Scheduling conflicts (25.9%) and forgetting (20.4%) were the most common reasons for missed appointments. When controlling for confounding factors in the logistic regression, Medicaid (odds ratio 2.36), distance from clinic, and time since appointment was scheduled were associated with missed appointments. Further work in this area is needed.

Life course experiences and lay diagnosis explain low-income parents' child dental decisions: a qualitative study

OBJECTIVE

This study aimed to better understand low-income parents' child dental care decisions through a life course approach that captured parents' experiences within the social context of poverty.

METHODS

We conducted 43 qualitative life history interviews with 10 parents, who were long-term social assistance recipients living in Montreal, Canada. Thematic analysis involved interview debriefing, transcript coding, theme identification and data interpretation.

RESULTS

Our interviews identified two emergent themes: lay diagnosis and parental oral health management. Parents described a process of 'lay diagnosis' that consisted of examining their children's teeth and interpreting their children's oral signs and symptoms based on their observations. These lay diagnoses were also shaped by their own dental crises, care experiences and oral health knowledge gained across a life course of poverty and dental disadvantage. Parents' management strategies included monitoring and managing their children's oral health themselves or by seeking professional recourse. Parents' management strategies were influenced both by their lay diagnoses and their perceived ability to manage their children's oral health. Parents felt responsible for their children's dental care, empowered to manage their oral health and sometimes forgo dental visits for their children because of their own self-management life history.

CONCLUSION

This original approach revealed insights that help to understand why low-income parents may underutilize free dental services. Further research should consider how dental programs can nurture parental empowerment and capitalize on parents' perceived ability to diagnose and manage their children's oral health.

Oral Health Disparities and Unmet Dental Needs among Preschool Children in Chelsea, MA: Exploring Mechanisms, Defining Solutions

BACKGROUND

Significant disparities exist in children's receipt of preventive dental care (PDC) in the United States. Many of the children at greatest risk of dental disease do not receive timely PDC; when they do receive dental care, it is often more for relief of dental pain. Chelsea is a low-income, diverse Massachusetts community with high rates of untreated childhood caries. There are various dental resources available in Chelsea, yet many children do not access dental care at levels equivalent to their needs.

OBJECTIVE

Using Chelsea as a case-study, to explore factors contributing to forgone PDC (including the age 1 dental visit) in an in-depth way.

METHODS

We used a qualitative study design that included semi-structured interviews with parents of preschool children residing in Chelsea, and Chelsea-based providers including pediatricians, dentists, a dental hygienist and early childhood care providers. We examined: a) parents' dental attitudes and oral health cultural beliefs; b) parents' and providers' perspectives on facilitators and barriers to PDC, reasons for unmet needs, and proposed solutions to address the problem. We recorded, transcribed and independently coded all interviews. Using rigorous, iterative qualitative data analyses procedures, we identified emergent themes.

RESULTS

Factors perceived to facilitate receipt of PDC included Head-Start oral health policies, strong pediatric primary care/dental linkages, community outreach and advertising, and parents' own oral health experiences. Most parents and providers perceived there to be an adequate number of accessible dental services and resources in Chelsea, including for Medicaid enrollees. However, several barriers impeded children from receiving timely PDC, the most frequently cited being insurance related problems for children and adults. Other barriers included limited dental services for children <2 years, perceived poor quality of some dental practices, lack of emphasis on prevention-based dental care, poor care-coordination, and insufficient culturally-appropriate care. Important family-level barriers included parental oral health literacy, cultural factors, limited English proficiency and competing priorities. Several solutions were proposed to address identified barriers.

CONCLUSION

Even in a community with a considerable number of dental resources, various factors may preclude access to these services by preschool-aged children. Opportunities exist to address modifiable factors through strategic oral health policies, community outreach and improved care coordination between physicians, dentists and early childhood care providers.

The association between oral health literacy and failed appointments in adults attending a university-based general dental clinic

OBJECTIVES

The purpose of this study is to determine the association between personal characteristics, a person's oral health literacy, and failing to show for dental appointments at a university dental clinic.

METHODS

A secondary data analysis was conducted on data collected from 200 adults at a university dental clinic between January 2005 and December 2006. In the original study, an oral health literacy instrument, the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D), was administered, sociodemographic and health information seeking behavior was gathered, and electronic records were reviewed.

RESULTS

Descriptive and bivariate analyses and a classification and regression tree (CART) analysis were conducted. Seeking health information through fewer sources vs. multiple sources was the strongest predictor of failing to show. The subjects' oral health literacy, as measured by the REALM-D List 3 score, was the next most significant variable. Classification and regression tree analyses also selected gender, chief complaint, age, and payment type as predictor variables.

CONCLUSIONS

Multiple factors contribute to failing to show for dental appointments. However, individuals who use fewer sources of oral health information, a subset of health literacy skills, are more likely to fail to show for dental appointments.

Determinantes individuais e contextuais da cárie em crianças brasileiras de 12 anos em 2010

OBJETIVO: Estimar a prevalência e gravidade de cárie em crianças brasileiras e sua associação com fatores individuais e contextuais. MÉTODOS: Foram utilizados os dados da Pesquisa Nacional de Saúde Bucal (SBBrasil 2010), em uma amostra de 7.247 crianças de 12 anos. Os dados foram coletados por meio de exames clínicos e entrevistas. As variáveis dependentes foram as prevalências de cárie (dentes permanentes cariados, perdidos ou obturados [CPOD] ≥ 1 e CPOD ≥ 4). Foram realizadas análises bivariadas (teste de Rao-Scott) e multinível (regressão de Poisson). As variáveis individuais foram sociodemográficas, condição periodontal e relato de incômodo ao escovar os dentes. Os fatores contextuais foram a presença de água fluoretada, a porcentagem de domicílios ligados à rede de abastecimento de água e a renda mediana do município. RESULTADOS: A prevalência de CPOD ≥ 1 foi 56,0%. O CPOD médio foi igual a 2,04 (IC95% 1,76;2,31) e 22,2% das crianças tinham CPOD ≥ 4. A experiência de cárie foi significantemente mais elevada em crianças de cor de pele preta, parda e amarela; em famílias com renda mais baixa; em crianças com cálculo dentário ou sangramento gengival; e naquelas que relataram incômodo ao escovar. Viver em cidades sem água fluoretada, com menor cobertura da rede de abastecimento de água e com renda mediana baixa foram fatores contextuais associados à doença. CONCLUSÕES: A prevalência de cárie em crianças brasileiras de 12 anos foi baixa, de acordo com os critérios da Organização Mundial da Saúde. Houve significantes desigualdades geográficas e socioeconômicas nos níveis da doença.

Oral health care for children in countries using dental therapists in public, school-based programs, contrasted with that of the United States, using dentists in a private practice model

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children's access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices.

County-level determinants of dental utilization for Medicaid-enrolled children with chronic conditions: how does place affect use?

Little is known about how place affects childrens' access to dental care. We analyzed data for 25,908 Iowa Medicaid-enrolled children with chronic conditions to identify the county-level determinants of dental utilization. Our analyses suggest that higher levels of poverty and designation as a dental health professional shortage area at the county-level are associated with lower probability of child-level dental use. There are significant interactions between child-level race/ethnicity and county-level poverty as well as between child-level disability and county-level unemployment. We present a new descriptive model on dental utilization that emphasizes county-level factors as well as interactions between county-level and child-level factors.

Racial and ethnic disparities in utilization of dental services among children in Iowa: the Latino experience

OBJECTIVES

We sought to understand the role of Latino acculturation in dental care utilization in Iowa children.

METHODS

We used logistic regression to evaluate factors associated with having a previous-year dental check-up with 2005 Iowa Child and Family Household Health Survey data. We constructed models to examine the association with race/ethnicity and used chosen interview language to measure Latino acculturation.

RESULTS

After we controlled for several factors, having a regular dental care source, having a dental need, dental insurance status, family income, children's dental health rating, children's age, and brushing habits were associated with having a previous-year dental check-up. Race/ethnicity was indirectly associated with use of dental services through other related factors with significant differences for less-acculturated Latinos.

CONCLUSIONS

Policymakers and health planners should implement strategies to address individual, community, and system factors affecting racial/ethnic minorities. A regular source of dental care for Latino children that will enhance their access to services should be ensured. Ignoring the needs of the fastest growing segment of children with the poorest oral health and the least access to care will lead to future increase of oral diseases in this population.

Wisconsin Medicaid enrollees' recurrent use of emergency departments and physicians' offices for treatment of nontraumatic dental conditions

BACKGROUND

Medicaid enrollees experience a number of barriers that prevent them from seeking care in dental offices, leading some to repeatedly seek treatment for nontraumatic dental conditions (NTDCs) in emergency departments (EDs) and physicians' offices (POs). The authors examined the rate of return visits to EDs and POs for treatment of NTDCs among Wisconsin Medicaid enrollees and sought to characterize frequent and typical users of such care in this population.

METHODS

The authors conducted a retrospective analysis of all Wisconsin Medicaid dental claims for NTDCs to EDs and POs from 2001 through 2003. They used finite mixture models, allowing for covariate dependence, to model separate rates of return for NTDC-related visits corresponding to typical and frequent users of EDs and POs.

RESULTS

Overall, 23,999 enrollees had made NTDC-related visits to EDs and POs, with 6.5 percent estimated to be frequent users of such care. Typical and frequent users had a mean (± standard error) rate of return visits of 0.2 ± 0.01 and 4.0 ± 0.08 per year, respectively. Male enrollees and people aged 19 to 42 years were more likely to be frequent users, with African American and Hispanic enrollees having lower odds of being frequent users than did white enrollees. The effect of living in an area with a shortage of dental health care professionals did not affect the likelihood of being a frequent user of EDs and POs for such care.

CONCLUSIONS

Male and middle-aged enrollees were significantly more likely to be frequent users of EDs and POs for treatment of NTDCs. Compared with white enrollees, African American and Hispanic enrollees were less likely to be frequent users and had lower rates of recurrent visits for NTDCs among typical users.

CLINICAL IMPLICATIONS

Improved access to dental care for Medicaid enrollees that is best managed by dental care providers should reduce the rates of recurrent NTDC-related visits to EDs and POs.

Inequalities in dental services utilization among Brazilian low-income children: the role of individual determinants

OBJECTIVES

To assess the role of the individual determinants on the inequalities of dental services utilization among low-income children living in the working area of Brazilian's federal Primary Health Care program, which is called Family Health Program (FHP), in a big city in Southern Brazil.

METHODS

A cross-sectional population-based study was performed. The sample included 350 children, ages 0 to 14 years, whose parents answered a questionnaire about their socioeconomic conditions, perceived needs, oral hygiene habits, and access to dental services. The data analysis was performed according to a conceptual framework based on Andersen's behavioral model of health services use. Multivariate models of logistic regression analysis instructed the hypothesis on covariates for never having had a dental visit.

RESULTS

Thirty one percent of the surveyed children had never had a dental visit. In the bivariate analysis, higher proportion of children who had never had a dental visit was found among the very young, those with inadequate oral hygiene habits, those without perceived need of dental care, and those whose family homes were under absent ownership. The mechanisms of social support showed to be important enabling factors: children attending schools/kindergartens and being regularly monitored by the FHP teams had higher odds of having gone to the dentist, even after adjusting for socioeconomic, demographic, and need variables.

CONCLUSIONS

The conceptual framework has confirmed the presence of social and psychosocial inequalities on the utilization pattern of dental services for low-income children. The individual determinants seem to be important predictors of access.

Disparities in child access to emergency care for acute oral injury

OBJECTIVE

We examined the impact of insurance status on dental practices' willingness to schedule an appointment for a child with a symptomatic fractured permanent front tooth.

PATIENTS AND METHODS

Between February and May 2010, 6 research assistants posed as mothers of a 10-year-old boy seeking an urgent dental appointment. Two calls 4 weeks apart, with the same clinical scenario, were made by the same caller to a stratified random sample of dental practices, one-half of which were enrolled in the state's combined Medicaid and Children's Health Insurance Program (CHIP) dental program. The only difference in the calls was the child's insurance coverage (Medicaid/CHIP versus private Blue Cross dental coverage). We estimated differences in the log-odds probability of scheduling an appointment for a child with public versus private insurance by using exact conditional (fixed-effects) logistic regression, which accounts for paired data.

RESULTS

Of 170 paired calls to 85 dental practices (41 participating in the Medicaid program), only 36.5% of Medicaid beneficiaries obtained any appointment compared with 95.4% of Blue Cross-insured children with the same oral injury. Among dental providers enrolled in the Medicaid program, children with Medicaid were still 18.2 times more likely to be denied an appointment than privately insured counterparts (95% confidence interval: 3.1 to ∞; P < .001).

CONCLUSIONS

Illinois dentists, including those participating in Medicaid, are less likely to see a child for an urgent dental complaint if the child has public versus private dental coverage. These results have implications for developing policies that improve access to oral health care.

Association between parents' and children's use of oral health services

OBJECTIVE

Several parental factors influence children's use of oral health services. Some localized studies have shown that children's dental use patterns correlate positively with those of their parents. The objective of this study was to investigate associations between parents' and children's oral health-seeking behaviors among a representative sample of US children.

METHODS

We used the 2007 National Health Interview Survey to analyze a sample of children aged 2 to 17 years, matched with 1 parent. Using logistic regression, we examined associations between parents' and children's use of dental services and deferred dental care because of cost.

RESULTS

The sample included 6107 child-parent pairs. Overall, 77% of children and 64% of parents had a dental visit in the previous 12 months. Adjusting for sociodemographic and use variables, children were more likely to have a dental visit when their parents also had a dental visit (adjusted odds ratio: 3.36 [95% confidence interval: 2.71-4.18]), compared with children of parents who did not have a dental visit. In addition, compared with children of parents who did not defer seeking dental care, children of parents who deferred their dental care because of cost were more likely to have care deferred because of cost as well (adjusted odds ratio: 12.47 [95% confidence interval: 9.09-17.11]).

CONCLUSIONS

Parental oral health-seeking behaviors for themselves may have an important effect on oral health-seeking behaviors on behalf of their children, regardless of the child's insurance status. Comprehensive strategies to eliminate barriers that target parents and not just children may help to address children's underuse of oral health services.