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Tan YR, Jawahir S, Doss JG. Oral healthcare seeking behavior of Malaysian adults in urban and rural areas: findings from the National Health and Morbidity Survey 2019. BMC Oral Health 2023; 23:719. [PMID: 37798660 PMCID: PMC10552245 DOI: 10.1186/s12903-023-03470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The development and implementation of appropriate strategies to enhance oral health in the community can be aided by an understanding of oral healthcare seeking behavior among urban and rural populations. The purpose of this study was to identify the factors associated with oral healthcare seeking behavior of the Malaysians in urban and rural locations who self-reported dental problems. METHODS The National Health and Morbidity Survey 2019, a cross-sectional nationwide household survey that focused on non-institutionalised Malaysians, provided the data for this study on adults in Malaysia who were 18 years of age and older. A two-stage stratified random sampling technique was employed to ensure national representativeness. Data was collected using a multilingual (Malay and English), structured, and validated questionnaire via face-to-face interviews from July to October 2019. The dependent variable was oral healthcare seeking behavior (sought oral healthcare and self-medication). Independent variables were predisposing, enabling and health needs factor based on Andersen's Behavioral Model. Descriptive statistics were used to describe the characteristics and oral healthcare seeking behavior of the respondents. The relationship between the independent and dependent variables were investigated using multivariable logistic regression analysis. RESULTS The analysis comprised a total of 10,134 respondents, representing about 18.2 million Malaysian adults aged 18 and above. The overall prevalence of Malaysian adults who self-reported dental problems was low (5.5%) and was slightly higher in the rural than urban population. Almost half sought treatment from healthcare practitioners, and almost a quarter self-medicated. Ethnicity was associated with seeking healthcare and self-medication among urban dwellers. Among the rural population, income level was associated with seeking healthcare while education level was associated with self-medication. CONCLUSION Disparities in oral healthcare seeking behaviors exist between Malaysians living in urban and rural areas. Future policies should adopt focused strategies that concentrate on oral healthcare accessibility and health literacy of the vulnerable and rural populations to achieve the best oral healthcare for this population group.
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Affiliation(s)
- Yeung R'ong Tan
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Jennifer Geraldine Doss
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Li Q, Wang Y, Knight JC, Yi Y, Ozbek S, Shariati M, Wang PP, Zhu Y. Dental health status, dentist visiting, and dental insurance of Asian immigrants in Canada. Int J Equity Health 2023; 22:73. [PMID: 37098603 PMCID: PMC10131415 DOI: 10.1186/s12939-023-01863-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/16/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVE This study examined the dental care utilization and self-preserved dental health of Asian immigrants relative to non-immigrants in Canada. Factors associated with oral health-related disparities between Asian immigrants and other Canadians were further examined. METHODS We analyzed 37,935 Canadian residents aged 12 years and older in the Canadian Community Health Survey 2012-2014 microdata file. Factors (e.g., demographics, socioeconomic status, lifestyles, dental insurance coverage, and year of immigration) associated with disparities in dental health (e.g., self-perceived teeth health, dental symptoms during past one month, and teeth removed due to decay in past one year) and service utilization (e.g., visiting dentist within the last three years, visiting dentist more than once per year) between Asian immigrants and other Canadians were examined using multi-variable logistic regression models. RESULTS The frequency of dental care utilization was significantly lower in Asian immigrants than their non-immigrant counterparts. Asian immigrants had lower self-perceived dental health, were less likely to be aware of recent dental symptoms, and more likely to report tooth extractions due to tooth decay. Low education (OR = 0.42), male gender(OR = 1.51), low household income(OR = 1.60), non-diabetes(OR = 1.87), no dental insurance(OR = 0.24), short immigration length (OR = 1.75) may discourage Asian immigrants from dental care utilization. Additionally, a perceived lack of necessity to dentist-visiting was a crucial factor accounting for the disparities in dental care uptake between Asian immigrants and non-immigrants. CONCLUSION Asian immigrants showed lower dental care utilization and oral health than native-born Canadians.
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Affiliation(s)
- Qianqian Li
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Sara Ozbek
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Matin Shariati
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Peizhong Peter Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 534, Toronto, ON, M5T 3M7, Canada.
- Centre for New Immigrant Wellbeing, 200-80 Acadia Ave, Markham, ON, L3R 9V1, Canada.
| | - Yun Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
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Palotie U, Vehkalahti MM, Varsio S. Direct restorations and enhanced caries prevention among 20- to 60-year-olds attending Helsinki City Public Dental Service - a register-based observation. Acta Odontol Scand 2023; 81:86-92. [PMID: 35697018 DOI: 10.1080/00016357.2022.2085788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Our retrospective register-based observational study evaluated age-specific aspects and changes in volume and content of direct restorative procedures, pulp cappings and enhanced caries prevention measures given to adults. METHODS Data included all treatments provided for 20- to 60-year-olds visiting the Helsinki City Public Dental Service (PDS) in 2012 and 2017. For both years, the data were aggregated into 5-year age groups. Data included means of DMFT indices, number and size of direct restorations, number of specific codes for pulp cappings and enhanced prevention. RESULTS Around half of all patients received restorations, 39,820 (50.9%) in 2012 and 43,392 (45.9%) in 2017. The greatest increase in DMFT means by age cohort was found for the 2012 age cohort of 25- to 29-year-olds and the smallest for the 2012 age cohort of 45- to 49-year-olds. In each same-age group and each age cohort, the enhanced prevention in 2017 was less frequent than in 2012. The proportion of two-surface restorations accounted for 44.7% of procedures in 2012 and 45.9% in 2017, followed by an increasing proportion of one-surface restorations, from 28.3% in 2012 to 32.9% in 2017. Associations between restoration size and age group were highly significant (p < .001). CONCLUSIONS The volume of direct restorative procedures and enhanced prevention measures were strongly age-dependent. Restorative treatment procedures were more frequent in older age groups than in younger age groups, and vice versa for enhanced prevention and pulp cappings. The magnitude of restorative treatment decreased slowly from 2012 to 2017, and overall enhanced preventive treatment was limited.
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Affiliation(s)
- Ulla Palotie
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.,Oral Diseases Teaching and Dental Care Unit, Helsinki University Central Hospital Head and Neck Center, Helsinki, Finland
| | - M M Vehkalahti
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - S Varsio
- Department of Social Services and Healthcare, City of Helsinki, Helsinki, Finland
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Shoaee S, Saeedi Moghaddam S, Masinaei M, Sofi-Mahmudi A, Hessari H, Heydari MH, Shamsoddin E, Parsaeian M, Ghasemian A, Larijani B, Fakhrzadeh H, Farzadfar F. Trends in dental caries of deciduous teeth in Iran: a systematic analysis of the national and sub-national data from 1990 to 2017. BMC Oral Health 2022; 22:634. [PMID: 36564764 PMCID: PMC9789600 DOI: 10.1186/s12903-022-02634-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dental caries is the most prevalent child affliction in the world and can be reduced through effective preventive interventions. To plan cost-effective interventions, clear and integrated data are needed. This study has been designed to overcome the lack of national trend in deciduous dental caries in Iran. OBJECTIVE To estimate the dental caries trend in deciduous teeth in the Iranian population at different ages from 1990 to 2017. METHODS From 1990 to 2017 a literature search about dmf and its components (decayed, missed, and filled tooth, abbreviated as dt, mt, and ft) as well as dental caries was done in the Iranian population in three English (PubMed, Web of Science, and Scopus) and three national databases (in Persian). All eligible national oral health surveys in these 28 years were included. National dmft data were categorised based on age (1-4, 5-9, and 10-14), sex, province and year. The final trends were estimated using an age-spatio-temporal hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. Finally, the estimations of dmft, dt, mt, and ft with a 95% UI were reported from 1990 to 2017. RESULTS Almost 22% of the Iranian deciduous teeth were involved with dental caries in 1990 [dmft = 4.37; (95% UI 2.23, 6.62)] which more than 83% of it was dt [3.64 (1.53, 5.88)] and less than 7% was ft [0.30 (0.06, 0.65)]. During 1990-2017, dmft increased by more than 15% [in 2017, dmft = 5.03 (2.82, 7.29)]. The highest increase was seen in dt which was more than 17% [in 2017, dt = 4.27 (1.96, 6.57)]. CONCLUSION Increasing dental caries among Iranian children over 28 years shows that oral health policies in Iran need critical evaluation. We need cost-effective nationwide interventions (e.g., supervised tooth brushing and improving dietary habits) and training well-experienced intermediate manpower (e.g., dental hygienists) to reduce dental caries.
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Affiliation(s)
- Shervan Shoaee
- grid.411705.60000 0001 0166 0922Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,grid.412105.30000 0001 2092 9755Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sahar Saeedi Moghaddam
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran
| | - Masoud Masinaei
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran
| | - Ahmad Sofi-Mahmudi
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Hossein Hessari
- grid.411705.60000 0001 0166 0922Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Hossein Heydari
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,grid.411600.2School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Shamsoddin
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Mahboubeh Parsaeian
- grid.411705.60000 0001 0166 0922Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Anooshe Ghasemian
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran
| | - Bagher Larijani
- grid.411705.60000 0001 0166 0922Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713111 Iran
| | - Hossein Fakhrzadeh
- grid.411705.60000 0001 0166 0922Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713111 Iran
| | - Farshad Farzadfar
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,grid.411705.60000 0001 0166 0922Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713111 Iran
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Jaffe K, Choi J, Hayashi K, Milloy MJ, Richardson L. A paradox of need: Gaps in access to dental care among people who use drugs in Canada's publicly funded healthcare system. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1799-1806. [PMID: 33491849 PMCID: PMC8310531 DOI: 10.1111/hsc.13289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
In Canada, publicly funded healthcare provides no-cost access to a large but not comprehensive suite of services. Dental care is largely funded by private insurance or patients, creating employment- and income-dependent gaps in care access. Difficulties accessing dental care may be amplified among vulnerable populations, including people who use drugs (PWUD), who may experience greater dental need due to side effects of substance use and health comorbidities, as well as barriers to care. Using data collected between 2014 and 2018 from two ongoing prospective cohort studies of PWUD in Vancouver, Canada, the aim of this study was to explore factors associated with dental care access. Among 1,638 participants, 246 participants (15%) reported never or only occasionally accessing adequate dental care. In generalised linear mixed-effects models, results showed significant negative associations between accessing dental care and using opioids (Adjusted Odds Ratios [AOR] = 0.73, 95% Confidence Interval [CI] = 0.58-0.91), methamphetamine (AOR = 0.75, 95% CI = 0.59-0.95) and cannabis (AOR = 0.78, 95% CI = 0.63-0.97), as well experiencing homelessness (AOR = 0.54, 95% CI = 0.42-0.70) and street-based income generation (AOR = 0.75, 95% CI = 0.59-0.94). There were significant positive associations between adequate dental care and accessing opioid agonist treatment (OAT) for opioid dependence (AOR = 1.36, 95% CI = 1.07-1.72) and receiving income assistance (AOR = 1.70, 95% CI = 1.05-2.77). These results highlight specific substance use patterns and structural exposures that may hinder dental care access, as well as how direct and indirect benefits of income assistance and OAT may improve access. These findings provide support for recent calls to expand healthcare coverage and address dental care inequities.
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Affiliation(s)
- Kaitlyn Jaffe
- British Columbia Centre on Substance Use, Vancouver, BC Canada
- Department of Sociology, University of British Columbia, Vancouver, BC Canada
| | - JinCheol Choi
- British Columbia Centre on Substance Use, Vancouver, BC Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC Canada
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, BC Canada
- Department of Sociology, University of British Columbia, Vancouver, BC Canada
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Matsuyama Y, Isumi A, Doi S, Fujiwara T. Poor parenting behaviours and dental caries experience in 6- To 7-year-old children. Community Dent Oral Epidemiol 2020; 48:493-500. [PMID: 32750206 PMCID: PMC7689935 DOI: 10.1111/cdoe.12561] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/12/2020] [Accepted: 06/16/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The association between poor parenting and dental caries in children remains unclear. We investigated the association of poor parenting with dental caries and oral health behaviour among children aged 6-7 years in Japan. METHODS Two waves of repeated cross-sectional surveys on children and their caregivers in Adachi City, Tokyo, were analysed. Questionnaires on parenting behaviour and the child's oral health behaviour were distributed through schools and completed by 8499 caregivers (response rate = 80.8%). The number of decayed or filled primary teeth (dft) at school dental health check-ups was linked to the survey data (N for complete case analysis = 6309). Factor analysis was performed to identify types of poor parenting: poor involvement, child abuse and lack of supervision of a child's health behaviours. The association between factor scores (z-score), the number of dft and oral health behaviour (not brushing teeth twice a day, not controlling snack eating habits and drinking juice every day) was evaluated by Poisson's regressions adjusted for covariates, including caregiver's socioeconomic status. RESULTS Poor involvement and lack of supervision of a child's health behaviours were positively associated with dft (mean ratio, MR [95% confidence interval, CI] =1.05 [1.03, 1.07] and 1.18 [1.16, 1.21], respectively) and unhealthy oral health behaviours. Child abuse was not associated with dft (MR = 0.99 [0.96, 1.01]) but was associated with all three unhealthy oral health behaviours (prevalence ratio, PR [95% CI] were 1.11 [1.06, 1.16], 1.11 [1.06, 1.16] and 1.06 [1.00, 1.11] for not brushing teeth, not controlling snack eating and drinking juice, respectively). CONCLUSIONS Poor involvement and lack of supervision of a child's health behaviours were associated with dental caries, and any type of poor parenting was associated with poor oral health behaviour among children.
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Affiliation(s)
- Yusuke Matsuyama
- Department of Global Health PromotionTokyo Medical and Dental UniversityBunkyo‐kuTokyoJapan
| | - Aya Isumi
- Department of Global Health PromotionTokyo Medical and Dental UniversityBunkyo‐kuTokyoJapan
- Japan Society for the Promotion of ScienceChiyoda‐kuTokyoJapan
| | - Satomi Doi
- Department of Global Health PromotionTokyo Medical and Dental UniversityBunkyo‐kuTokyoJapan
- Japan Society for the Promotion of ScienceChiyoda‐kuTokyoJapan
| | - Takeo Fujiwara
- Department of Global Health PromotionTokyo Medical and Dental UniversityBunkyo‐kuTokyoJapan
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Tikhonova S, Jessani A, Girard F, Macdonald ME, De Souza G, Tam L, Eggert F, Nguyen‐Ngoc C, Morin N, Aggarwal N, Schroth RJ. The Canadian Core Cariology Curriculum: Outcomes of a national symposium. J Dent Educ 2020; 84:1245-1253. [DOI: 10.1002/jdd.12313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/14/2020] [Accepted: 07/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
| | - Abbas Jessani
- College of Dentistry University of Saskatchewan Saskatoon Saskatchewan Canada
- Schulich School of Medicine & Dentistry University of Western Ontario London Ontario Canada
| | - Felix Girard
- Faculty of Dentistry Université de Montréal Montreal Quebec Canada
| | | | - Grace De Souza
- Faculty of Dentistry University of Toronto Toronto Ontario Canada
| | - Laura Tam
- Faculty of Dentistry University of Toronto Toronto Ontario Canada
| | | | | | - Nathalie Morin
- Faculty of Dentistry McGill University Montreal Quebec Canada
| | - Neha Aggarwal
- Faculty of Dentistry McGill University Montreal Quebec Canada
| | - Robert J. Schroth
- Dr. Gerald Niznick College of Dentistry University of Manitoba Winnipeg Manitoba Canada
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Raphael D. Narrative review of affinities and differences between the social determinants of oral and general health in Canada: establishing a common agenda. J Public Health (Oxf) 2020; 41:e218-e225. [PMID: 30165524 DOI: 10.1093/pubmed/fdy152] [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] [Received: 04/21/2018] [Revised: 07/24/2018] [Accepted: 08/03/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This article overviews Canadian work on the social determinants of oral and general health noting their affinities and differences. METHODS A literature search identified Canadian journal articles addressing the social determinants of oral health and/or oral health inequalities. Analysis identified affinities and differences with six themes in the general social determinants of health literature. RESULTS While most Canadian social determinants activity focuses on physical and mental health there is a growing literature on oral health-literature reviews, empirical studies and policy analyses-with many affinities to the broader literature. In addition, since Canada provides physical and mental health services on a universal basis, but does not do so for dental care, there is a special concern with the reasons behind, and the health effects-oral, physical and mental-of the absence of publicly financed dental care. CONCLUSIONS The affinities between the social determinants of oral health and the broader social determinants of health literature suggests the value of establishing a common research and action agenda. This would involve collaborative research into common social determinants of oral and general health and combined policy advocacy efforts to improve Canadians' living and working conditions as means of achieving health for all.
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Affiliation(s)
- Dennis Raphael
- School of Health Policy and Management, York University, Toronto 4700 Keele Street, Toronto, Ontario, Canada
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Azevedo MBD, Pinto RDS, Abreu MHNGD, Lucas SD. Factors associated with the needs of specialised dental treatment among adults aged 35-44 years old in the state of Minas Gerais, Brazil: a multilevel cross-sectional study. CIENCIA & SAUDE COLETIVA 2020; 25:2783-2792. [PMID: 32667559 DOI: 10.1590/1413-81232020257.29852018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022] Open
Abstract
This study evaluated the individual and contextual factors associated with the specialised dental treatment needs of a population of adults aged 35 to 44 years old in the state of Minas Gerais. The individual variables were obtained from the database of the SB Minas Gerais project - a survey of oral health status of the population of Minas Gerais, Brazil. The variables at the municipal level were derived from any available public databases related to oral health services. A multilevel analysis was performed to evaluate the association of independent individuals and contextual variables with or without dental treatment needs in the secondary care of the oral health network. Individuals with a higher income (OR 0.53; CI95% 0.31-0.93) and with greater access to oral health care (OR 0.94; CI95% 0.90-0.99) had less secondary care treatment needs. Income and access to oral health care are related to the needs of specialised dental treatment in Minas Gerais.
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Affiliation(s)
- Mônica Baltazar de Azevedo
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Rafaela da Silveira Pinto
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Mauro Henrique Nogueira Guimarães de Abreu
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Simone Dutra Lucas
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais. Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
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Jessani A, Aleksejuniene J, Donnelly L, Phillips JC, Nicolau B, Brondani M. What are the self-reported unmet dental treatment needs of people living with HIV in British Columbia? A case of minority subpopulation in Canada. J Public Health Dent 2020; 80:114-122. [PMID: 31950515 DOI: 10.1111/jphd.12355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/10/2019] [Accepted: 12/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify associations of Andersen and Newman's (A&N) predisposing, enabling, and need factors with self-reported oral health status and self-reported unmet dental treatment needs in a sample of people living with HIV (PLHIV) in British Columbia (BC), Canada. METHODS Participants responded anonymously to a 41-item online questionnaire with the following inclusion criteria: a) be at least 19 years old; b) self-identify as HIV-positive; c) be able to provide consent and be willing to voluntarily participate in the study; d) be residing in British Columbia; and e) be able to proficiently respond to the questions in English. Following the descriptive statistics, associations between A&N model factors and the main outcome variables (self-reported oral health status and self-reported dental treatment needs) were evaluated using bivariate inferential analyses. RESULTS A total of 186 participants met the inclusion criteria. Approximately 40% (n = 74) of participants rated the health of their mouth as fair/poor and more than half (n = 112; 60.2%) reported having bleeding gums, tooth decay or tooth sensitivity. The bivariate analysis for the self-reported oral status as the outcome variable showed "having fair/poor general health" (P = 0.001), "unemployment" (P = 0.019), "avoiding dental treatment due to cost" (P = 0.005), and "not visiting a dental professional within the last year" (P < 0.001) as the strongest predictors. For the second outcome variable unmet dental treatment needs, the strongest predictors were "experience of being discriminated by dental professionals" (P = 0.001), "having fair/poor general health" (P = 0.006), and "suffering from past and current medical conditions due to HIV" (P < 0.001). CONCLUSIONS Several predisposing, enabling and need factors from the A&N model were associated with self-reported oral health status and unmet dental treatment needs of PLHIV. Results from this study highlight the needs of improving access to affordable dental care to address the unmet oral health needs of PLHIV.
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Affiliation(s)
- Abbas Jessani
- College of Dentistry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jolanta Aleksejuniene
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leeann Donnelly
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Belinda Nicolau
- Division of Oral Health and Society at the Faculty of Dentistry, McGill University, Montréal, Quebec, Canada
| | - Mario Brondani
- Dental Public Health Program at the Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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da Cunha IP, Mialhe FL, Pereira AC, Vedovello SAS, Bulgareli JV, Frias AC, Ambrosano GMB, de Castro Meneghim M. Self-perceived dental treatment need among adolescents: A hierarchical analysis. Community Dent Oral Epidemiol 2019; 48:130-136. [PMID: 31828838 DOI: 10.1111/cdoe.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/18/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of the present study was to analyse the factors associated with self-perceived need for dental treatment among adolescents. METHODS A representative sample in the state of São Paulo, Brazil, comprising 5558 adolescents, was evaluated in 2015. The adolescents were selected by probabilistic sampling by conglomerates in two stages. The outcome evaluated was self-perceived treatment need measured via a validated questionnaire. Independent variables included sociodemographic factors, type, frequency and reason for last dental visit, and examination of oral conditions. Statistical analysis was based on the multiple hierarchical logistic regression model. RESULTS Of the total sample, 3340 (62.6%) adolescents reported needing dental treatment. After fitting the model, the self-perceived need for treatment was associated with adolescents with family income of up to $1,500 BRL (OR 1.39; [95% CI = 1.20-1.60]; P < .001), who sought dental services solely for curative treatment (OR 1.58; [95% CI = 1.46-1.72]; P < .001), reported toothaches in the previous six months (OR 2.88; [95% CI = 2.53-3.28]; P < .001), were dissatisfied with the appearance of their teeth and mouth (OR 5.94; [95% CI = 5.03-7.01]; P < .001), had caries in the posterior teeth only (OR 3.04; [95% CI = 2.77-3.33]; P < .001) or had caries in the anterior teeth (OR 4.75; [95% CI = 4.05-5.56]; P < .001). CONCLUSIONS The self-perceived need for dental treatment among Brazilian adolescents was associated with normative and subjective needs, and sociodemographic context factors. This finding provides important evidence for collective health planning.
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Affiliation(s)
- Inara Pereira da Cunha
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Fábio Luiz Mialhe
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Antonio Carlos Pereira
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | | | - Antônio Carlos Frias
- Department of Social Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Jessani A, Aleksejuniene J, Donnelly L, Craig Phillips J, Nicolau B, Brondani M. Dental care utilization: patterns and predictors in persons living with HIV in British Columbia, Canada. J Public Health Dent 2019; 79:124-136. [PMID: 30624773 DOI: 10.1111/jphd.12304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To identify the predisposing, enabling, and need factors of the Andersen and Newman (A&N) model and their associations with the pattern of dental service utilization in a sample of people living with HIV (PLHIV) in British Columbia. METHODS Participants responded anonymously to a 40-item online questionnaire to explore the patterns of dental service utilization. Following the descriptive statistics, the associations between A&N model factors and main outcome variables (having a dental visit in the last year and reasons for the dental visit) were evaluated using simple and multiple logistic regression analyses. RESULTS Out of 600 potential PLHIV participants, 210 responded to the survey and 186 met the inclusion criteria. The experience of being discriminated against by dental professionals (P = 0.005), having dental anxiety (P < 0.001), not having dental insurance (P = 0.001), and having living condition difficulties (P = 0.004) were significantly associated with nonemergency dental visits. In multiple logistic regression analysis, dental anxiety (OR = 0.1; 95 percent CI 0.0; 0.4), having a regular dentist (OR = 3.7; 95 percent CI 1.1; 12.6), and visiting a dental office in the last year (OR = 21.6; 95 percent CI 6.1; 76.5) were the strongest predictors of dental service utilization in this study. CONCLUSIONS Several predisposing, enabling, and need factors from the A&N model were associated with dental service utilization by PLHIV. In addition to various psychosocial barriers, a significant number of respondents reported experiencing stigma and discrimination from their oral care providers.
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Affiliation(s)
- Abbas Jessani
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolanta Aleksejuniene
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leeann Donnelly
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Craig Phillips
- School of Nursing, and Vice-Dean Governance and Secretary of the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Belinda Nicolau
- Division of Oral Health and Society at the Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Mario Brondani
- Dental Public Health Program at the Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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Raphael D, Komakech M, Bryant T, Torrence R. Governmental Illegitimacy and Incompetency in Canada and Other Liberal Nations: Implications for Health. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2018; 49:17-36. [PMID: 30170503 DOI: 10.1177/0020731418795136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The welfare state literature on developing nations is concerned with how governmental illegitimacy and incompetency are the sources of inequality, exploitation, exclusion, and domination of significant proportions of their citizenry. These dimensions clearly contribute to the problematic health outcomes in these nations. In contrast, developed nations are assumed to grapple with less contentious issues of stratification, decommodification, and the relative role of the state, market, and family in providing economic and social security, also important pathways to health. There is an explicit assumption that governing authorities in developed nations are legitimate and competent such that their citizens are not systematically subjected to inequality, exploitation, exclusion, and domination by elites. In this article, we argue that these concepts should also be the focus of welfare state analysis in developed liberal welfare states such as Canada. Such an analysis would expose how public policy is increasingly being made in the service of powerful economic elites rather than the majority, thereby threatening health. It would also serve to identify means of responding to these developments.
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Affiliation(s)
- Dennis Raphael
- 1 York University, School of Health Policy and Management, Toronto, Ontario, Canada
| | - Morris Komakech
- 1 York University, School of Health Policy and Management, Toronto, Ontario, Canada
| | - Toba Bryant
- 2 Faculty of Health Sciences, University of Ontario Institute of Technology, Ontario, Canada
| | - Ryan Torrence
- 1 York University, School of Health Policy and Management, Toronto, Ontario, Canada
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Araujo MEA, Silva MT, Galvao TF, Pereira MG. Prevalence of health services usage and associated factors in the Amazon region of Brazil: a population-based cross-sectional study. BMJ Open 2017; 7:e017966. [PMID: 29151052 PMCID: PMC5701988 DOI: 10.1136/bmjopen-2017-017966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of healthcare use and associated factors in the Manaus metropolitan region and to describe the reasons for lack of access. DESIGN Cross-sectional population-based study. SETTING A survey conducted between May and August of 2015 in eight cities from Manaus metropolitan region, Amazonas, Brazil. PARTICIPANTS 4001 adults ≥18 years of age. PRIMARY OUTCOMES MEASURES Physician visits, dentist visits and hospitalisations in the last 12 months were the primary outcomes. Associated factors were investigated through the calculation of prevalence ratio (PR) obtained by hierarchical Poisson regression modelling. RESULTS 4001 adults were included in the study, 53% of whom were women. The self-reported prevalence of medical visits was 77% (95% CI 75% to 77%); dentist visits, 36% (95% CI 34% to 37%) and hospital admission, 7% (95% CI 6% to 7%). Physician visits were higher in women PR=1.18 (95% CI 1.14 to 1.23), the elderly PR=1.18 (95% CI 1.10 to 1.26) and people with health insurance PR=1.14 (95% CI 1.10 to 1.19). Dentist visits declined with older age PR=0.38 (95% CI 0.30 to 0.49), lower education level PR=0.62 (95% CI 0.51 to 0.74) and lower economic class PR=0.65 (95% CI 0.57 to 0.75). Hospitalisations were found to be twice as frequent for women than for men and three times as frequent among those who reported very poor health status. Among the individuals who did not receive medical attention in the previous 2 weeks, 58% reported lack of facilities or appointment unavailable and 14% reported lack of doctors. CONCLUSION While more than half visited the doctor in the last year, a lower proportion of people with socioeconomic inequities visited the dentist. Organisational and service policies are needed to increase equity in health services in the region.
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Affiliation(s)
- Maria Elizete A Araujo
- Post-Graduate Program Health Sciences, University of Brasilia, Brasilia, Federal District, Brazil
- Getulio Vargas University Hospital, Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Marcus T Silva
- Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Sao Paulo, Brazil
| | - Tais F Galvao
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Mauricio G Pereira
- Faculty of Medicine, University of Brasilia, Brasilia, Federal District, Brazil
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Kim N, Kim CY, Shin H. Inequality in unmet dental care needs among South Korean adults. BMC Oral Health 2017; 17:80. [PMID: 28446178 PMCID: PMC5406911 DOI: 10.1186/s12903-017-0370-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 04/20/2017] [Indexed: 12/29/2022] Open
Abstract
Background The current public health research agenda was to identify the means to reduce oral health inequalities internationally. The objectives of this study were to provide evidence of inequality in unmet dental needs and to find influencing factors attributable to those among South Korean adults. Methods Pooled cross-sectional data from the fourth Korean National Health and Nutrition Examination Survey (2007–2009) on 17,141 Korean adults were used. Demographic factors (sex, age, and marital status), socioeconomic factors (education level, employment status, and income level), need factors (normative dental needs and self-perceived oral health status), and oral health-related factors (the number of decayed teeth, the presence of periodontitis, and the number of missing teeth) were included. Multiple logistic regression analysis was performed. Results Of South Korean adults, 43.9% had perceived unmet dental needs, with the most common reason being financial difficulties. The disparities in unmet dental care needs were strongly associated with income level, normative treatment needs, and self-perceived oral health status. The low-income group, people with normative dental treatment needs, and those with perceived poor oral health status were more likely to have unmet dental needs. There was considerable inequality in unmet dental care needs due to economic reasons according to such socioeconomic factors as income and education level. Conclusions Public health policies with the expansion of dental insurance coverage are needed to reduce inequalities in unmet dental care needs and improve the accessibility of dental care services to vulnerable groups who are experiencing unmet dental care needs due to socioeconomic factors despite having normative and self-perceived needs for dental treatment.
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Affiliation(s)
- Nayoung Kim
- Department of Postanesthetic Care Unit, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang-Yup Kim
- Department of Health Policy and Management, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, 151-742, Seoul, Korea.
| | - Hosung Shin
- Department of Social and Humanity in Dentistry, College of Dentistry, Wonkwang University, Iksan, Jeolabuk-do, Korea
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Dehmoobadsharifabadi A, Singhal S, Quiñonez C. Investigating the "inverse care law" in dental care: A comparative analysis of Canadian jurisdictions. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2017; 107:e538-e544. [PMID: 28252372 PMCID: PMC6972048 DOI: 10.17269/cjph.107.5454] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 10/29/2016] [Accepted: 08/31/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare physician and dentist visits nationally and at the provincial/territorial level and to assess the extent of the "inverse care law" in dental care among different age groups in the same way. METHODS Publicly available data from the 2007 to 2008 Canadian Community Health Survey were utilized to investigate physician and dentist visits in the past 12 months in relation to self-perceived general and oral health by performing descriptive statistics and binary logistic regression, controlling for age, sex, education, income, and physician/dentist population ratios. Analysis was conducted for all participants and stratified by age groups - children (12-17 years), adults (18-64 years) and seniors (65 years and over). RESULTS Nationally and provincially/territorially, it appears that the "inverse care law" persists for dental care but is not present for physician care. Specifically, when comparing to those with excellent general/oral health, individuals with poor general health were 2.71 (95% confidence interval [CI]: 2.70-2.72) times more likely to visit physicians, and individuals with poor oral health were 2.16 (95% CI: 2.16-2.17) times less likely to visit dentists. Stratified analyses by age showed more variability in the extent of the "inverse care law" in children and seniors compared to adults. CONCLUSIONS The "inverse care law" in dental care exists both nationally and provincially/territorially among different age groups. Given this, it is important to assess the government's role in improving access to, and utilization of, dental care in Canada.
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Factors associated with unmet dental care needs in Canadian immigrants: an analysis of the longitudinal survey of immigrants to Canada. BMC Oral Health 2014; 14:145. [PMID: 25465024 PMCID: PMC4265528 DOI: 10.1186/1472-6831-14-145] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background Immigrants are often considered to have poorer oral health than native born-populations. One possible explanation for immigrants’ poor oral health is lack of access to dental care. There is very little information on Canadian immigrants’ access to dental care, and unmet dental care needs. This study examines predictors of unmet dental care needs among a sample of adult immigrants to Canada over a three-point-five-year post-migration period. Methods A secondary data analysis was conducted on the Longitudinal Survey of Immigrants to Canada (LSIC). Sampling and bootstrap weights were applied to make the data nationally representative. Simple descriptive analyses were conducted to describe the demographic characteristics of the sample. Bivariate and multiple logistic regression analyses were applied to identify factors associated with immigrants’ unmet dental care needs over a three-point-five-year period. Results Approximately 32% of immigrants reported unmet dental care needs. Immigrants lacking dental insurance (OR = 2.63; 95% CI: 2.05-3.37), and those with an average household income of $20,000 to $40,000 per year (OR = 1.62; 95% CI: 1.01-2.61), and lower than $20,000 (OR = 2.25; 95% CI: 1.31-3.86), were more likely to report unmet dental care needs than those earning more than $60,000 per year. In addition, South Asian (OR = 1.85; CI: 1.25-2.73) and Chinese (OR = 2.17; CI: 1.47-3.21) immigrants had significantly higher odds of reporting unmet dental care needs than Europeans. Conclusions Lack of dental insurance, low income and ethnicity predicted unmet dental care needs over a three-point-five-year period in a sample of immigrants to Canada.
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Roncalli AG, Tsakos G, Sheiham A, de Souza GC, Watt RG. Social determinants of dental treatment needs in Brazilian adults. BMC Public Health 2014; 14:1097. [PMID: 25339315 PMCID: PMC4287338 DOI: 10.1186/1471-2458-14-1097] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 10/10/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The chronic cumulative nature of caries makes treatment needs a severe problem in adults. Despite the fact that oral diseases occur in social contexts, there are few studies using multilevel analyses focusing on treatment needs. Thus, considering the importance of context in explaining oral health related inequalities, this study aims to evaluate the social determinants of dental treatment needs in 35-44 year old Brazilian adults, assessing whether inequalities in needs are expressed at individual and contextual levels. METHODS The dependent variables were based on the prevalence of normative dental treatment needs in adults: (a) restorative treatment; (b) tooth extraction and (c) prosthetic treatment. The independent variables at first level were household income, formal education level, sex and race. At second level, income, sanitation, infrastructure and house conditions. The city-level variables were the Human Development Index (HDI) and indicators related to health services. Exploratory analysis was performed evaluating the effect of each level through calculating Prevalence Ratios (PR). In addition, a three-level multilevel modelling was constructed for all outcomes to verify the effect of individual characteristics and also the influence of context. RESULTS In relation to the need for restorative treatment, the main factors implicated were related to individual socioeconomic position, however the city-level contextual effect should also be considered. Regarding need for tooth extraction, the contextual effect does not seem to be important and, in relation to the needs for prosthetic treatment, the final model showed effect of individual-level and city-level. Variables related to health services did not show significant effects. CONCLUSIONS Dental treatment needs related to primary care (restoration and tooth extraction) and secondary care (prosthesis) were strongly associated with individual socioeconomic position, mainly income and education, in Brazilian adults. In addition to this individual effect, a city-level contextual effect, represented by HDI, was also observed for need for restorations and prosthesis, but not for tooth extractions. These findings have important implications for the health policy especially for financing and planning, since the distribution of oral health resources must consider the inequalities in availability and affordability of dental care for all.
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Affiliation(s)
- Angelo Giuseppe Roncalli
- />Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN Brazil
- />Department of Epidemiology and Public Health, University College London, London, UK
| | - Georgios Tsakos
- />Department of Epidemiology and Public Health, University College London, London, UK
| | - Aubrey Sheiham
- />Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Richard G Watt
- />Department of Epidemiology and Public Health, University College London, London, UK
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Dental treatment needs in vancouver inner-city elementary school-aged children. Int J Dent 2013; 2013:602791. [PMID: 23861684 PMCID: PMC3687495 DOI: 10.1155/2013/602791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/11/2013] [Accepted: 04/20/2013] [Indexed: 11/12/2022] Open
Abstract
Aims. To examine the dental treatment needs of inner-city Vancouver elementary school-aged children and relate them to sociodemographic characteristics. Methods. A census sampling comprising 562 children from six out of eight eligible schools was chosen (response rate was 65.4%). Dental treatment needs were assessed based on criteria from the World Health Organization. Results. Every third child examined needed at least one restorative treatment. A higher proportion of children born outside Canada were in need of more extensive dental treatments such as pulp care and extractions compared to the children born in Canada. There were no statistically significant differences in dental treatment needs between age, gender, or income groups or between children with or without dental insurance (Chi Squared P > 0.05). The best significant predictors (Linear Multiple Regression, P > 0.05) of higher dental treatment needs were being born outside Canada, gender, time of last dental visit, and family income. Having dental insurance did not associate with needing less treatment. Conclusion. A high level of unmet dental treatment needs (32%) was found in inner-city Vancouver elementary school-aged children. Children born outside Canada, particularly the ones who recently arrived to Canada, needed more extensive dental treatments than children born in Canada.
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Ramraj C, Sadeghi L, Lawrence HP, Dempster L, Quiñonez C. Is accessing dental care becoming more difficult? Evidence from Canada's middle-income population. PLoS One 2013; 8:e57377. [PMID: 23437378 PMCID: PMC3577722 DOI: 10.1371/journal.pone.0057377] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 01/22/2013] [Indexed: 11/24/2022] Open
Abstract
Objective To explore trends in access to dental care among middle-income Canadians. Methods A secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages. Results By 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7%) compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978. Conclusions This study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance.
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Affiliation(s)
- Chantel Ramraj
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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