Dental visits and access to dental care among Maryland schoolchildren

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.

Prevalence of dental caries among 6 - 12 year old schoolchildren in social marginated zones of Valencia, Spain

Background

To estimate the prevalence of caries and to study oral health habits (oral hygiene, toothbrushing frequency, cariogenic or no cariogenic diet, visits to dentist) in children aged 6 to 12 with social exclusion risk.

Material and Methods

A cross sectional study was conducted in a sample of 160 children aged form 6 to 12 years belonging to Colegio Madre Petra in Torrent and Colegio Nuestra Señora de los Desamparados in Nazaret (Valencia). Among other variables DMFT and Greene and Vermilion simplified plaque index were analyzed.

Results

The prevalence of caries observed was 81.87% and the global DMFT was 4.481. The mean plaque index observed was 1.12. No statistically significant differences were found between global DMFT and sex, global DMFT and age, global DMFT and diet, global DMFT and visits to the dentist and global DMFT and plaque index. A significant association was seen between global DMFT and ethnicity and global DMFT and brushing frequency. Statistically significant association was found also between plaque index and visits to the dentist and plaque index and diet.

Conclusions

It was observed that children at risk of social exclusion had a very high global DMFT and a regular plaque index. So, it can be concluded that social exclusion constitute an underlying factor that increase caries prevalence and global DMFT and a marker of poor oral hygiene habits.

Key words:Dental caries, caries prevalence, oral hygiene habits, plaque index, toothbrushing frequency, social exclusion.

The role of parental education and socioeconomic status in dental caries prevention among Lithuanian children

BACKGROUND AND OBJECTIVE

The aim of this study was to disclose parental attitudes toward their children's dental care and preventive measures used as well as to evaluate their associations with parental education and socioeconomic status.

MATERIALS AND METHODS

A total of 1248 parents of 7-, 9-, and 12-year-old children from 5 largest Lithuanian cities were enrolled in the study. The questionnaire comprised 34 items, which were grouped into 4 clusters.

RESULTS

The parents with a high educational level scored better than those who had a low educational level (2.13 [SD, 0.39] vs. 2.2 [0.43], P=0.002). The parents who reported sufficient-family income scored their child's and their own health significantly better than those reporting insufficient-family income (2.02 [SD, 0.37] vs. 2.27 [SD, 0.41], P<0.001). The parents cared about their child's health more than about their own (1.53 [SD, 0.51] vs. 2.15 [0.61], P<0.001). The parents with a high educational level and those receiving sufficient income cared about education on oral hygiene and regular preventive dental check-ups more than those with a low educational level and insufficient income (36.7% and 40.8% vs. 30.2% and 28.7%, P<0.01 and P<0.001, respectively). The children whose parents had a high educational level brushed their teeth 2 times a day more frequently than those of the parents with a low educational level (48.5% and 42.4%, respectively, P<0.001).

CONCLUSIONS

Greater attention to children's dental care as well as keeping their teeth healthy was paid by the parents with a high educational level and sufficient income.

Healthy families study: design of a childhood obesity prevention trial for Hispanic families

BACKGROUND

The childhood obesity epidemic disproportionately affects Hispanics. This paper reports on the design of the ongoing Healthy Families Study, a randomized controlled trial testing the efficacy of a community-based, behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach.

METHODS

The study will enroll 272 Hispanic families with children ages 5-7 residing in greater Nashville, Tennessee, United States. Families are randomized to the active weight gain prevention intervention or an alternative intervention focused on oral health. Lay community health promoters implement the interventions primarily in Spanish in a community center. The active intervention was adapted from the We Can! parent program to be culturally-targeted for Hispanic families and for younger children. This 12-month intervention promotes healthy eating behaviors, increased physical activity, and decreased sedentary behavior, with an emphasis on parental modeling and experiential learning for children. Families attend eight bi-monthly group sessions during four months then receive information and/or support by phone or mail each month for eight months. The primary outcome is change in children's body mass index. Secondary outcomes are changes in children's waist circumference, dietary behaviors, preferences for fruits and vegetables, physical activity, and screen time.

RESULTS

Enrollment and data collection are in progress.

CONCLUSION

This study will contribute valuable evidence on efficacy of a childhood obesity prevention intervention targeting Hispanic families with implications for reducing disparities.

Evaluating a community-based dental registration program for preschool children living in areas of high social deprivation

AIM

This was to evaluate the effectiveness of a community-based program to promote dental registration and access to dental services for preschool children residing in areas of high social deprivation using monthly registration data provided by the Central Services Agency (CSA).

DESIGN

A quasi-experimental non-equivalent two group comparison.

SETTING

Areas of high social deprivation in the greater Belfast area.

METHODS

The dental registration program was conducted by community-based nurses (health visitors). The health visitors provided oral health education and distributed registration vouchers to mothers of new babies during home visits. The mothers exchanged the vouchers for motivational materials from the participating dental practices. Preschool child registration data were obtained from the CSA to evaluate the effectiveness of the program.

RESULTS

The registration rates were significantly greater 5 months after the program for 0-2-year old children residing in the intervention wards compared with control wards. During the program the rate of change in registration for the 0-2-year-old group residing in the intervention wards was significantly greater compared with those residing in the control wards (t [DF:21]=4.26: p<0.001). There was a significant increase in registration rate 5 months after the program compared with 6 months before the study started for the 0-2 year old group residing in the intervention wards compared with those residing in the control wards (t [df: 21]=3.33: P=0.003). There were no equivalent effects for the 3-5-year old group.

CONCLUSION

The adoption of a community-based approach assisted in promoting dental registration and access to dental services for preschool children residing in areas of high social deprivation.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Characteristics of publicly insured children with high dental expenses

BACKGROUND

Dental coverage is provided for all children with Medicaid in Washington State. The goal of this study was to illuminate the characteristics of a sample of Medicaid-enrolled children with high dental expenses.

METHODS

Dental care utilization data for a 33-month period were obtained from Washington State's Medicaid database. For children, 0 to 6 years, these data were linked with a parent survey addressing oral health behaviors, knowledge, family history of caries, snacking patterns, and access to dental care. Children with dental expenses of $1,000 or more were classified as the "high-expense" group. Risk factors for the high-expense group were evaluated using multiple logistic regression.

RESULTS

345 children had at least one dental procedure including preventive and diagnostic care. Among these, 30 children (9 percent) incurred 64 percent of total dental expenses for the entire group. Parent perception of lack of dental coverage was associated with incurring high dental expenses. Children of Asian or Pacific Islander heritage were at disproportionately high risk compared to White children. Age of child and family history of caries were also associated with increased risk for high expenses.

CONCLUSIONS

Not all low-income children on Medicaid are at high risk for caries. A combination of factors, including family history of caries and parent's perception of lack of dental insurance coverage, can potentially increase a child's likelihood for high-expense dental treatment. This study highlighted a small group of children with disproportionately high dental expenses. For some, earlier knowledge of coverage may have resulted in more timely access to preventive and diagnostic care, reducing the subsequent need for expensive restorative treatment.

Effects of the State Children's Health Insurance Program on access to dental care and use of dental services

OBJECTIVE

To provide national estimates of implementation effects of the State Children's Health Insurance Program (SCHIP) on dental care access and use for low-income children.

DATA SOURCE

The 1997-2002 National Health Interview Survey.

STUDY DESIGN

The study design is based on variation in the timing of SCHIP implementation across states and among children observed before and after implementation. Two analyses were conducted. The first estimated the total effect of SCHIP implementation on unmet need for dental care due to cost in the past year and dental services use for low-income children (family income below state SCHIP eligibility thresholds) using county and time fixed effects models. The second analysis estimated differences in dental care access and use among low-income children with SCHIP or Medicaid coverage and their uninsured counterparts, using instrumental variables methods to control for selection bias. Both analyses controlled for child and family characteristics.

PRINCIPAL FINDINGS

When SCHIP had been implemented for more than 1 year, the probability of unmet dental care needs for low-income children was lowered by 4 percentage points. Compared with their uninsured counterparts, those who had SCHIP or Medicaid coverage were less likely to report unmet dental need by 8 percentage points (standard error: 2.3), and more likely to have visited a dentist within 6 or 12 months by 17 (standard error: 3.7) and 23 (standard error: 3.6) percentage points, respectively. SCHIP program type had no differential effects.

CONCLUSIONS

Consistent results from two analytical approaches provide evidence that SCHIP implementation significantly reduced financial barriers for dental care for low-income children in the U.S. Low-income children enrolled in SCHIP or Medicaid had substantially increased use of dental care than the uninsured.

Preventive dental care for children in the United States: a national perspective

OBJECTIVE

Preventive dental care is a cornerstone of optimal oral health. However, in 1996, only 38% of US children received preventive dental care. We used the National Survey of Children's Health to (1) describe the proportion of US children with > or = 1 preventive dental visit within the previous year, (2) identify factors that were associated with preventive dental care use, and (3) test the hypothesis that preventive dental care use by near-poor children is associated with State Child Health Insurance Program policies for covering dental care.

METHODS

The National Survey of Children's Health includes data from 102,353 children, weighted to represent 72.7 million children, nationally. Our outcome of interest was > or = 1 preventive dental visit in the past year. We conducted multivariate regression analysis to identify factors that were associated significantly with this outcome using Stata survey capabilities.

RESULTS

In 2003, 72% of US children had a reported preventive dental care visit in the previous year. On multivariable analysis, we found that being young, black or multiracial relative to white, lower income, and lacking a personal doctor were variables with a significantly lower likelihood of a preventive dental visit. Children in states with State Child Health Insurance Program dental coverage and broadest income eligibility had a 24% higher likelihood of a preventive dental visit when compared with children in states with limited or no State Child Health Insurance Program coverage for dental services, on adjusted analysis.

CONCLUSIONS

Although the proportion of US children with a preventive dental visit now is higher than previously reported, children who are at highest risk for dental problems still are those who are least likely to receive preventive dental care. When states cover preventive dental care at income eligibility levels > or = 200% of the federal poverty level, there is a greater likelihood that near-poor children will receive preventive dental care.