Barriers and facilitators of dental service utilization by children aged 8 to 11 years in Enugu State, Nigeria

Evaluating the harmonization potential of oral health-related questionnaires in national longitudinal birth and child cohort surveys

BACKGROUND/OBJECTIVES

Effective use of longitudinal study data is challenging because of divergences in the construct definitions and measurement approaches over time, between studies and across disciplines. One approach to overcome these challenges is data harmonization. Data harmonization is a practice used to improve variable comparability and reduce heterogeneity across studies. This study describes the process used to evaluate the harmonization potential of oral health-related variables across each survey wave.

METHODS

National child cohort surveys with similar themes/objectives conducted in the last two decades were selected. The Maelstrom Research Guidelines were followed for harmonization potential evaluation.

RESULTS

Seven nationally representative child cohort surveys were included and questionnaires examined from 50 survey waves. Questionnaires were classified into three domains and fifteen constructs and summarized by age groups. A DataSchema (a list of core variables representing the suitable version of the oral health outcomes and risk factors) was compiled comprising 42 variables. For each study wave, the potential (or not) to generate each DataSchema variable was evaluated. Of the 2100 harmonization status assessments, 543 (26%) were complete. Approximately 50% of the DataSchema variables can be generated across at least four cohort surveys while only 10% (n = 4) variables can be generated across all surveys. For each survey, the DataSchema variables that can be generated ranged between 26% and 76%.

CONCLUSION

Data harmonization can improve the comparability of variables both within and across surveys. For future cohort surveys, the authors advocate more consistency and standardization in survey questionnaires within and between surveys.

A scoping review on the associations between early childhood caries and sustainable cities and communities using the sustainable development goal 11 framework

BACKGROUND

Early childhood caries (ECC) is a multifactorial disease in which environmental factors could play a role. The purpose of this scoping review was to map the published literature that assessed the association between the Sustainable Development Goal (SDG) 11, which tried to make cities and human settlements safe, inclusive, resilient and sustainable, and ECC.

METHODS

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to housing, urbanization, waste management practices, and ECC. Studies that solely examined ECC prevalence without reference to SDG11 goals were excluded. Of those that met the inclusion criteria, a summary highlighting the countries and regions where the studies were conducted, the study designs employed, and the findings were done. In addition, the studies were also linked to relevant SDG11 targets.

RESULTS

Ten studies met the inclusion criteria with none from the African Region. Six studies assessed the association between housing and ECC, with findings suggesting that children whose parents owned a house had lower ECC prevalence and severity. Other house related parameters explored were size, number of rooms, cost and building materials used. The only study on the relationship between the prevalence of ECC and waste management modalities at the household showed no statistically significant association. Five studies identified a relationship between urbanization and ECC (urbanization, size, and remoteness of the residential) with results suggesting that there was no significant link between ECC and urbanization in high-income countries contrary to observations in low and middle-income countries. No study assessed the relationship between living in slums, natural disasters and ECC. We identified links between ECC and SDG11.1 and SDG 11.3. The analysis of the findings suggests a plausible link between ECC and SDG11C (Supporting least developed countries to build resilient buildings).

CONCLUSION

There are few studies identifying links between ECC and SDG11, with the findings suggesting the possible differences in the impact of urbanization on ECC by country income-level and home ownership as a protective factor from ECC. Further research is needed to explore measures of sustainable cities and their links with ECC within the context of the SDG11.

Clinical characteristics and caries risk assessment of tobacco heating systems smokers, cigarette smokers and non-smokers: a cross-sectional study

OBJECTIVES

The study compared clinical characteristics and caries risk assessments between tobacco heating system (THS) smokers, cigarette smokers and non-smokers.

MATERIALS AND METHODS

General data, data regarding fluoridation, smoking and dietary habits was obtained through a questionnaire. Caries experience was assessed by the DMFT index; the amount of biofilm by the Full mouth plaque score index; the amount of salivation by the quantum of stimulated salivation test; salivary pH with pH indicator strips and salivary number of S.mutans and Lactobacilli by cultivation on agar plates. The Cariogram method was used to assess caries risk.

RESULTS

No differences between the groups was detected regarding education level, average daily number of meals, fluoridation programs, systemic diseases, and caries experience. The groups significantly differed in the amount of salivary S.mutans and Lactobacilli (p < 0.001), accumulated biofilm (p = 0.034), salivation quantum (p < 0.001), and saliva pH (p = 0.009). Exposure to tobacco smoke and heated tobacco aerosol increased the accumulation of biofilm and decreased salivary pH. Smoking increased S. mutans, while THS consumption decreased salivation and Lactobacilli the most. The Cariogram analysis found no differences in chances of avoiding new caries lesions between the groups, but a significant difference in developing caries lesions due to dietary habits was detected (p < 0.001) with non-smokers having higher risk than smokers, but not than THS consumers.

CONCLUSIONS

THS and cigarette smoking were related to clinical characteristics that affect caries activity even though the caries risk assessment revealed no significant difference in the chances of avoiding new caries lesions between the groups.

CLINICAL RELEVANCE

THS and cigarette smokers could have higher caries activity than non-smokers. The clinical study protocol has been registered on ClinicalTrials.gov under the ID number: NCT06314100.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China

Background

Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments.

Methods

We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific.

Results

Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries.

Conclusions

The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

Knowledge and attitude of parents toward child dental visits in a rural setting in Nigeria

Introduction

The study determined the proportion of rural parents with good knowledge about and good attitude toward children making their first dental visit by their first birthday. It also assessed the association among age, sex, level of education, past dental visits of parents, and knowledge about and good attitude toward children making their first dental visit by their first birthday.

Materials and Methods

This was a cross-sectional study that collected data from 115 parents in a rural setting using an interviewer-administered questionnaire. Data on age, sex, level of education, past dental visits, knowledge about, and attitude toward children making their first dental visit by their first birthday were collected from one of the parents of children aged 16 years and below. Socio-demographic factors associated with knowledge about and attitude to a child's dental visit were considered significant at the level of P < 0.05 using the Chi-square test. Logistic regression was conducted to determine the predictor of good knowledge.

Results

The age of the study participants ranged from 15 years to 63 years with a mean of 40 ± 15.51 years. Only 25 (21.7%) parents had visited the dentist. More females 31 (40.3%) than males 6 (15.8%) significantly (P = 0.008) had good knowledge of child dental visits while more males 12 (31.6%) than females 6 (7.8%) (P = 0.001) and a greater percentage of those with past dental visits 8 (32.0%) had significantly (P = 0.02) good attitude to child dental visit.

Conclusion

More mothers had good knowledge of child dental visits, while more fathers and those with past dental visits had a good attitude toward child dental visits.

Assessment of Oral Health Knowledge of Pharmacists in Two Tertiary Hospitals in Enugu, Nigeria

Introduction

Oral health is defined as a state of being free of mouth and facial pain, oral infections and sores, and other diseases that limit an individual's capacity for biting, chewing, smiling, speaking, and psychosocial well-being. This study assessed the knowledge, barriers, and facilitators of oral health knowledge among Pharmacists in Enugu, Nigeria.

Methods

This was a cross-sectional study of 163 pharmacists in two tertiary hospitals in Enugu, South East, Nigeria. Data on sociodemographic profiles, knowledge of oral health care, barriers, and facilitators of oral health knowledge was collected. Data were analyzed using SPSS version 26 and P < 0.05 was considered significant.

Results

There were more female 96 (58.9%) than male pharmacists 67 (41.1%). Their mean age was 32.98 ± 8.33 years. The majority of respondents, 56 (34.4%) graduated between 2010 and 2019, and 44 (27%) had additional qualifications. Many of the pharmacists 88 (54%) believed that oral health is part of general health. Also, 107 (65.6%) of the respondents had a good knowledge of oral health while 56 (34.4%) had poor knowledge. There was a significant association between academic qualification (P = 0.04) and having good knowledge of oral health care among pharmacists with those with additional qualifications having better knowledge than the others. Poor creation of oral health awareness by dentists 106 (65.0%) was considered as the main barrier to having good oral health knowledge by the pharmacists.

Conclusion

More than half of the pharmacists had good knowledge of oral health and academic qualification was associated with having a good knowledge of oral health care among pharmacists in the study population.

Andersen health care utilization model: A survey on factors affecting the utilization of dental health services among school children

BACKGROUND

Children's quality of life, academic performance, and future achievement can all be negatively affected by poor dental health. The present study aimed to assess the need for dental health services and the factors influencing their utilization using the Andersen health care utilization model among school children.

METHODS

The current cross-sectional study was conducted among schoolchildren aged 13 to 15 in Bangalore, India (n = 1100). A questionnaire was developed using the concepts of the Andersen healthcare usage model. The parents of the children filled out the questionnaire. The factors were investigated using bivariate analysis and multivariate logistic regression analysis.

RESULTS

About 78.1% of the children did not utilize dental health services. Regarding the reasons for not visiting a dentist, 65.8% said they did not have a dental problem, and 22.2% said they could not afford it. Bivariate analysis showed that age, gender, education level, occupation of the family's head of household, monthly family income, socioeconomic status, perceived oral health problems, accessibility of dental health facilities, and parental attitudes toward their children's oral health were significantly associated with using dental health services (p<0.05). Multiple regression analysis showed dental health service utilization was directly related to age (OR = 2.206), education, family size (OR = 1.33), and brushing frequency twice a day (OR = 1.575) with no significant relationship between distance to reach the dental facility, the number of dental visits, and socioeconomic status.

CONCLUSION

Dental health service utilization was low in the past year. The age, number of family members, parent's education level, travel time to the dental facility, the child's oral health behaviors, and positive parental attitude all play a role in a children's utilization of dental health service.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Factors associated with the use of oral health services in Peruvian children under the age of 12 years

OBJECTIVES

To determine the prevalence and factors associated with the use of oral health services in Peruvian children under 12 years of age.

MATERIAL AND METHODS

A secondary analysis of 2019 Demographic and Family Health Survey was conducted. The sample consisted of 40,751 children. The main variable was the use of dental services (attended/not attended) in the last 6 months, and the independent variables were gender, age, area of residence, wealth quintile, health insurance coverage, information received on oral health care, age, and educational level of the caregivers. Analyses of absolute and relative frequencies, differences in proportions, and multivariate analysis using generalized linear models were performed.

RESULTS

The dental service utilization prevalence during the last 6 months was 31%. Correlation was found with urban area residents (PRa = 0.945; 95% CI: 0.904-0.988), the Jungle geographical domain (PRa = 0.926; 95% CI: 0.877-0.977), the highest wealth quintile (PRa = 1.323; 95% CI: 1.232-1.421), the higher education level of the caregiver (PRa = 1.375; 95% CI: 1.231-1.536), affiliation with the Public Health Insurance (PRa = 1.112; 95% CI: 1.069-1.158), and the condition of having received information on oral health care (PRa = 2.355; 95% CI: 2.263-2.245) with respect to their baseline variables.

CONCLUSIONS

Several socio-demographic factors were correlated with the use of oral health services in Peruvian children under 12 years of age and the percentage of their use was low. Information on oral health care had a more significant impact on both, the population from the highest wealth quintile and the highest educational attainment.

Predictors of low dental service utilization among school children in Mekelle, Northern Ethiopia: a cross-sectional study

BACKGROUND

Dental service utilization is important for maintaining and enhancing children's oral health status. However, there is paucity of information regarding dental service utilization and factors affecting it among school aged children in Ethiopia.

OBJECTIVES

The purpose of this study was to determine the dental service utilization and associated factors among school aged children (6-15) years in Mekelle city, Northern Ethiopia.

METHODS

A school-based cross-sectional study was conducted in Mekelle city of Northern Ethiopia from January 2016 to June 2016. A multi-stage sampling method was used to select 405 school children. A modified World Health Organization oral health assessment form for children was used to collect data. Univariate and multivariable logistic regressions with 95% CI were used to test the association between past-year dental service utilization, as an outcome variable, and parental socio-demographic, and child characteristics as independent variables.

RESULTS

A total of 398 school children participated in the study. The overall dental service utilization among these children was (10.6%), 95% Confidence Interval (CI) (7.5%, 13.6%). In multivariable logistic regression analysis, maternal educational status (illiterate versus college and above (adjusted odds ratio (AOR) 0.13, 95% CI 0.01, 0.93)), higher monthly income (AOR 11.69, 95% CI 1.19, 114.61)), and having dental pain (AOR 50.8, 95% CI 17.8, 145.17)) were significantly associated with past year dental service utilization.

CONCLUSION

Our findings showed that a small proportion of the study population visited a dentist in the past year. Maternal educational status, monthly income, and dental pain were associated with past year dental service utilization. Oral health education programs focusing on dental service utilization targeting school children are crucial.

Pathway of Effects of Socioeconomic Status on Rural Left-behind Children to Receive Oral Health Services: A Structural Equation Modeling

In a rural area with a high proportion of left-behind children (LBC), we aimed to identify the pathway of influence of socioeconomic status (SES) on LBCs to receive oral health services after individualized advice. Between September and October 2020, in a rural area of Yunnan, a survey of 238 LBC and 210 non-left-behind children (NLBC) showed that 91.9% and 94.2% had primary teeth caries, respectively. Their caregivers were advised on (1) dental care: bringing the children to seek professional dental care; and (2) self-care: supervising the children's oral health behaviors. Two to three months later, the children and their caregivers were visited to assess the compliance with these items of advice. Structural equation modeling (SEM) was used to handle the association between SES and compliance with the advice. A heatmap was used to visualize the data of reasons for seeking dental care or not. A total of 183 (87.1%) NLBCs and 206 (86.6%) LBCs were given the above advice; 32.9% of caregivers complied with dental care advice without a statistical difference between the LBC and NLBC group; 69.9% of caregivers of NLBCs complied with self-care advice, statistically more than those LBCs (59.2%). The education of caregivers was significantly associated with compliance with both advice items in univariate analysis. SES had a direct effect on the children being left behind and the level of oral health knowledge and awareness of the caregivers. Being left behind did not have an independent effect on receiving oral health services for children. "Dental disease was not severe" and "having no pain" were the main reasons for not seeking dental care. There was no clear grouping of participants with different background information based on the reasons given for seeking or not seeking dental care. Our study pointed to the importance of SES level. Being left behind alone may not be a risk factor for missing oral health services among rural children.

APPLICABILITY of DENTAL PATIENT REPORTED OUTCOMES in LOW RESOURCE SETTINGS -A CALL to BRIDGE the GAP in CLINICAL and COMMUNITY DENTISTRY

Low resource settings (LRSs) are typically regions where inadequate healthcare resources exist and the healthcare system does not meet the acceptable global standards. The problems encountered in LRS in oral and dental medicine could be related to lack of human personnel, e.g., insufficient numbers of dentists and other dental professionals, poor infrastructure, limited or remote treatment/care facilities, lack of dental materials and supplies as well as inadequate monitoring and evaluation of public health programs. Despite the limited human resources in LRS, such settings are currently experiencing a brain drain, a situation where there is massive emigration of highly trained and qualified healthcare professionals including dentists to other countries for better living conditions. To allocate health resources judiciously, exploration of alternatives to traditional oral health assessments, which are cheap, easily available, and patient-oriented, becomes pertinent. Thus, there is a need to consider the applicability of oral assessment tools such as dental patient-reported outcomes (dPROs) in general, and oral health-related quality of life (OHRQoL) in particular. Therefore, the aim of this narrative review was to describe opportunities for the applicability of dPROs in LRSs with a focus on Nigeria, based on empirical data. The applicability of dPROs and OHRQoL in LRS includes prevention, screening, diagnosis, assessment of oral health impact, application of the first step of targeted treatment, treatment evaluation, planning, and monitoring of public health programs, as well as research needs. dPROs could be very useful in LRS because their practical advantages may be utilized to improve patient and population health.

Risk indicators for dental caries, and gingivitis among 6-11-year-old children in Nigeria: a household-based survey

Background

There is little is known about the factors associated with caries experience and gingivitis among 6–11-year-old children in Nigeria. The aim of the study was to determine the prevalence and preventive oral health behaviors associated with caries and gingivitis among 6–11-year-old children in Nigeria.

Methods

A cross-sectional questionnaire-based survey was conducted in Ile-Ife, Nigeria. The dependent variables were caries and gingivitis. The dmft/DMFT index was used to assess dental caries experience (present or absent) and caries severity. The gingival index was used to assess the prevalence (present or absent) and severity of gingivitis (healthy gingiva/mild gingivitis versus moderate/severe gingivitis). The independent variables were preventive oral health behaviors (frequency of daily tooth brushing, frequency of consumption of refined carbohydrates in-between-meals, use of fluoridated toothpaste, and use of dental floss, history of dental service utilization). A series of logistic regression analysis models were constructed to determine the associations between the dependent and independent variables after adjusting for confounders (age, sex, and socioeconomic status).

Results

There were 69 (5.2%) children with caries. The mean (standard deviation) dmft was 0.08 (0.457) and the mean DMFT was 0.02 (0.159). There were 839 (63.3%) children with gingivitis with a mean (SD) gingival index score of 0.503 (0.453). Children who seldom or never used fluoride toothpaste had significantly higher odds of developing moderate to severe gingivitis (AOR; 1.671; 95% CI: 1.003–2.786; p = 0.049). Children with middle socio-economic status had significantly lower odds of developing moderate to severe gingivitis (AOR: 0.573; 95%CI: 0.330–0.994; p = 0.048). There were no risk indicators identified for caries.

Conclusion

The prevalence of dental caries was low while the prevalence of gingivitis was high in the study population. The daily used of fluoridated toothpaste seem to reduce the risk for moderate/severe gingivitis. Further studies are needed to understand these findings.

Satisfaction with dental condition and oral health-related quality of life of school-age children with dental pain in Ibadan, Nigeria

OBJECTIVES

The aim of the study was to determine the association between oral health-related quality-of-life domains and satisfaction with dental condition of school-age children with dental pain in Ibadan, Nigeria.

METHODS

This cross-sectional study was conducted among 1006 pupils aged 9-12 years who attended 18 randomly selected primary schools in Ibadan, Nigeria. An interviewer-administered questionnaire, Child Oral Impact on Daily Performances inventory in addition to oral examination was used to obtain data. Analysis was done with SPSS 23 and STATA 14 and p-value set at <0.05.

RESULTS

The prevalence of self-reported dental pain was 10.2%. The mean Child Oral Impact on Daily Performances inventory score was 2.6(±7.2) overall and 9.8(±12.4) for pupils with pain. There was a greater impact on oral health-related quality of life of respondents who reported dental pain than in others (mean rank = 749.54 vs 475.4, U = 21,162, p < 0.001) compared to those with clinically assessed pain (mean rank = 541.21 vs 502.97, U = 6416, p = 0.489). Those who reported dental pain were more dissatisfied with their dental condition (odds ratio = 7.7, 95% confidence interval = 5.0-12.0, p < 0.001) compared to those with clinically assessed dental pain (odds ratio = 1.3, 95% confidence interval = 0.4-4.9, p = 0.687). The direct effect of pain on satisfaction with dental condition and Child Oral Impact on Daily Performances inventory was β = 0.74 (standard error = 0.12, 95% confidence interval = 0.50-0.97, p < 0.001) and β = 0.53 (standard error = 0.05, 95% confidence interval = 0.44-0.63, p < 0.001), respectively. The indirect effect was β = 0.12 (standard error = 0.039, 95% confidence interval = 0.05-0.20, p = 0.001) and the total effect was β = 0.86 (standard error = 0.11, 95% confidence interval = 0.64-1.08, p < 0.001); R 2 = 0.21.

CONCLUSION

Self-reported dental pain significantly impacted the quality of life of the pupils to cause dissatisfaction with dental condition when compared to clinically assessed pain.

Association between maternal socioeconomic factors, decision-making status, and dental utilization by children with early childhood caries in sub-urban Nigeria

AIM

To determine the association between maternal education, income, and decision-making status and the presence of early childhood caries (ECC) and dental-service utilization among young children.

METHODS

This cross-sectional study was based on data from a household survey of 1,549 mother-preschool-aged-child dyads conducted in Ife Central Local Government Area, Nigeria. The explanatory variables were maternal education, income, and decision-making status (related to healthcare, large household purchases, and visits to family/relatives). Outcome variables were the presence of ECC and the child's history of dental-service utilization. Poisson regression analyses were conducted to identify factors associated with outcomes; the models were adjusted for maternal age, child's socioeconomic status, oral hygiene status, and frequency of sugar consumption.

RESULTS

The study recruited 1,549 mother-child dyads, of which 66 (4.3 percent) children had ECC, and 90 (5.9 percent) children had a history of dental-service utilization. Fewer than half (42.3 percent) of the mothers earned between N18,001($49.00) and 60,000 ($168.00) per month. Also, 896 (57.8 percent) reported not making any independent decisions, 152 (9.8 percent) made one of three decisions independently, and 313 (20.2 percent) made two or three decisions independently. In the adjusted model, children of mothers with monthly income higher than N60,000 were more likely to have used dental services than were those whose mother's monthly income was less than or equal to N18,000 (adjusted prevalence ratio = 2.29; 95%CI: 1.30-4.02; P = 0.004). No other maternal factor was associated with ECC.

CONCLUSIONS

Although maternal socioeconomic factors and decision-making abilities were not associated with ECC prevalence, more preschool children whose mothers had high income used dental services.

Predisposing, enabling, and need characteristics of dental services utilization among socially deprived schoolchildren

OBJECTIVES

To test the relationship of predisposing, enabling and need characteristics with dental services utilization and pattern of dental attendance among 12-year-old schoolchildren living in a socially deprived urban area.

METHODS

A cross-sectional study was carried out involving 358 children enrolled in public schools located in a deprived area of the city of Manaus, Brazil. Predisposing, enabling, and need characteristics were selected according to Andersen's behavioral conceptual model. Self-completed questionnaires were used to collect the predisposing characteristics (child's gender, sense of coherence, self-esteem, oral health beliefs). Parents or guardians provided data on enabling characteristics, including dental health insurance and socioeconomic status. Evaluated need characteristics included oral clinical status assessed through dental examinations conducted by five calibrated examiners. Structural equation modeling was used to test the predictors of dental services utilization and pattern of dental attendance.

RESULTS

Predisposing characteristics, including male gender and low parents/guardians sense of coherence predicted poor dental services utilization and inadequate pattern of dental attendance, respectively. Low socioeconomic status and poor oral clinical status were linked to poor dental services utilization and worse children's pattern of dental attendance.

CONCLUSIONS

The present findings suggest that predisposing (child's gender and parental sense of coherence), enabling (socioeconomic conditions) and evaluated need characteristics (oral clinical status) are associated with dental services utilization among children.

Social predictors of oral hygiene status in school children from suburban Nigeria

Oral hygiene, which is measured by the status of plaque-free tooth surfaces, is essential for the promotion of oral health. This study aimed to determine the social predictors of good oral hygiene for children in a suburban population in Nigeria. This was a secondary analysis of data. The study participants were 8- to 16-year-old children who were residents in Ile-Ife, which is a suburban population in Nigeria. Information on the age, gender, socioeconomic status, family structure, number of siblings and birth rank of each study participant was retrieved from the an interviewer-administered questionnaire. Oral hygiene status was determined through a simplified-oral hygiene index (OHI-S) and categorized as good, fair and poor. The association between oral hygiene status and sociodemographic variables was determined. The predictors of good oral hygiene were determined using a binomial regression analysis. Data on 2,107 individuals were retrieved, of which 44.8% had good oral hygiene and 17.1% had poor oral hygiene. The odds of having good oral hygiene were reduced for children who were 13 to 16 years old (p = 0.02) or male (P=0.002) and children with low socioeconomic status (p ≤ 0.001). The odds of having good oral hygiene increased for children who were last-born compared with those who were first-born (p = 0.02). Age, gender, socioeconomic status and birth-rank were significant social predictive factors of oral hygiene status among the study population. Based on these findings, targeted interventions can be conducted to improve the oral hygiene status of children and adolescents with these social profiles.

Use of oral health care services in Peru: trends of socio-economic inequalities before and after the implementation of Universal Health Assurance

Background

Oral health inequalities are profound worldwide. Despite major improvements in oral health, inequalities exist for many racial and ethnic groups, by socioeconomic status, gender, age, and geographic location. Therefore, the purpose of this study was to investigate trends of socio-economic inequalities in access to oral health services in Peru before and after the implementation of Universal Health Assurance (AUS).

Methods

Analytical cross-sectional study based on the National Household Survey on Living Conditions and Poverty (ENAHO) 2004, 2008, 2010 and 2017. Two periods were defined before and after the AUS Law (2009). Use of oral health services was the dependent variable, for the general population and according to ages, the area of residence, and natural region. Measurements of inequality in the use of health services were made based on the concentration curves (CC), dominance test and concentration index (CI).

Results

We included a number of 85,436 (2004), 88,673 (2008), 87,074 (2010) and 124,142 (2017) participants. The proportion of people who used oral health services was 8.4% (2014), 10.1% (2008), 10.6% (2010) and 10.4% (2017). Use of oral health services showed an increase in different age groups, urban and rural areas, and natural regions of residence during the study period. The CC were distributed below the line of equality, indicating an inequality of use of oral health services, in favor of the richest groups and dominance of the CC in 2017 over the previous years. Changes in the CI were statistically significant for < 5 years and in the rural area, and for the period 2010-2017 they were also significant in the general population, children aged 5-17 years, urban area, and Andean and Jungle regions, which indicates a reduction in the concentration of use of these services in these groups.

Conclusions

The use of oral health services in Peru increased and inequality decreased in the period 2004-2017, coinciding with the implementation of the AUS. However, the use of these services continue having a distribution in favor of the richest populations. It requires the introduction of new strategies and oral health programs in the Peruvian population, with the aim of closing the gap currently mediated by the economic possibilities.

Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study

OBJECTIVES

To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation.

DESIGN

Cross-sectional survey between April and May 2016.

SETTING

Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China.

PARTICIPANTS

We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year.

MAIN OUTCOME MEASURES

The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups).

RESULTS

In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status.

CONCLUSIONS

Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.

Socioeconomic inequalities in caries experience, care level and dental attendance in primary school children in Belgium: a cross-sectional survey

OBJECTIVES

Oral health inequality in children is a widespread and well-documented problem in oral healthcare. However, objective and reliable methods to determine these inequalities in all oral health aspects, including both dental attendance and oral health, are rather scarce.

AIMS

To explore oral health inequalities and to assess the impact of socioeconomic factors on oral health, oral health behaviour and dental compliance of primary school children.

METHODS

Data collection was executed in 2014 within a sample of 2216 children in 105 primary schools in Flanders, by means of an oral examination and a validated questionnaire. Intermutual Agency database was consulted to objectively determine individuals' social state and frequency of utilisation of oral healthcare services. Underprivileged children were compared with more fortunate children for their mean DMFt, DMFs, plaque index, care index (C, restorative index (RI), treatment index (TI), knowledge and attitude. Differences in proportions for dichotomous variables (RI100%, TI100% and being a regular dental attender) were analysed. The present study was approved by the Ethics Committee of the University Hospital Ghent (2010/061). All parents signed an informed consent form prior to data collection. All schools received information about the study protocol and agreed to participate. Children requiring dental treatment or periodic recall were referred to the local dentist.

RESULTS

Underprivileged children had higher D1MFT (95% CI 0.87 to 1.36), D3MT (95% CI 0.30 to 0.64), plaque scores (95% CI 0.12 to 0.23) and lower care level (p<0.02). In the low-income group, 78.4% was caries-free, compared with 88.4% for the other children. Half of the low-income children could be considered as regular dental attenders, while 12.6% did not have any dental visit during a 5-year period.

CONCLUSION

Oral health, oral hygiene, oral healthcare level and dental attendance patterns are negatively affected by children's social class, leading to oral health inequalities in Belgian primary school children.