Factors associated with the utilization of dental health services by the pediatric population: an integrative review

Public Dental Service Access Policies for People with Autism Spectrum Disorder (ASD) in Salvador, Bahia, Brazil: A Pre-Evaluation Study

This study sought to carry out a systematic and preliminary evaluation of the policies on access to public dental services for people with ASD in a Brazilian city. The study, conducted between November/2019 and February/2020, was developed through document analysis, the design of the theoretical logical model of the policies, and seven semi-structured interviews with key informants. The sample was intentionally selected. We also considered the answers to 108 questionnaires from a pilot study on the access of people with ASD to dental services applied to caregivers, dentists, and non-dental professionals. No refusals were recorded. The availability study showed that the policies' objectives were not being achieved in terms of care network organization: there were no institutional flows, personal contacts were used between professionals to guarantee access to secondary attention, there was no specific training for the dentists about ASD, and the oral health care network was unknown to non-dentist professionals and caregivers. Most people with ASD have visited the dentist at least once in their lives, but a large percentage of those within this study did not do so in the last year. This study identified difficulties in implementing policies and suggested possible strategies for overcoming them as dimensions and subdimensions for evaluation.

Perception of parents and caregivers about the need for dental appointments for adolescents from a Brazilian birth cohort

OBJECTIVE

To investigate the perception of parents or caregivers regarding the need for dental appointments for adolescents aged 12-13 years and associated factors.

METHODS

Data from the Pelotas 2004 Birth Cohort were used. The outcome variable was the need for dental appointments for young adolescents perceived by parents or caregivers. Demographic and economic exposure variables were obtained from the first (2004) and sixth general follow-up (2015), respectively. The exposure variables 'previous history of dental pain', 'self-rated oral health', clinical variables and the outcome variable were obtained from the second oral health follow-up (2017). Unadjusted and adjusted multivariate Poisson regression analyses provided prevalence ratios (PR) and respective 95% confidence intervals (CI).

RESULTS

At the first oral health follow-up (2009), 1303 five-year-old children were recruited, 996 of whom were reassessed and underwent oral health examinations at 12 and 13 years of age (response rate: 76.4%). The findings showed that 72.4% of parents/caregivers perceived that the adolescents needed dental appointments. No associations were found between the outcome and sociodemographic or economic variables. After adjustments, the outcome remained positively associated with previous history of toothache (PR 1.22; 95% CI 1.14-1.32), self-rated oral health as fair or poor (PR 1.26; 95% CI 1.15-1.39), the presence of dental caries (PR 1.27; 95% CI 1.20-1.38) and severe or disabling malocclusion (PR 1.14; 95% CI 1.05-1.25).

CONCLUSIONS

The perception of parents/caregivers regarding the need for dental appointments on the part of their adolescent sons and daughters was associated with oral health problems, and these findings can serve as the basis for creating and improving oral health programmes that seek a better understanding on the part of parents and caregivers regarding the importance of integral care for their adolescent children.

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.

Utilization of dental care service and associated factors among pre-school children in northwest China over the past decade

OBJECTIVE

The purpose of this study was to analyze the factors influencing the utilization of oral health care among 5 years old children.

METHODS

We conducted two observational cross-sectional studies. The studies were conducted in 2005 and 2015 and included 5-year-old children who underwent dental examination by trained dentists and the caregivers of the children were requested to answer the questionnaire. Multi-level stratified sampling method was used. Chi-square tests were used to analyze the utilization of dental care and other socio-economic variables. Logistic regression models were employed to explore the primary factors influencing the use of dental care among pre-school children.

RESULTS

In 2005, a total of 399 and in 2015, 492 child-caregiver pairs were included. The majority of the caregivers in both surveys were females, comprising 68.2% and 74.8% of the caregivers in 2005 and 2015, respectively. 75.2% and 87.0% (p < 0.05) of the respondents had an education level of lesser than 9 years. The prevalence of caries was higher in 2015 (63.2%) (p < 0.05) than in 2005 (53.4%). In 2005 and 2015, the utilization of dental care services was 20.8% and 20.0%, respectively. A statistically significant association was observed between caries and dental care use in 5-year-olds over the past decade. After adjusting for confounders, dental service usage among children in urban areas was 1.62 times higher than that of rural areas in 2005 (95% CI 0.069-0.571), and the self-assessment of caregivers regarding their child's oral health significantly improved oral health use in 2015.

CONCLUSION

The utilization of dental care services over the past decade is insufficient among pre-school children in northwest China. Hence, with the decreasing gap about economic and health service resources, policymakers should place greater emphasis on raising awareness among caregivers about the oral health status of their children.

Socio-economic inequalities in dental pain in children: A birth cohort study

OBJECTIVE

To describe socio-economic inequalities in dental pain and dental caries in 5 and 12-year-old children enrolled in a birth cohort.

METHODS

This prospective study was carried out with children enrolled in a birth cohort in Pelotas, Brazil. The main outcome was history of dental pain in the last six months, collected at 5 and 12 years of age. Dental caries was evaluated as a secondary outcome. Inequalities dimensions were investigated using maternal education and family income. The inequalities indicators used were the slope index of inequality (SII) and the concentration index (CIX).

RESULTS

Some 1,114 and 990 children were included in the analyses at the 5- and 12-year follow-ups, respectively. The prevalence of dental pain was 16.5% (95% CI 14.4-18.8) at 5 years and 31.6% (95% CI 28.7-34.6) at 12 years. Regarding SII, the difference in the prevalence of dental pain was 14 and 11 percentage points at 5 and 12 years, respectively, when comparing the less to the more maternal schooled strata. Relative inequalities (CIX) were found for dental pain only at age 12, considering family income (-5.8 CI95% -11.0; -0.6). Absolute socio-economic inequalities were also observed for dental caries in both ages.

CONCLUSION

Dental pain in the last six months and dental caries was unequally distributed. Economically disadvantaged groups had the highest prevalence of dental pain and dental caries in both dentitions. Actions to tackle socio-economic inequalities must be designed throughout life.

Impact of early childhood caries on oral health-related quality of life: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to conduct a systematic review in order to assess the impact of early childhood caries (ECC) and its severity on Oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

An electronic search was conducted in MEDLINE, EMBASE, Cochrane, SciELO and Lilacs databases. The study eligibility criteria were primary studies published in English, Spanish or Portuguese that assessed OHRQoL in preschool children with dental caries using validated instruments. Two researchers independently performed the selection process and data extraction. The Effective Public Health Practice Project's Quality Assessment Tool was used for the quality assessment. Random effects models were used to estimate the pooled effect for continuous and categorical data.

RESULTS

Of 2,037 identified articles, thirty-five studies (37 articles) met the inclusion criteria. The methodological quality was judged mainly as moderate. Children with ECC were more likely to report any impact on OHRQoL than children without caries (OR: 1.99; 95% CI: 1.51-2.62; 6 studies). Severe ECC (dmft > 5) presented a higher effect (OR: 5.00; 95% CI: 3.70-6.74; 8 studies). Sensitivity analysis including only population studies showed uncertain results on the impact of ECC on OHRQoL (OR: 1.67; 95% CI: 0.99-2.82; I²  = 95%). The symptom and psychological domains were the most affected (SMD: 0.60, 95% CI: 0.38-0.81 and SMD: 0.61, 95% CI: 0.37-0.85 respectively).

CONCLUSIONS

ECC has a negative impact on the OHRQoL of both preschoolers and their families. However, its impact on OHRQoL is diluted when it is evaluated at population level.

Cuidados em saúde bucal a crianças e adolescentes com paralisia cerebral: percepção de pais e cuidadores

Resumo Objetivou-se avaliar os cuidados em saúde bucal de crianças/adolescentes com Paralisia Cerebral (PC) segundo a gravidade, através da percepção dos pais/cuidadores. Estudo série de casos realizado em serviços de saúde de Pernambuco com 94 mães/cuidadores de sujeitos com PC entre 5 e 18 anos. Avaliaram-se fatores socioeconômicos, demográficos, cuidados em saúde bucal e uso de serviços odontológicos (SO). O Sistema de Classificação da Função Motora Grossa mostrou 67% com comprometimento motor grave. Indivíduos com PC grave tiveram frequência significantemente maior de pertencerem a famílias com renda mais baixa (89%, p < 0,001), residirem no interior (44%, p < 0,005), terem dificuldades de transporte (60%, p = 0,04) e acessibilidade aos SO (88%, p = 0,009) e maior necessidade de higiene bucal (67%, p = 0,008) realizada pelas mães (94%, p < 0,001). Apesar das barreiras de acesso aos SO, o mesmo foi facilitado para aqueles com PC grave, com uso precoce dos SO, mas com baixa oferta de dentistas e de humanização. Esses resultados informam problemas relacionados aos cuidados diários em saúde bucal, contexto de vida das famílias, de apoio institucional e de qualidade dos SO a serem enfrentados com políticas públicas socioeconômicas e de saúde integrais inclusivas e equânimes.

Regular use of dental services among university students in southern Brazil

OBJECTIVE

To verify the prevalence and factors associated with regular use of dental services in university students of the Universidade Federal de Pelotas (UFPel).

METHODS

This cross-sectional study interviewed 1,865 students aged 18 years or older, starting bachelor’s degrees in 2017, enrolled in the second academic semester of 2017 and in the first of 2018 in classroom courses at UFPel. We considered regular users those who reported regularly going to the dentist with or without perceived dental problems. To test factors associated with regular use of dental services, demographic, socioeconomic and oral health variables were collected. Statistical analyses were based on Poisson regression models.

RESULTS

The prevalence of regular use of dental services was 45.0% (95%CI 42.7–47.3). University students of high economic class (PR = 1.47; 95%CI 0.91–2.36), with last private dental appointment (PR = 1.29; 95%CI 1.03–1.61), positive self-perception of oral health (PR = 2.33; 95%CI 1.79–3.03) and no report of toothache in the last six months (PR = 1.22; 95%CI 1.03–1.45) showed higher prevalence of regular use of dental services.

CONCLUSION

The results point to inequalities in the regular use of dental services related to socioeconomic factors and a lower use among university students with worse oral health conditions. These results suggest that public health prevention and promotion policies in higher education institutions must be carried out to ensure quality of life among these young adults.

ATTACHMENT STYLE IN CHILDREN WITH CHRONIC DISEASES: A COMPREHENSIVE REVIEW

Objective:

To investigate how attachment style has been studied in children with chronic disease in the scientific literature, and what repercussions this attachment has on this population.

Data sources:

An integrative review of the literature was carried out from a survey in the LILACS, MEDLINE and SciELO databases, including original national and international publications in Portuguese, Spanish and English from 2007 to 2018, using the descriptors “apego” and “criança” in the Health Sciences Descriptors (DeCS), and “attachment” and “children” for the Medical Subject Headings (MeSH). Sixteen (16 articles) were obtained for the sample analysis.

Data synthesis:

The chronic diseases found in the research were neurobehavioral disorders such as attention deficit hyperactivity disorder (ADHD) and autism, childhood obesity, and chronic migraine. The predominant attachment style was insecurity, which could compromise the biopsychosocial development of the child.

Conclusions:

The type of attachment between child and primary caregiver may be considered a protective or risk factor for child development. Considering this premise, it is important to equip/inform families based on dialogic educational practices, in which professionals create opportunities and means for families to develop their skills and competencies, and acquire resources which meet the child’s needs. It is important that this professional helps the family to build secure bases for their child with chronic disease, understanding that the main focus for promoting child development is in the family unit.

[An investigation on the need, the utilization, and the influencing factors of dental services for pre-school children in selected areas in Chongqing province]

OBJECTIVE

The aim of this study is to survey the need, the utilization, and the influencing factors of dental services for children in selected areas in Chongqing province by investigating their oral health status. The survey will provide references for preventive oral health care in targeted Chongqing areas, which may improve the level of oral health among pre-school children.

METHODS

Random cluster sampling was utilized according to standards of the Fourth National Oral Health Epidemiological sampling survey, and 1 300 children between the ages of three and four years old from 24 kindergartens in 12 subdistricts of three areas in Chongqing were interviewed for free dental checkups and to participate in the survey. The questionnaires were designed according to the Anderson model and were answered by the children's parents. The results were analyzed utilizing Chi-square test logistic regression.

RESULTS

The prevalence rate of caries among the pre-school children in selected areas of Chongqing was 55.4%, the decay, missing, filled surface (dmfs) was 6 696, the mean dmfs was 5.2, and the caries filling constituent ratio was 2.3%. A total of 1 173 questionnaires were analyzed. The ratio for seeing a dentist for therapeutic reasons was 6.31% (74/1 173) and for prevalence was 22.93% (269/1 173).

CONCLUSIONS

The oral health service needs of pre-school children in selected areas of Chongqing are large and the oral health service utilization rate is low. Oral health care processes are arduous; thus, targeted oral prevention policies should be created.