Dental care utilization: examining the associations between health services deficits and not having a dental visit in past 12 months

A Three Delays theoretical framework to describe social determinants as barriers to dental care

OBJECTIVES

The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1-Deciding to seek care, (2) Delay #2-Reaching an appropriate facility and (3) Delay #3-Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework.

METHODS

This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework.

RESULTS

Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma.

CONCLUSION

The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.

The impact of dentition status and barriers to dental care services on perceived oral health of medicare beneficiaries

OBJECTIVE

To examine the association among barriers to dental care services, dentition groups, and self-reported oral health status for Medicare beneficiaries.

METHODS

We used data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES), which included participants aged ≥65 years who were enrolled in Medicare and had completed the oral health exam. We created a dentition group variable using the detailed dental examination data to account for the presence of natural, replaced, removable, or missing teeth. Through bivariate and logistic analyses, we explored the relationship between barriers to receiving dental care services, dentition groups, and reported oral and general health statuses, along with other control variables.

RESULTS

For the total Medicare population as well as in the four subgroup analyses, we showed that those with barriers to dental care services were more likely to report fair or poor oral health status. Those who were edentulous, had complete dentures, or had less than a full mouth of teeth had greater barriers and worse oral and general health than did those with all-natural teeth. Among those who reported fair or poor general health, those with less than a full mouth of teeth showed similar levels of barriers to dental care services and worse perceived oral health than did those without any teeth.

CONCLUSIONS

Helping the 65 years and older population retain their teeth in good condition will improve their overall health. Investment in oral hygiene and health for the current and future Medicare populations could improve their overall health.

Race and gender disparities in preventive health activity engagement of older adults in the southeastern United States

A cross-sectional study was conducted to determine preventive-health-activity engagement in community-dwelling older adults participating in student-led health screenings in east Alabama. From 2017-2019, health professions students conducted health screenings at 23 community and independent living sites to assess medical and social needs of adults. Clients' responses to questions regarding vaccinations (flu/pneumonia/shingles), cancer screenings (colon/sex-specific), and other (dental/vision) screenings were aggregated to create a preventive health behavior (prevmed) score. Chi-square, t-tests, and regression analyses were conducted. Data from 464 adults ages 50-99 (72.9±10.1) years old were analyzed. The sample was 71.3% female, 63.1% Black/African American (BA), and 33.4% rural. Linear regression indicated BA race (p=0.001), currently unmarried (p=0.030), no primary care provider (p<0.001) or insurance (p=0.010), age <65 years (p=0.042) and assessment at a residential site (p=0.037) predicted lower prevmed scores. Social factors predict preventive health activity engagement in community-dwelling adults in east Alabama, indicating several opportunities to improve health outcomes.

Dental caries, tobacco usage and associated risk factor of dental caries in patients visiting a government hospital in Western, Nepal

BACKGROUND

This study was conducted to assess the prevalence of dental caries, tobacco usage, and associated risk factors for dental caries in patients who visited a government hospital in Western, Nepal.

METHODS

This analytical cross-sectional study was conducted from January to April 2022. Patients above 18 years visiting the dental OPD of a government hospital, and who had provided informed consent were enrolled in the study using a convenience sampling technique. As the study also involved an illiterate population, in that case, informed consent was obtained from their respective legal guardian as well. A pretested standardized, close-ended questionnaire was administered by researchers to gather information regarding the associated risk factors and oral hygiene practices. Clinical examination was done for dental caries according to the criteria by the World Health Organization (WHO) using the "DMFT" index (WHO modification 1987). Bivariate and multivariable logistic regression was done and the odds ratio and p-value was calculated. For all tests, statistical significance was set at p < 0.05.

RESULTS

A total of 219 participants completed the study with a mean age of 31.73 ± 12.46. The prevalence of dental caries and tobacco was found to be 80.36% and 5.02% respectively. Participants without health insurance had 2.35 times higher odds of dental caries (95% CI: 1.03-5.36). Not rinsing the mouth after eating sweets was associated with 3.07 times higher odds of dental caries (95% CI: 1.31-7.18). Those who hadn't visited a dentist in the past 12 months had lower odds (0.42; 95% CI: 0.18-0.94). Eating fresh fruit daily showed statistically higher odds (2.70; 95% CI: 1.04-6.99) of dental caries. Non-tobacco users had higher odds (14.19; 2.55-78.99) of dental caries.

CONCLUSION

Dental caries is highly prevalent, while tobacco usage is relatively low. Factors associated with dental caries included lack of health insurance coverage, consumption of fruits once daily, recent dental visits within the past year, not rinsing the mouth with water after consuming sweets, and non-tobacco users.

Perceived experiences of racism linked to dental fear and anxiety among Black women

OBJECTIVES

Dental fear and anxiety are known determinants of delaying or avoiding dental care and vary considerably based on factors such as age and gender. However, little is known about dental fear and anxiety in racial/ethnic minority populations, which bear a disproportionate burden of poor oral health outcomes. Structural and social pathways responsible for producing these disparities are also understudied. Experiences of racism over the lifecourse may contribute to poor oral health outcomes through a pathway of dental fear and anxiety. This paper aimed to evaluate perceived experiences with racism, dental fear and anxiety, and the utilization of dental services, in the Black Women's Health Study (BWHS), a United States-based prospective cohort.

METHODS

Analysis of prospective data obtained from a geographic subset of participants in the BWHS was conducted. In 2014, BWHS participants residing in Massachusetts responded to a mailed oral health questionnaire that included the Index of Dental Anxiety and Fear (IDAF-4C+) instrument (N = 484; 69% response rate). Previously collected demographic and health information, along with reported experiences of everyday and lifetime racism, obtained from national BWHS questionnaires between 1995 and 2009, were merged with the Massachusetts-based sub-sample. Associations between high dental anxiety (HDA) (mean IDAF-4C+ score ≥2.5 on the dental fear and anxiety module) and oral health outcomes and perceived racism and HDA were explored via prevalence ratios (PR) calculated using log-binomial regression models, including adjustment for potential confounders.

RESULTS

Reported exposures to everyday racism occurred weekly on average for the top 25% of the sample, while 13% of participants reported exposure to multiple (n = 3) experiences of unfair treatment due to their race over their lifetime. HDA was prevalent among 17.8% of the sample and was significantly associated with indicators of poor oral health status. High exposures to everyday and lifetime experiences of racism were positively associated with HDA (PR = 1.08; 95% CI: 0.90, 1.58 and PR = 1.72; 95% CI: 1.03, 2.88, respectively).

CONCLUSIONS

Significant associations between racism and HDA, and between HDA and poor oral health and reduced utilization of dental care were observed. Dental anxiety may be a pathway through which perceived experiences with racism may impact oral health outcomes.

Characteristics of dentists in the National Dental Practice-Based Research Network

OBJECTIVES

Our aims are to describe the characteristics of dentists, members of the US National Dental practice-based research network (PBRN) in the United States, and determine how often these dentists provide specific dental procedures.

METHODS

Dentists completed a questionnaire when they enrolled in the Network about their demographic and training characteristics and characteristics of their practices and patients. Dentists also reported the frequency of providing specific dental procedures. Data were analyzed using descriptive statistics.

RESULTS

Of 4,483 dentists in active clinical practice, 34% identified as females, 70% as white, and 73% as general dentists. Most dentists practiced in large metropolitan areas (87%) and in solo or small practices (72%). On average, they reported about one-half of their patients were children or older adults, a third were from historically underrepresented racial and ethnic groups, and one-quarter were covered by public insurance. Most dentists routinely performed restorations and fixed prosthetics (78%), extractions (59%), removable (44%) and implant (40%) prosthetics, and endodontics on incisor and premolar teeth (44%).

CONCLUSIONS

Dentists participating in the National Dental PBRN have much in common with dentists at large. The network has a broad representation of dentists, practice types, patient populations, and treatments offered, including diversity regarding race/ethnicity, gender, insurance, and geography of its practitioners and patients.

CLINICAL SIGNIFICANCE

Characteristics of National Dental PBRN dentists suggest that a broad range of dentists is interested in participating in national-level research studies, thereby enabling an array of clinical study settings and topics that can optimize the generalizability of study findings.

Utilization of dental care among adult populations: a scoping review of applied models

BACKGROUND

The timely and appropriate utilization of dental health care is essential to the prevention and accurate treatment of oral diseases. Therefore, it is crucial that managers, health professionals and healthcare providers be fully aware of the predictors encouraging the utilization of dental services and reduce social inequalities. In this scoping review, we aimed to analyze the published articles and reports to find out the factors associated with dental services utilization and the comprehensiveness of the applied models among general adult populations.

MATERIALS AND METHODS

This scoping study was based on the 5-steps of Arksey and O'Malley framework. Keywords were selected under two main concepts: determinants of dental care utilization and the concept of the applied models. Searches were conducted in some electronic databses including PubMed, Google Scholar and Scopus with variations, and a combination of the keywords under the two main afore-mentioned concepts. All the relevant articles reporting the utilization of dental care and its potential predictors among adult populations were chosen. No restrictions involving terms of study time, location or methodological aspects of oral health utilization were considered. Using tables and charts mapping, we tried to group the studies based on the year of their publication, geographic distribution, the range of included indices and the type of their measurement. Also, a directed content analysis method was used to investigate the comprehensiveness of the studies in regard to considering the determinant factors at different levels suggested by the Andesen model.

RESULTS

Fifty-two articles were included in the analysis. Thirty-six (69%) had been published between 2016 and 2020. The United States had conducted the most research in this scope. About 30% of studies had mentioned all three domains of demographics, social structure and beliefs, simultaneously. To evaluate the enabling factors, in 84.61% and 59.61% of studies, the income levels and insurance feature were assessed, respectively. 57.69% of the retrieved studies considered the perceived need features and 38.46% referred to the evaluated ones. The dental services utilization, in terms of the last visit during the "past 12 months", was assessed more commonly. Only 11.54% of studies did evaluate the contextual characteristics and about 71.15% of articles were relatively comprehensive.

CONCLUSION

Overall, it seems that in most of the studies, not all of the determinant factors at different levels of the Andersen model have been considered. In order to discover the conceptual linkages and feedback loops of the model, it is essential to conduct more comprehensive research in the future.

Trends in dental care utilisation among the elderly using longitudinal data from 14 European countries: A multilevel analysis

BACKGROUND

The use of dental care among older people is low compared to other forms of health care, with significant health consequences. However, the evidence on the extent to which countries' welfare systems and socio-economic factors influence the uptake of dental care by older people is limited. This study aimed to describe trends of dental care utilisation, and to compare use of dental care with other types of healthcare services among the elderly, considering different socio-economic factors and welfare systems in European countries.

METHODS

Multilevel logistic regression analysis was performed using longitudinal data from four waves (between Wave 5 and 8) of the Survey of Health, Ageing and Retirement in Europe database, with a follow-up period of 7 years. The study sample included 20,803 respondents aged 50 years or older from 14 European countries.

RESULTS

The annual dental care attendance was the highest in Scandinavian countries (85.7%), however, improving trends of dental attendance was recognized in Southern and Bismarckian countries (p<0.001). The difference in use of dental care services between socio-economic groups was expanding over time regarding low- and high-income level and residential area. A more marked difference was observed between social groups in dental care utilisation compared to other forms of care. Income level and unemployed status had significant effect on forgoing dental care due to cost and unavailability.

CONCLUSION

The observed differences between socioeconomic groups may highlight the health consequences of the different organization and financing of dental care. The elderly population could benefit from adopting policies aiming to reduce the financial barriers to dental care usage, especially in Southern and Eastern European countries.

People's Willingness to Pay for Dental Checkups and the Associated Individual Characteristics: A Nationwide Web-Based Survey among Japanese Adults

This study aimed to determine the willingness-to-pay (WTP) values for dental checkups and analyze the association between the values and individual characteristics. This cross-sectional study was conducted using a nationwide web-based survey, and 3336 participants were allocated into groups that received regular dental checkups (RDC; n = 1785) and those who did not (non-RDC; n = 1551). There was a statistically significant difference in the WTP value for dental checkups between the RDC (median: 3000 yen [22.51 USD]) and non-RDC groups (2000 yen [15.01 USD]). In the RDC group, age 50-59 years, household income <2 million yen, homemaker and part-time worker employment status, and having children were significantly associated with decreased WTP values; male sex, household incomes ≥8 million yen, and tooth brushing ≥3 times daily were associated with increased WTP values. In the non-RDC group, age ≥30 years, household incomes <4 million yen, and having ≥28 teeth were significantly associated with decreased WTP values; household income ≥8 million yen was associated with increased WTP values. Conclusively, WTP values for dental checkups were lower in the non-RDC group than in the RDC group; in the non-RDC group, those with lower household income aged ≥30 years were more likely to propose lower WTP values, suggesting the need for policy intervention to improve access to RDC.

Utilization of dental care services among adult Indian population: A meta-analysis of evidence from 2011-2022

Background: This study aimed to generate a pooled national estimate on dental health care services utilization by the adult population in India from any public or private facility in an effort to highlight the demand and usage for oral health care. Methods: In this meta-analysis, PubMed, ScienceDirect, DOAJ, and Google Scholar were searched using a search strategy that combined MeSH headings and keywords (e.g., "Oral Health", "Dental Health Services", utilization, India, etc.) for articles on dental utilization among Indian adults, published between January 2011 and June 2022. Study quality was assessed using the NIH Quality assessment tool, and a random-effects inverse-variance method was used for pulling utilization proportions. Meta-regression and sub-group analyses were conducted to identify the sources of heterogeneity. Heterogeneity is reported as I². To examine publication bias, the funnel plot, egger's test, and trim-and-fill analysis were performed. Results: From 4012 identified articles, 21 were eligible for inclusion. The pooled dental care utilization amongst Indian adults were found to be 23.96% (confidence interval [CI]: 16.81%- 31.11%, P<0.001, I²=98.93%), and the highest estimate was in South Zone (30.02%, CI: 19.14-40.90, P<0.01, I²=98.63%). Visual inspection of the funnel plot revealed the presence of publication bias (egger's P value 0.02). A mild decrease in utilization estimate was noted through trim and fill analysis (adjusted estimate 17.65%, CI: 8.97-26.33, P=0.03). No significant subgroup effect was found for the variables study zone and conduction years (P value: 0.09 & 0.34 respectively). Conclusion: Future studies should be undertaken to focus on the demand and supply of oral health care services since an evidential gap has been identified due to the uneven distribution of studies available from various regions of India. The heterogeneity can be attributed to the diverse socioeconomic, literacy, and inherent health system performance status.

Oral-Health-Related Self-Efficacy among the Elderly Population in Riyadh, Saudi Arabia

Oral health self-efficacy is a fundamental determinant of behavioral changes among elderly patients. Objective: To assess the oral self-efficacy among the Saudi population aged 65 years old and above in Riyadh, Saudi Arabia. Methodology: This was a cross-sectional survey conducted on elderly individuals in Riyadh. An Arabic version of the Geriatric Self-Efficacy Scale for Oral Health (GSEOH) was administered to all participants. The dependent variables included oral function, oral hygiene habits, and dental visits. For the statistical analysis, two independent sample t-tests and a one-way ANOVA test were used. Significance was judged at a p-value less than 0.05. Results: Of 400 participants recruited, 53% were males. About 58% had retained teeth, and 72% had visited a dentist in the past 12 months. Overall, 31.6%, 34.64%, 22.65%, and 11.14% of the participants rated their oral health as good, fairly good, rather poor, and poor, respectively. Age (p < 0.001), educational level (p < 0.001), and working status (p < 0.001) were significantly associated with GSEOH scores. Other sociodemographic characteristics were not found to affect the GSEOH scores. Conclusions: The overall self-efficacy of oral health among Saudi elderly individuals is fairly good. Age, educational level, and occupational status are the main determinants of oral health self-efficacy scores.

Association of sociodemographic factors with the prescription pattern of opioids for dental patients: a systematic review

Aim To evaluate the association of patients' sociodemographic factors (sex, age, ethnicity, income, educational level, living environment and health insurance) with the prescription pattern of opioids provided by oral health practitioners.Methods Observational studies that evaluated the association of patients' sociodemographic factors and the likelihood of receiving an opioid prescription provided by an oral health practitioner were eligible. Electronic searches were conducted in Medline (PubMed), Embase, Scopus, Web of Science, LILACS, SciELO, Google Scholar, and OpenGrey up to March 2021. Two authors independently screened the studies, performed data extraction, and assessed the risk-of-bias using the critical appraisal tools developed by the Joanna Briggs Institute (JBI). Certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).Results Eight studies were included in this systematic review. Publication year ranged from 2011 to 2021. Narrative synthesis showed with very low certainty of evidence that younger individuals were more likely to receive a prescription of opioids than older individuals. Regarding the other sociodemographic factors and the prescriptions of opioids in dentistry, the evidence is controversial. Risk of bias was low for most items assessed in the included studies.Conclusion The available evidence suggests that there is an association between patients' sociodemographic factors and the prescription patterns of opioids provided by oral health practitioners.

Factors associated with cost conversations in oral health care settings

BACKGROUND

Patient-provider cost conversations can minimize cost-related barriers to health, while improving treatment adherence and patient satisfaction. The authors sought to identify factors associated with the occurrence of cost conversations in dentistry.

METHODS

This was a cross-sectional study using data from an online, self-administered survey of US adults who had seen a dentist within the past 24 months at the time of the survey. Multivariable hierarchical logistic regression analysis was used to identify patient and provider characteristics associated with the occurrence of cost conversations.

RESULTS

Of the 370 respondents, approximately two-thirds (68%) reported having a cost conversation with their dental provider during their last dental visit. Cost conversations were more likely for patients aged 25 through 34 years (odds ratio [OR], 2.84; 95% CI, 1.54 to 5.24), 35 through 44 years (OR, 3.35; 95% CI, 1.50 to 7.51), and 55 through 64 years (OR, 3.39; 95% CI, 1.38 to 8.28) than patients aged 18 through 24 years. Cost conversations were less likely to occur during visits with dental hygienists than during visits with general or family dentists (OR, 0.25; 95% CI, 0.11 to 0.58). In addition, respondents from the South (OR, 1.90; 95% CI, 1.04 to 3.48) and those screened for financial hardship were more likely to report having cost conversations with their dental providers (OR, 6.70; 95% CI, 2.69 to 16.71).

CONCLUSIONS

Within the study sample, cost conversations were common and were facilitated via financial hardship screening.

PRACTICAL IMPLICATIONS

Modifying oral health care delivery processes to incorporate financial hardship screening may be an effective way to facilitate cost conversations and provision of patient-centered care.

Characteristics of Individuals in Japan Who Regularly Manage Their Oral Health by Having a Family Dentist: A Nationwide Cross-Sectional Web-Based Survey

Dental healthcare systems may differ between countries; however, having a family dentist is generally important for proper oral health management. This study aims to analyze the proportion of people in Japan who have a family dentist, and their characteristics. A nationwide web-based survey with 3556 participants (1708 men and 1848 women) showed that 45.6% of men and 54.1% of women had a family dentist (FD group). A multiple logistic regression analysis revealed that men in the FD group mostly belonged to older age groups (≥70 s, OR: 2.41), received higher household incomes (≥8000 K JPY, OR: 1.47), brushed their teeth three or more times daily (OR: 1.60), practiced habitual interdental cleaning (OR: 3.66), and fewer lived in rural areas (towns and villages, OR: 0.52). Regarding the women, the majority belonged to older age groups (60 s, OR: 1.52; ≥70 s, OR: 1.73), practiced habitual interdental cleaning (OR: 3.68), and fewer received lower household incomes (<2000 K JPY, OR: 0.61). These results suggest that despite Japan being a country with a public insurance coverage system for both men and women, having a family dentist is associated with disparities in individual socioeconomic factors, particularly age and household income.

Effects of early preventive dental visits and its associations with dental caries experience: a cross-sectional study

Objectives

Limited information is known about preventive dental visits (PDVs) before seven years of age among children in China. This study aimed to examine the early PDV rate, identify the impact of PDV on dental caries and untreated dental caries, and explore the factors related to PDV among Chinese sampled children under seven years old.

Methods

A cross-sectional survey was conducted in five selected primary health care facilities in Chengdu, China, from May to August 2021. Parent–child dyads during regular systematic medical management were recruited to participate. Children's dental caries were identified through dental examinations and documented as decayed, missing and filled teeth index (dmft) by trained primary care physicians. Dental-related information was collected through a questionnaire. Zero-inflated negative binomial (ZINB) regression was used to test the effect of early PDV on the dmft value, and logistic regression was used to analyse impact factors on the early PDV.

Results

A total of 2028 out of 2377 parent–child dyads were qualified for analysis. Half of the children (50.4%) were male, with a mean age of 4.8 years. Among all the children, 12.1% had their first dental visit for preventive purposes, 34.4% had their first dental visit for symptomatic purposes, and more than half had never visited a dentist. The results showed that a lower dmft value (adjusted OR: 0.69, 95% CI: 0.48–0.84), a higher rate of caries-free (aOR: 6.5, 95% CI: 3.93–10.58), and a lower rate of untreated dental caries (aOR: 0.40, 95% CI: 0.21–0.76) were associated with early PDV utilization. Children who had a higher rate of PDV were positively associated with living in a family with better parental behaviours (aOR: 2.30, 95% CI: 1.71–3.08), better parental oral health perception (aOR: 1.23, 95% CI: 1.06–1.32), fathers who had no untreated caries (aOR: 0.68, 95% CI: 0.47–0.97), families with higher socioeconomic status (aOR: 1.09, 95% CI: 1.04–1.16), and dental health advice received from well-child care physicians (aOR: 1.47, 95% CI: 1.08–2.00).

Conclusions

Early PDV was associated with a lower rate of dental caries prevalence and untreated dental caries among sampled children younger than seven in Western China. Underutilization and social inequities existed in PDV utilization. Public health strategies should be developed to increase preventive dental visits and eliminate social disparities that prevent dental care utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02190-6.

Exploring the contexts, mechanisms and outcomes of a torture, abuse and dental anxiety service in Norway: a realist evaluation

Background

Torture, abuse and dental anxiety (TADA) are often precursors to developing a pathological relationship with dental care due to elevated anxiety. Consequently, patients who suffer from one or more of these tend to avoid dental services. This could leave them with severe tooth decay, which could affect their general and psychosocial health. Norwegian dental services have implemented the TADA service to specifically alleviate dental anxiety and restore oral health for the TADA patient group. However, the service has not been evaluated, and there is a need to understand how and why this service works, for whom, under what circumstances. Therefore, this study aimed to develop theories on how the service’s structure alleviates dental anxiety and restores these patients’ oral health. Although developed in a Norwegian context, these theories may be applicable to other national and international contexts.

Methods

This realist evaluation comprised multiple sequential methods of service and policy documents (n = 13), followed by interviews with service developers (n = 12).

Results

The analysis suggests that, by subsidising the TADA service, the Norwegian state has removed financial barriers for patients. This has improved their access to the service and, hence, their service uptake. National guidelines on service delivery are perceived as open to interpretation, and can hereby meet the needs of a heterogeneous patient group. The services have become tailored according to the available regional resources and heterogeneous needs of the patient population. A perceived lack of explicit national leadership and cooperative practices has resulted in regional service teams becoming self-reliant and insular. While this has led to cohesion within each regional service, it is not conducive to interservice collaborations. Lastly, the complexity of migration processes and poor dissemination practices is presumed to be the cause of the lack of recruitment of torture survivors to the service.

Conclusions

Policy documents and service developers described the TADA service as a hybrid bottom-up/top-down service that allows teams to practise discretion and tailor their approach to meet individual needs. Being free of charge has improved access to the service by vulnerable groups, but the service still struggles to reach torture survivors.

Dental and medical care visits among persons with diabetes in Ontario, Canada, who self-report oral health status

Periodontal disease is associated with diabetes mellitus and poor overall health. While the biological underpinnings of this relationship have been identified, less is known about the extent to which this relationship is affected by dental and medical care visits. Two studies lead by the primary author (KKP) explored the likelihood of diabetes complications among persons living with diabetes in Ontario, Canada, who were followed prospectively in administrative health data. The results from both studies confirmed that poor to fair self-reported oral health was associated with a greater risk for diabetes complications, and that poor dental and medical care visiting behaviours increased this risk. In general, the findings indicate that a greater number of dental and medical visits had a protective effect on the overall health of persons with diabetes. This discovery has important implications for all health care providers interested in managing oral and systemic health.

Associations of Medical Visits with Dentist Visits: A Register-Linkage Study of a Working-Age Population in Finland

Studies have usually addressed the utilization of either medical or dental services, and less is known about how medical and dentist visits are associated. As oral health is linked to systemic health, knowledge on care coordination between dental and medical services is important to gain understanding of the overall functioning of health care. Register data on 25-64-year-old residents of the city of Oulu, Finland, were used for the years 2017-2018 (N = 91,060). Logit models were estimated to analyze the probability of dentist visits, according to the number of medical visits in total and by three separate health care sectors. The majority, 61%, had visited both a medical professional and a dentist. All sectors combined, as few as one to two visits increased the odds of dentist visits (OR: 1.43, CI: 1.33, 1.53). When separated by medical professionals' health care sectors, for one to two visits, the strongest association was found with public (OR: 1.17, CI: 1.12, 1.22) and private sector (OR: 1.35, CI: 1.30, 1.41). For occupational health service visits, the odds increased only after six or more visits. The results support the idea of integrated medical and dental care. However, the result may also arise from individual health behavior where health-conscious persons seek both medical and dental care independently.

Dental care utilization in Massachusetts before and after initiation of medication for opioid use disorder: A cross-sectional study of a state all-payer claims database

BACKGROUND

Individuals with opioid use disorder (OUD) are at higher risk of poor oral health. Medication for opioid use disorder (MOUD) has been shown to improve outcomes for patients with OUD, but it is unknown how initiation of MOUD affects access to oral health services.

METHODS

This was a retrospective analysis of all individuals in the Massachusetts All-Payer Claims Database prescribed oral buprenorphine-naloxone or injectable naltrexone from 2013 to 2016. We evaluated dental utilization in the year before and after beginning MOUD. A logistic regression predicting dental utilization was conducted.

RESULTS

Among the 54,791 individuals, rates of dental utilization were low both before and after MOUD (10.5% and 10% with a dental visit, respectively). Of those who did not have a dental visit in the year before starting MOUD, 95.1% did not have a dental visit in the year after. Rates of various procedure types were comparable before and after MOUD. In a logistic regression, a prior dental visit was associated with 9.82 times the odds (95% CI 9.14-10.55) of having a dental visit after starting MOUD; increasing age, being prescribed naltrexone, having a mood disorder or HIV, year of initiation or being on Medicaid were also associated with having a dental visit. Male patients and those with Medicare or private insurance were less likely to have a dental visit.

CONCLUSIONS

Initiating MOUD did not substantially result in increased dental access or substantial changes in dental procedures received. Patients receiving treatment for OUD may require additional support to access dental care.

GIS mapping of healthcare practices: do older adults have equitable access to dental and medical care in the UK?

Introduction Considering an ageing population with increasing comorbidities, access to oral and general healthcare is a growing concern. This study aimed to identify and compare access to dental and general practices. This study further aimed to ascertain if there exists a socioeconomic distribution of dental and general practices among older adults.Materials and methods A total of 13,007 dental practices and 13,759 general practices were mapped using geographic information system software, and overlaid with the UK older adult population and deprivation data by health areas. Data analysis was carried out by creating a geographical distribution map and by using descriptive statistics, Gini coefficients and Lorenz curves.Results NHS Central London Clinical Commissioning Group (CCG) held the highest dental practice-to-population ratio of 958 practices per 100,000 older adults, while NHS Manchester CCG held the highest general practice-to-population ratio of 264.4 general practices per 100,000 older adults. England had the highest Gini coefficients for general and dental practice at 0.214 and 0.195, respectively. Both dental and general practices were socioeconomically distributed among older adults in England, Wales and Northern Ireland, but not in Scotland.Conclusions An increasing proportion of older adults need access to healthcare that is based on clinical need, not the ability to pay; a founding principle of the NHS. This nation-wide study captures inequities in the spatial accessibility for older adults in the UK.

Neighborhood Contexts and Oral Health Outcomes in a Pediatric Population: An Exploratory Study

Aims: This study aimed to explore the impacts of neighborhood-level socioeconomic contexts on the therapeutic and preventative dental quality outcome of children under 16 years. Materials and Methods: Anonymized billing data of 842 patients reporting to a university children’s dental over three years (March 2017–2020) met the inclusion criteria. Their access to care (OEV-CH-A), topical fluoride application (TFL-CH-A) and dental treatment burden (TRT-CH-A) were determined by dental quality alliance (DQA) criteria. The three oral health variables were aggregated at the neighborhood level and analyzed with Canadian census data. Their partial postal code (FSA) was chosen as a neighborhood spatial unit and maps were created to visualize neighborhood-level differences. Results: The individual-level regression models showed significant negative associations between OEV-CH-A (p = 0.027) and TFL-CH-A (p = 0.001) and the cost of dental care. While there was no significant association between neighborhood-level sociodemographic variables and OEV-CH-A, TRT-CH-A showed a significant negative association at the neighborhood level with median household income and significant positive association with percentage of non-official first language (English or French) speakers. Conclusion: Initial analysis suggests differences exist in dental outcomes according to neighborhood-level sociodemographic variables, even when access to dental care is similar.

Use of oral health care services in the United States: unequal, inequitable-a cross-sectional study

Background

Social determinants drive disparities in dental visiting. Disparities can be measured simply by comparing outcomes between groups (inequality) but can also consider concepts of social justice or fairness (inequity). This study aimed to assess differences in dental visiting in the United States in terms of both social inequality and inequity.

Methods

Data were obtained from a cross-sectional study—the National Health and Nutrition Examination Survey (NHANES) 2015–2016, and participants were US adults aged 30+ years. The outcome of interest, use of oral health care services, was measured in terms of dental visiting in the past 12 months. Disparity was operationalized through education and income. Other characteristics included age, gender, race/ethnicity, main language, country of birth, citizenship and oral health status. To characterize existing inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration index (ACI and RCI), the slope index of inequality (SII) and relative index of inequality (RII) and through concentration curves (CC). Indirect standardization with a non-linear model was used to measure inequity.

Results

A total of 4745 US adults were included. Bivariate analysis showed a gradient by both education and income in dental visiting, with a higher proportion (> 60%) of those with lower educational attainment /lower income having not visited a dentist. The concentration curves showed pro-higher education and income inequality. All measures of absolute and relative indices were negative, indicating that from lower to higher socioeconomic position (education and income), the prevalence of no dental visiting decreased: ACI and RCI estimates were approximately 8% and 20%, while SII and RII estimates were 50% and 30%. After need-standardization, the group with the highest educational level had nearly 2.5 times- and the highest income had near three times less probability of not having a dental visit in the past 12 months than those with the lowest education and income, respectively.

Conclusion

The findings indicate that use of oral health care is threatened by existing social inequalities and inequities, disproportionately burdening disadvantaged populations. Efforts to reduce both oral health inequalities and inequities must start with action in the social, economic and policy spheres.

Association between periodontal disease and oral cancer screening among US adults: NHANES 2011-2014

OBJECTIVES

To examine oral cancer screening rates and associated factors among adults with periodontal disease (PD). We hypothesized that adults with severe PD will be less likely to report receipt of any type of oral cancer screening than adults with no PD.

MATERIALS AND METHODS

We used 2011-2014 National Health and Nutrition Examination Survey (NHANES) data on adults ≥30 years. PD status was classified as no PD, mild/moderate PD and severe PD. Survey-adjusted logistic regression analysis was used to examine the model adjusted risk ratio (RR) and 95% confidence intervals (CI) for the outcome of not receiving intraoral, extraoral or both types of oral cancer screenings among adults with PD. Control variables included age, sex, race/ethnicity, health insurance, education, income level, smoking status, alcohol use and last dental visit.

RESULTS

The analytic sample included 6962 adults weighted to the national population of adults who had a periodontal examination during 2011-2014. Overall, 31.5%, 26.8% and 20.9% of adults reported receipt of intraoral, extraoral and both types of oral cancer screening, respectively. Almost 40% of adults had some form of PD (7.6% severe and 32.4% mild/moderate PD). A higher proportion of 45-64-year-olds, males, non-Hispanic Blacks, those with less than high school education, with income level less than 200% federal poverty level, or those with no insurance had severe PD than no PD. In adjusted analyses, adults with severe PD were significantly more likely to report no receipt of intraoral (RR = 1.25, 95% CI = 1.12-1.40), extraoral (RR = 1.17, 95% CI = 1.07-1.27) or both types of oral cancer screenings (RR = 1.18, 95% CI = 1.10-1.27) than those with no PD.

CONCLUSIONS

Significantly low proportion of adult's age ≥30 years with severe PD reported receiving any type of oral cancer screening. The association between PD and risk of oral cancers points to the need to improve oral cancer screening rates among adults with PD.

Barriers and facilitators to oral health care utilization in culturally and linguistically diverse mothers: a mixed methods systematic review protocol

OBJECTIVE

The objective of the review is to synthesize existing literature examining the barriers and facilitators to preventive oral health care utilization experienced by culturally and linguistically diverse mothers.

INTRODUCTION

Preventive oral health care in the absence of pain is underutilized in culturally and linguistically diverse groups. Culturally and linguistically diverse mothers experience oral health care utilization barriers compared to their host country counterparts. Much of the current evidence is focused on oral health care knowledge, attitudes, and beliefs of culturally and linguistically diverse groups. To date, it remains unclear as to which barriers or facilitators impact preventive oral health care utilization in culturally and linguistically diverse mothers.

INCLUSION CRITERIA

This review will consider studies that explore oral health care utilization in culturally and linguistically diverse mothers (with children younger than 18 years) who are either born in a different country or who have one parent born in a country that differs culturally and/or linguistically to the host population. Papers that explore barriers and facilitators to oral health care utilization will be included. Quantitative and qualitative studies will be included.

METHODS

A three-step search strategy will be conducted within the following databases: MEDLINE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Central, and Scopus. The search will be supplemented with gray literature and reference searching from collected articles. No date limitation will be applied. Two reviewers will assess papers against the inclusion criteria. A convergent integrated approach using the JBI mixed methods methodology will be followed for critical appraisal, data extraction, and data synthesis and integration.

US adults with diabetes mellitus: Variability in oral healthcare utilization

BACKGROUND

Diabetic patients are advised to have at least one dental examination per year. It is unclear to what extent different subgroups of US diabetic adults closely follow this recommendation. Thus, we assessed dental care utilization and related factors in a representative sample of US diabetic adults from rural and urban counties.

METHODS

Cross-sectional data were from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). Survey logistic regression was used to account for the complex sampling design.

RESULTS

Among 40,585 eligible participants, 24,887 (60% of the population) had at least one dental visit for any reason within the past year. The lowest compliance was observed among edentulous participants (27%, adjusted OR = 0.26, 95% CI = 0.22-0.31 vs. fully dentate). Dental compliance was also negatively associated with having a lower income or education, ever being a smoker, or having barriers to access to care. Rural residents had lower dental compliance compared to urban residents, particularly those without healthcare coverage.

CONCLUSIONS

Dental compliance among US adult diabetic individuals was low, particularly among rural residents, and as compared to other recommended diabetic care practices. Future public health interventions may target rural individuals without healthcare coverage, smokers and edentulous individuals. There is a need to integrate dental and medical care to facilitate cross-talks among different health professionals, so that educational preventive messages are reinforced at every healthcare visit.

Prevalence of Past-Year Dental Visit Among US Adults Aged 50 Years or Older, With Selected Chronic Diseases, 2018

In this study, we used data from the Behavioral Risk Factor Surveillance System to conduct multivariable analyses to examine whether having selected chronic diseases was associated with lower past-year dental service utilization among US adults aged 50 years or older. We found consistent lower dental service utilization among older adults with diabetes, heart disease or stroke, and chronic obstructive pulmonary disease (COPD) compared with those without the disease after adjusting for sociodemographic characteristics. We also found lower dental service utilization among older adults with lower income, less education, and no health care coverage and among those who smoked. Effective interventions are needed to reduce disparities in access to dental care among at-risk and vulnerable populations.

Utilization of dental care in Iranian pregnant women: Findings from a population-based study

BACKGROUND

Although dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among pregnant women. The aim of this study was to examine the prevalence of not receipt dental care and also determinants of that during pregnancy.

MATERIALS AND METHODS

This population-based study was conducted on 4071 mothers in 10 provinces of Iran, during 2014-2015. We calculated the prevalence of not receipt of dental care, and reasons for nonreceipt of care. We used logistic regression to estimate odds of nonreceipt of care by demographics variables. In the analyses, the level of statistical significance was set at P < 0.05.

RESULTS

Overall, 54.70% of women had no dental visit during pregnancy. In mothers who had a history of stillbirth, neonatal death and live birth, the prevalence of not receipt dental care during pregnancy were 54.56%, 48.92%, and 58.76%, respectively. The logistic regression analyses showed that parity second-to-fourth birth than first birth (odds ratio [OR] 1.37 confidence interval [CI] 95% 1.17-1.59, residence in rural (OR 1.68 CI 95% 1.45-1.95), and not intended pregnancy (OR 1.32 CI 95% 1.03-1.68) associated with not received dental care during pregnancy.

CONCLUSION

Most pregnant women in this study received insufficient dental care. The need for dental care during pregnancy must be promoted widely among women of reproductive age, and family barriers to dental care should be addressed.

Oral Health Status, Knowledge, and Behaviours of People with Diabetes in Sydney, Australia

This study assessed self-reported oral health status, knowledge, and behaviours of people living with diabetes along with barriers and facilitators in accessing dental care. A cross sectional survey of 260 patients from four public diabetes clinics in Sydney, Australia was undertaken using a 35-item questionnaire. Data were analysed using SPSS software with descriptive and logistic regression analyses. More than half (53.1%) of respondents reported having dental problems which negatively impacted their related quality of life. Less than half (45%) had adequate oral health knowledge. Only 10.8% reported receiving any oral health information in diabetes care settings, which had higher odds of demonstrating adequate oral health knowledge (AOR, 2.60; 95% CI, 1.06-6.34). Similarly, 62.7% reported seeing a dentist in the last 12 months. Having private health insurance (AOR, 3.70; 95% CI, 1.85-7.40) had higher odds of seeing a dentist in the past 12 months. Dental costs were a major contributor to avoiding or delaying dental visit. Patients living with diabetes have unmet oral health needs particularly around the awareness of its importance and access to affordable dental services. Diabetes care providers can play a crucial role in this area by promoting oral health to their patients.

The Cupola: an additional layer of protection for providers working in the oropharyngeal region

OBJECTIVES

To reduce the spread of the infection, especially during aerosol generating procedures, we invented "The Cupola", a shield that creates a mechanical barrier around the patient's head and body. With this pilot study we aimed to assess the effectiveness of an additional layer of protection (The Cupola) developed for providers working in the oropharyngeal region.

RESULTS

The mean number of 0.3 μm particles with no Cupola was 3777 (SD: ± 556), with The Cupola was 2068 (SD: ± 1468) and with the Cupola and Drape was 2031 (SD: ± 1108) (p < 0.015). The mean number of 0.5 μm airborne particles with no Cupola was 65 (SD: ± 7), with The Cupola was 29 (SD: ± 28) and with the Cupola and Drape was 28 (SD: ± 23) (p < 0.05). Results showed a significant reduction of aerosols generated during simulated dental procedures when the Cupola was used. The Cupola offers an extra layer of protection in addition to the recommended personal protective equipment.

Racial inequities in tooth loss among older Brazilian adults: A decomposition analysis

OBJECTIVE

To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services.

METHODS

Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities.

RESULTS

The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years.

CONCLUSIONS

Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.

Geofencing: Mobile Technology as a Health Promotion Tool to Raise Awareness of a Dental Clinic in Rural North Carolina

PURPOSE

The purpose of the study was to assess the use of geofence technology to raise awareness of a dental clinic in rural North Carolina.

METHODS

The catchment area of the dental clinic was defined by ZIP Codes. A geofence was identified, and cell phones within the perimeter were targeted for oral health message drops to occur over 3 months from April to June 2017. Surveys conducted twice, pre- and postintervention (message drop), evaluated change in community awareness of services available at the dental clinic. A cross-sectional analysis was used to measure the effect of the exposure to the geofence technology in survey respondents.

FINDINGS

The survey included 200 participants (100 pre- and 100 postintervention). There were no significant differences in race or age for pre- and postintervention survey groups. The majority of respondents were American Indians (47.0% pre, 58.6% post) or black (28.8% pre, 25.5% post). There was a statistically significant improvement in awareness of the dental clinic (P = .045) from pre- to postintervention. A significant increase was also observed in the question related to dental visits by the respondent or family member of the respondent (from 6.5% to 15.0%, P = .04). A more modest improvement was found in questions related to the cost of dental care, type of insurance accepted, and services provided.

CONCLUSION

Geofencing has the potential to increase awareness of health care services and ultimately increase the number of patients receiving care.

Oral Health Among Older Adults With Complex Needs Living in the Community and in Aged Residential Care Facilities within New Zealand

OBJECTIVES

To describe the oral health status and dental service use of older adults with complex needs living within the community and aged residential care (ARC) facility settings, and to determine associations between dental service utilization and sociodemographic variables.

DESIGN

Secondary analysis of 2 continuously recruited national cohorts.

SETTING AND PARTICIPANTS

Adults aged ≥65 years having standardized assessments between July 1, 2012, and May 31, 2018, within New Zealand and who provided consent.

METHODS

All community-living older people with complex needs undergo a standardized assessment, using the Home Care International Residential Assessment Instrument (interRAI-HC), whereas all ARC facility residents undergo Long Term Care Facilities assessments (interRAI-LTCF). Anonymized data from consenting participants were extracted. Cross-sectional analyses of oral health status and dental service use variables employed logistic regression models, whereas longitudinal analysis of factors influencing dental service utilization employed binary generalized estimating equation models.

RESULTS

Overall, 144,380 interRAI-HC assessments from 97,229 participants, and 195,549 interRAI-LTCF assessments from 62,798 participants were eligible. At first assessment, their average age was 81.9 years (range: 65-109 years) and 84.4 years (range: 65-110 years), respectively. Approximately 65% of the participants wore dentures; 9% had broken, fragmented, loose, or otherwise nonintact natural teeth; and 10% reported difficulties chewing. Overall, only 25.3% of community-dwelling older adults and 17.5% of ARC residents had a dental examination within the previous year. Stark inequalities were observed with, for example, Māori participants having adjusted odds 3.14 [95% confidence interval (CI): 2.88, 3.42] and 2.08 (95% CI: 1.81, 2.39) of not having a dental examination in community and ARC facility settings compared with their New Zealand European counterparts.

CONCLUSIONS AND IMPLICATIONS

Heavy and unequal oral health burdens were observed among older adults with complex needs, together with low dental service uptake. New Zealand needs an oral health policy for older adults.

Evaluation of oral health care seeking behavior in rural population of central India

Objectives

To study the perception regarding common oral diseases and health seeking behaviour related to those diseases among rural population of central India.

Methods

A cross sectional study was conducted in the rural areas of Wardha, Maharashtra on a population between the age group of 18 and above. Data was recorded by a self administered, structured questionnaire in this study. Questionnaire was based on oral health literacy and health seeking behaviour of participants.

Results

Study included 700 participants, 343 males and 347 females. Dental problem was reported by 68% of participants. Toothache was the most common dental problem reported. Government hospitals were chosen by 19% of participants as treatment centre. Fear 24.3% was found to be the major reason for not visiting the dentist.

Conclusion

Healthcare seeking behaviour among rural population towards oral diseases was poor. So efforts must be made to bring a change in this scenario.

Knowledge of heart attack and stroke symptoms among US Native American Adults: a cross-sectional population-based study analyzing a multi-year BRFSS database

Background

Heart disease and stroke are among the leading causes of death in Native Americans. Knowledge of heart attack and stroke symptomology are essential for prompt identification of symptoms and for appropriate action in seeking care. Knowledge of heart attack and stroke symptoms among US Native American adults was this study’s focus.

Methods

Multivariate techniques were used to analyze national surveillance data. Native American adults comprised the study population. Low heart attack and stroke knowledge score was the dependent variable.

Results

Logistic regression analysis yielded that Native American adults with low heart attack and stroke composite knowledge scores were more likely to be: older, less educated, poorer, uninsured, a rural resident, male, without a primary health care provider, and lacking a recent medical checkup.

Conclusions

The identified characteristics of Native American adults with heart attack and stroke knowledge deficits or disparities should guide educational initiatives by health care providers focusing on improving such knowledge.

Healthcare Services Use Among Dental Patients

Regular medical attendance proved to have a positive impact on health, therefore the aim of the study is to detect the reasons and frequency for health care use among a group of 110 urban dental patients aged between 33 and 75 years, 50% males. The subjects completed an anonymous questionnaire with items related to their medical visits patterns: reason (treatment/control and emergency) and frequency of healthcare services use; self-assessed oral and general health and socio-demographic data. Most of the patients were adults (81.8%) and with more than 12 years of study (50%). In terms of reason for attending the dental office, 72% visited the dentist for emergency reasons, mainly men, elderly, patients with low level of education, and those who self-rated their oral health as satisfying or poor. Regarding medical visits, 54% from all patients attended healthcare for emergency reasons, regardless age, gender, education level and self-perceived general health. The results showed that worse healthcare services use is associated with low education level and gender, especially men visited the dentist when there is pain only. There is need to increase the number of individuals who use regular health care, for prevention and early detection of diseases.

Salivary total Immunoglobulin G as a surrogate marker of oral immune activity in salivary bioscience research

The integration of salivary biomeasures in biobehavioral, psychophysiological, and clinical research has greatly expanded our ability to study the biopsychosocial processes underlying health. Much of this research, however, has failed to adequately assess and adjust for the impact of oral immune activity on salivary biomeasure concentrations and associations with serum levels. Aiming to improve the validity and reliability of salivary biomeasure data, we examine salivary total Immunoglobulin G (IgG) as a potential surrogate marker of oral inflammation and immune activity. During a single study visit in Baltimore, Maryland, healthy young adult participants provided matched blood and saliva samples (N=99; age 18-37 years, 42% female) and completed an oral health questionnaire. Biospecimens were assayed for total IgG and immune markers related to inflammation (cytokines), blood in saliva (transferrin), and tissue remodeling (matrix metalloproteinase-8). Total IgG (μg/mL) concentrations were higher in serum than saliva. Salivary total IgG was associated with some self-reported oral health measures, and strongly positively associated with all salivary immune markers. Controlling for salivary total IgG may be a feasible, affordable approach to adjusting salivary biomeasure findings for the influence of the oral immune environment when it is not possible or practical to obtain clinical oral health data.

Socioeconomic inequality in dental care utilization in Iran: a decomposition approach

PURPOSE

Socioeconomic inequalities in dental care utilization in Iran are rarely documented. This study aimed to provide insight into socioeconomic inequalities in dental care utilization and its main contributing factors among Iranian households.

DESIGN/METHODOLOGY/APPROACH

A total of 37,860 households from the 2017 Household Income and Expenditure Survey (HIES) were included in the study. Data on dental care utilization, age, gender and education attainment of the head of household, socioeconomic status of households, health insurance coverage, living areas and provinces were obtained for the survey. The concentration curve and the normalized concentration index (C_n) was used to illustrate and quantify socioeconomic inequalities in dental care utilization among Iranian households. The C_n was decomposed to identify the main determinants of the observed socioeconomic inequality in dental care utilization in Iran.

FINDINGS

The study indicated that the prevalence of dental care utilization among Iranian's households was 4.67% (95% confidence interval [CI]: 4.46 to 4.88%). The results suggested a higher concentration of dental care utilization among socioeconomically advantaged households (C_n = 0.2522; 95% CI: 0.2258 to 0.2791) in Iran. Pro-rich inequality in dental care utilization also found in rural (C_n = 0.2659; 95%CI: 0.2221 to 0.3098) and urban (C_n = 0.0.2504; 95% CI: 0.0.2159 to 0.2841) areas. The results revealed socioeconomic status of households, age and education status of head of households and residing provinces as the main contributing factors to the concentration of dental care utilization among the wealthy households.

ORIGINALITY/VALUE

This study revealed pro-rich inequalities in dental care utilization among households in Iran and its provinces. Thus, health policymakers should focus on designing effective evidence-based interventions to improve healthcare utilization among household with the older head of households, lower education status, and living in relatively poor provinces to reduce socioeconomic inequality in dental care utilization in Iran.

Barrier to Access and Dental Care Utilization Behavior with Related Independent Variables in the Elderly Population of Saudi Arabia

Objectives:

The study aimed to evaluate barriers associated with access and utilization of dental services among the elderly population of Saudi Arabia.

Materials and Methods:

A systematic random sample of 350 elderly people recruited from various gathering places of the elderly including all nursing home residents (n = 73) was included in this study. The data were collected through face-to-face structured interviews related to access and utilization of dental services, and sociodemographic, behavioral, medical, and financial barriers to dental services. Statistical analysis included frequency distributions, chi-squared tests, and regression analysis using the Statistical Package for the Social Sciences (SPSS) program.

Results:

Approximately 37% of the elderly had proper access to and utilization of dental services. Independent variables that affect access and utilization of dental services were low income (odds ratio [OR] = 2.23, confidence interval [CI] = 1.34–3.72), unmarried participants (OR = 3.25, CI = 1.75–6.05), community residents (OR = 5.15, CI = 2.52–10.53), smokers (OR = 1.93, CI = 1.02–3.68), irregular users of toothbrushing (OR = 3.53, CI = 2.09–5.95), no dental insurance (OR = 1.88, CI = 1.06–3.37), and unaffordable price (OR = 2.55, CI = 1.38–4.69) in the bivariate analysis. In logistic regression analysis, the significant variables that were associated with proper access and utilization of dental services were having dental insurance (OR = 2.24, CI = 1.15–3.82), affordable prices (OR = 2.19, CI = 1.21–3.70), brushing regularly (OR = 3.58, CI = 2.01–6.37), higher education (OR = 1.87, CI = 1.10–3.20), and being married (OR = 1.68. CI = 0.97–2.91).

Conclusion:

Lack of perceived need, no dental insurance, unaffordable price, transportation, and fear from dental treatment were the most common significant barriers to dental services.

Patients' perspectives on integrated oral healthcare in a northern Quebec Indigenous primary health care organisation: a qualitative study

OBJECTIVE

Patient-centred care is considered to be an important element in the evaluation of integrated healthcare and has been effective in addressing oral health disparities. This study explored the patients' perspectives of patient-centred integrated care in oral health services integrated into a primary healthcare organisation serving a northern Quebec Cree population.

DESIGN

This study used a multiple case study design within a qualitative approach and developmental evaluation methodology. Two theoretical models, Picker's Principles of Patient-Centred Care and Valentijn's Rainbow Model of Integrated Care, guided data collection and data analysis. The thematic analysis included transcription, debriefing, codification, data display and interpretation.

SETTING

This study was conducted in purposefully selected four Cree communities of Northern Quebec.

PARTICIPANTS

Adult patients in need of oral healthcare and who attended the local dental clinic were identified and recruited by maximum variation sampling and snowball techniques.

OUTCOME MEASURES

Patients' perspectives of patient-centred integrated oral healthcare.

RESULTS

Data analysis generated six major themes: enhanced accessibility, creating supportive environment, building trust through shared decision making, appreciation of public health programmes, raising oral health awareness and growing cultural humility among healthcare providers. Patients identified the integration of dental care into primary healthcare with respect to co-location, provision of free oral healthcare services, care coordination and continuity of care, referral services, developing supportive environment, shared decision making, oral health promotion and culturally competent care.

CONCLUSION

These results confirmed that patient-centred care is an important element of integrated care. Patients valued the use of this concept in all domains and levels of integration. They recommended to further strengthen the clinical integration by involving parents in oral health promotion as well as optimising care coordination and empowering a supportive environment in organisational integration.

Protocol for the evaluation of chewing among older adults

Abstract Objectives : To evaluate the functional and physiological structures of the stomatognathic system of the oral cavity of older adults based on self-perception, comparing the same with a professional clinical evaluation, and investigating the difficulties encountered when chewing. Method : An analytical cross-sectional study with a quantitative approach was conducted with a sample of 53 older adults aged 60 to 90 years. A protocol consisting of three questionnaires was used: a sociodemographic evaluation, a self-perception based interview with 19 questions on the chewing of the older adults and a clinical evaluation containing 30 questions covering aspects of the oral cavity tissue. The self-perception and clinical evaluation scores were compared using the Mann-Whitney test and the proportions observed for each item were compared by the binomial test. Results : It was found that the self-perception of older adults did not correspond to the result of the clinical evaluation. While 31 (58.5%) reported satisfaction with chewing, 16 (30.2%) had high/very high impairment and 14(26.4%) moderate impairment, based on the results of the clinical evaluation found. Conclusion : It was found that the chewing analysis process cannot be exclusively based on the answers provided by the older adults, and assessment proved to be more accurate when combined with a clinical evaluation performed by a professional.