Inequality in Utilization of Dental Services: A Systematic Review and Meta-analysis

Contesting the conventional wisdom of periodontal risk assessment

Over the years, several reviews of periodontal risk assessment tools have been published. However, major misunderstandings still prevail in repeated attempts to use these tools for prognostic risk prediction. Here we review the principles of risk prediction and discuss the value and the challenges of using prediction models in periodontology. Most periodontal risk prediction models have not been properly developed according to guidance given for the risk prediction model development. This shortcoming has led to several problems, including the creation of arbitrary risk scores. These scores are often labelled as 'high risk' without explicit boundaries or thresholds for the underlying continuous risk estimates of patient-important outcomes. Moreover, it is apparent that prediction models are often misinterpreted as causal models by clinicians and researchers although they cannot be used as such. Additional challenges like the critical assessment of transportability and applicability of these prediction models, as well as their impact on clinical practice and patient outcomes, are not considered in the literature. Nevertheless, these instruments are promoted with claims regarding their ability to deliver more individualized and precise periodontitis treatment and prevention, purportedly resulting in improved patient outcomes. However, people with or without periodontitis deserve proper information about their risk of developing patient-important outcomes such as tooth loss or pain. The primary objective of disseminating such information should not be to emphasize assumed treatment efficacy, hype individualization of care, or promote business interests. Instead, the focus should be on providing individuals with locally validated and regularly updated predictions of specific risks based on readily accessible and valid key predictors (e.g. age and smoking).

Global and regional trends in prevalence of untreated caries in permanent teeth: Age-period-cohort analysis from 1990 to 2019 and projections until 2049

OBJECTIVES

This study aims to update the relevant epidemiological information of untreated caries in permanent teeth.

METHODS

Data were derived from the Global Burden of Disease (GBD) study 2019. We described temporal trends in age-standardized prevalence rate (ASPR) of untreated caries in permanent teeth by gender and region from 1990 to 2019. Age-period-cohort (APC) model was utilized to analyze age, period and cohort effects on prevalence, and we used the Bayesian age-period-cohort (BAPC) model to make projections of prevalence between 2020 and 2049.

RESULTS

The global ASPR of untreated caries in permanent teeth presented a decreasing trend from 1990 to 2019 (26593.58/105 vs. 25625.53/105), with females exceeding males annually. Negative correlation was observed between ASPR and Socio-demographic Index (SDI) levels. APC analyses showed that net drift was -0.16 % globally and generally below 0 across all SDI regions. The overall global peak in prevalence occurred in the 20-24 years group (36319.99/105), and there was a decrease trend in the overall global period rate ratio (RR). Compared to younger birth cohorts, prior birth cohorts had higher prevalence risks globally and across all SDI regions. Significant upward trends was predicted in the global ASPR of untreated caries in permanent teeth for both genders from 2020 to 2049.

CONCLUSIONS

Age-period-cohort effects exerted a significant impact on the prevalence of untreated caries in permanent teeth during the study period.

CLINICAL SIGNIFICANCE

The ASPR of untreated caries in permanent teeth may increase in the next 30 years by projections. And the disease burden of untreated caries in permanent teeth may be affected by population ageing. It is essential to implement targeted prevention and control policies to disadvantaged groups and attempt to reduce caries inequalities.

To appreciate the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities

BACKGROUND

To appreciate dental care utilization in ‌the context of socio-economic inequalities, it is imperative to identify sources of inequalities and evaluate the extent to which dental care utilization is still related to socio-economic status. This study aimed to quantify the influence of contributed determinants on dental care utilization in the context of socio-economic inequalities amongst adults residing in Tehran metropolis.

METHODS

In this cross-sectional community-based study, a stratified random sample of 1,510 subjects aged over 18 years was investigated by the zero-inflated Poisson analysis to measure the effect of determinants on utilization of dental care, and concentration index as well as the decomposition approach to identify the contributions of deterministic variables to the socio-economic inequality. Data was obtained by employing a phone interview survey. Individuals who were not willing or able to answer the questions in the telephone interview due to hearing or neurological problems did not participate in the interview. Dental care utilization was measured using the number of dental appointments.

RESULTS

Gender (male), oral health-related behaviors (such as brushing and dental flossing), experience of toothache, and concern about dental appearance were associated with an increased likelihood of utilizing dental care. Individuals who belonged to advanced age groups and lived alone significantly underutilized dental care. The concentration index equaling 0.05 (SE = 0.05) corroborates a pro-rich inequality. Decomposition analysis demonstrated the impact of oral health-related behaviors (i.e. dental brushing and use of dental flossing), concern about dental appearance, toothache, gender (male), insurance coverage of dental care, and smoking habit on the poor-rich gap in the dental care utilization.

CONCLUSIONS

The influence of socio-economic inequalities on dental care utilization is discernable along the entire spectrum of socio-economic status. Individuals with lower socio-economic status experience more underutilization of dental care. Community subgroups, particularly the more deprived bracket, require consideration from key stakeholders, including policymakers and health professionals for the enhancement of dental care utilization as revealed by underlying determinants.

Knowledge, attitudes, and practice related to tooth loss and dentures among patients with dental arch deficiencies

BACKGROUND

Tooth loss is a common problem that affects many people worldwide. Exploring knowledge, attitude, and practice (KAP) among patients can identify barriers and challenges in following recommended practices, providing valuable insights for dental healthcare providers, policymakers, and researchers. This study aimed to explore the KAP of patients with dental arch deficiencies regarding tooth loss and dentures.

METHODS

This web-based, cross-sectional study was conducted among patients with dental arch deficiencies using a self-designed questionnaire.

RESULT

3166 valid questionnaires were included. Participants' mean KAP scores were 6.84 ± 2.27 (possible range: 0 ~ 12), 39.4 ± 3.72 (possible range: 9 ~ 45), and 27.7 ± 4.36 (possible range: 8 ~ 40), respectively. Multivariable logistic regression analysis showed that knowledge (OR = 1.383), employed (OR = 1.805), family history (OR = 2.158), and treatment (OR = 1.683) were independently associated with attitude. Moreover, knowledge (OR = 1.239), attitude (OR = 1.250), female (OR = 0.619), age (OR = 0.967), college/bachelor (OR = 0.373), and master and above degree (OR = 0.418), employed (OR = 0.554) or student (OR = 0.434), with 10,001-20,000 Yuan household income per month (OR = 0.492), have been married (OR = 0.609), smoking (OR = 0.595), drinking (OR = 0.397), disease duration (OR = 0.972), with family history (OR = 1.676), and with treatment (OR = 3.492) were independently associated with practice (all P < 0.05).

CONCLUSION

Patients with dental arch deficiencies have insufficient knowledge, positive attitudes, and moderate practice toward tooth loss and dentures, which might be affected by multiple demographic factors.

Patterns and factors associated with dental service utilization among insured people: a data mining approach

BACKGROUND

Insurance databases contain valuable information related to the use of dental services. This data is instrumental in decision-making processes, enhancing risk assessment, and predicting outcomes. The objective of this study was to identify patterns and factors influencing the utilization of dental services among complementary insured individuals, employing a data mining methodology.

METHODS

A secondary data analysis was conducted using a dental insurance dataset from Iran in 2022. The Cross-Industry Standard Process for Data Mining (CRISP-DM) was employed as a data mining approach for knowledge extraction from the database. The utilization of dental services was the outcome of interest, and independent variables were chosen based on the available information in the insurance dataset. Dental services were categorized into nine groups: diagnostic, preventive, periodontal, restorative, endodontic, prosthetic, implant, extraction/surgical, and orthodontic procedures. The independent variables included age, gender, family size, insurance history, franchise, insurance limit, and policyholder. A multinomial logistic regression model was utilized to investigate the factors associated with dental care utilization. All analyses were conducted using RapidMiner Version 2020.

RESULTS

The analysis encompassed a total of 654,418 records, corresponding to 118,268 insured individuals. Predominantly, restorative treatments were the most utilized services, accounting for approximately 38% of all services, followed by diagnostic (18.35%) and endodontic (13.3%) care. Individuals aged between 36 and 60 years had the highest rate of utilization for any dental services. Additionally, families comprising three to four members, individuals with a one-year insurance history, people contracted with a 20% franchise, individuals with a high insurance limit, and insured individuals with a small policyholder, exhibited the highest rate of service usage compared to their counterparts. The regression model revealed that all independent variables were significantly associated with the use of dental services. However, the patterns of association varied among different service categories.

CONCLUSIONS

Restorative treatments emerged as the most frequently used dental services among insured individuals, followed by diagnostic and endodontic procedures. The pattern of service utilization was influenced by the characteristics of the insured individuals and attributes related to their insurance.

Exploring discrimination and racism in healthcare: a qualitative phenomenology study of Dutch persons with migration backgrounds

OBJECTIVE

To explore and characterise the discrimination and racism experienced in healthcare from the perspective of Dutch patients with a migration background.

DESIGN

This was a qualitative phenomenological study incorporating an inductive thematic analysis of the answers provided to a free form online survey. Descriptive and differential analyses were conducted for the closed-ended questions.

SETTING

This study used an online survey distributed in Dutch about experiences of discrimination and racism in healthcare to the general population in the Netherlands.

PARTICIPANTS

The survey was completed by 188 participants (Mage=39.89, SDage=10.2). Of whom 80 (Mage=37.92, SDage=10.87) met the eligibility criteria for thematic analysis (ie, has a migration background or a relative with a migration background and experienced discrimination in healthcare based on their background) and were thus included in the analysis.

RESULTS

From the total sample, women, relative to men, were 2.31 times more likely to report experiencing healthcare discrimination (OR=2.31; 95% CI 1.23 to 4.37). The majority of the participants (60.1%) had a Moroccan or Turkish background. Six themes were identified relating to experienced discrimination in healthcare based on one's migration background: (1) explicit discrimination, (2) prejudice, (3) not being taken seriously, (4) discriminatory behaviour, (5) language barriers and (6) pain attribution to cultural background. Some participants reported that their attire or religion was linked to their migration background, thus contributing to their experiences of discrimination.

CONCLUSION

Dutch patients with a migration background may experience discrimination based on their ethnic identity or other factors related to their backgrounds, such as their faith, culture and skin colour. Discrimination manifests as intersectional and may take different forms (eg, discrimination based on the intersection between race and gender). Therefore, healthcare discrimination may increase health inequities and lead to unequal access to healthcare services. Implicitly or explicitly discriminating against patients is immoral, unethical, illegal and hazardous for individual and public health. Further research on the magnitude of discrimination in healthcare and its relation to health is needed.

Does subsidizing the cost of care impact on dental attendance patterns among older adults?

OBJECTIVES

To assess whether eligibility for an age-related universal (pioneer generation [PG]) subsidy incentivises dental attendance by older Singaporeans.

METHODS

Data were collected between 2018 and 2021 from in-person interviews of Singaporean adults aged 60-90 years using a questionnaire and a clinical examination. The questionnaire included details of age, gender, ethnicity, education, residential status, socio-economic status, marital status, eligibility for subsidy (community health assistance/CHAS, PG or both) and frequency of dental attendance. The clinical examination recorded number of teeth (categorized as edentulous, 1-9 teeth;10-19 teeth; ≥20 teeth). To estimate the effect of the PG subsidy on dental attendance pattern, a regression discontinuity (RD) analysis was applied using age as the assignment variable.

RESULTS

A total of 1172 participants aged 60-90 years (64.2% female) were recruited, with 498 (43%) being eligible for the PG subsidy. For those eligible for PG subsidy, there was a higher proportion of regular attenders than irregular attenders (53.6% vs. 46.4%). In age adjusted RD analysis, those eligible for the PG subsidy were 1.6 (95% CI: 1.0, 2.7) times more likely to report regular attendance than their PG non-eligible counterparts. The association remained strong (OR 2.1; 95% CI: 1.1-3.7) even after further controlling for demographics, socioeconomic factors, number of teeth and eligibility for the CHAS subsidy.

CONCLUSIONS

Being eligible for the PG subsidy substantially increased the odds of regular dental attendance.

Access to dental care in individuals with disability: a systematic review

OBJECTIVE

This systematic review was conducted to explore the factors influencing access to oral health services and to identify and examine the strategies to improve the access.

MATERIALS AND METHODS

PubMed, Scopus and Embase databases were searched. Studies except editorials reported in English regardless of the study design were included. Risk of Bias assessment was carried out using Agency for Healthcare Research and Quality, Newcastle Ottawa Scale and The Joanna Briggs Institute tool for cross-sectional, case-control and cohort and qualitative studies, respectively.

RESULTS

In total, 11,372 records were initially identified, eventually leading to 12 relevant publications to be included in the review. Individuals valued oral health but found it difficult to access oral health services. Dental care was mainly accessed during emergencies and participants felt apprehensive in visiting dentists. Caregiver's and dentist's perspective was also reported.

CONCLUSION

There is a need for provision of education, training and increasing awareness on dental hygiene and annual dental checkups to improve access.

Periodontitis and alveolar resorption in human skeletal remains: The relationship between quantitative alveolar bone loss, occlusal wear, antemortem tooth loss, dental calculus and age at death in a low socioeconomic status, modern forensic human collection from Yucatan

OBJECTIVE

This paper assesses the relationship between the distance between the cemento-enamel junction and alveolar crest and risk factors commonly associated with periodontitis.

MATERIALS

Eighty individuals between 28 and 92 years old with known biological sex and age were analyzed from a 20th century forensic human collection from Merida, Yucatan (Mexico).

METHODS

Macroscopic assessment, along with metric analysis, was employed using a probe.

RESULTS

Ante-mortem tooth loss was positively correlated with the distance between the cemento-enamel junction and alveolar crest, as was the presence of root calculus in females.

CONCLUSIONS

Cemento-enamel junction to alveolar crest distance is not a reliable indicator of periodontitis since it is not directly related to periodontitis-causing infectious pathogens, and since ante-mortem tooth loss can affect root exposure.

SIGNIFICANCE

This study demonstrates that a purely quantitative approach to diagnosing periodontitis in archaeological and forensic human remains can be misleading.

LIMITATIONS

The skeletal collection is only representative of the low socioeconomic class of Merida, and its female cohort is underrepresented. In addition, because the Xoclan collection is modern, limitations (particularly with respect to tooth wear) of the applicability of these interpretations to older archaeological remains exist.

SUGGESTION FOR FURTHER RESEARCH

A combination of quantitative and qualitative characteristics of alveolar bone is needed to reliably diagnose periodontitis in skeletal populations.

Understanding lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London: a qualitative study protocol

INTRODUCTION

It is important to promote resilience in preadolescence; however, there is limited research on children's understandings and experiences of resilience. Quantitative approaches may not capture dynamic and context-specific aspects of resilience. Resilience research has historically focused on white, middle-class Western adults and adolescents, creating an evidence gap regarding diverse experiences of resilience in middle childhood which could inform interventions. East London's Muslim community represents a diverse, growing population. Despite being disproportionately affected by deprivation and racial and cultural discrimination, this population is under-represented in resilience research. Using participatory and arts-based methods, this study aims to explore lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London.

METHODS AND ANALYSIS

We propose a qualitative study, grounded in embodied inquiry, consisting of a participatory workshop with 6-12 children and their parents/carers to explore lived experiences and perceptions of resilience. Participants will be identified and recruited from community settings in East London. Eligible participants will be English-speaking Muslims who identify as being black or South Asian, have a child aged 8-12 years and live in East London. The workshop (approx. 3.5 hours) will take place at an Islamic community centre and will include body mapping with children and a focus group discussion with parents/carers to explore resilience perspectives and meanings. Participants will also complete a demographic survey. Workshop audio recordings will be transcribed verbatim and body maps and other paper-based activities will be photographed. Data will be analysed using systematic visuo-textual analysis which affords equal importance to visual and textual data.

ETHICS AND DISSEMINATION

The Queen Mary Ethics of Research Committee at Queen Mary University of London has approved this study (approval date: 9 October 2023; ref: QME23.0042). The researchers plan to publish the results in peer-reviewed journals and present findings at academic conferences.

Development of oral health resources and a mobile app for caregivers and autistic children through consensus building

LAY ABSTRACT

Caregivers of autistic children often lack knowledge regarding oral homecare and when and where to see the dentist. To address this need, we developed a series of information on oral health. An autistic child assisted in developing two social stories to showcase a dental visit. A mobile app was developed to deliver the above mentioned. Other features include creation of customised social stories and visual schedule and an inbox to allow dentists to send messages to parents. The developed information and social stories were reviewed by experts and parents. The app also underwent anonymous and independent testing by parents. Overall the information and app were well received by the experts and parents.

Utilization of a public subsidy scheme for dental care services among socially vulnerable citizens out of labor in Copenhagen, Denmark

OBJECTIVE

Addressing social inequality in oral health and access to dental care is a global concern. This study aims to describe the utilization of a public subsidy scheme targeting vulnerable individuals out of labor in Copenhagen municipality (2013-2018) and to identify key characteristics of individuals eligible to apply.

MATERIAL AND METHODS

Data from Copenhagen municipality were combined with data from population and health registers. Employing logistic regression analyses, we examined the association between demographic, socioeconomic, and health-related characteristics and (1) having applied, (2) being granted, and (3) using the subsidy.

RESULTS

The study included 65,174 individuals aged 18-65. Of these 10,369 (15.9%) applied for subsidies, submitting a total of 18,529 applications. Overall, 83% of the applications were granted and 85% were used. Significantly increased odds of applying for subsidies were observed among individuals receiving social benefits non-stop over the past year versus none (odds ratio [OR] = 15.45, 95% confidence interval [CI] = 14.24-16.76), aged 50-65 versus 18-29 years (OR = 4.41, CI= 4.15-4.69), and having combined indicators of social vulnerability versus none (OR = 2.90, CI= 2.73-3.07).

CONCLUSIONS

While the utilization of the public subsidy scheme is low, individuals who apply are likely to be granted a subsidy and use it. Vulnerability was associated with greater utilization of the scheme, yet a substantial portion of those at risk of poor oral health did not take advantage of it.

Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies

AIM

To systematically review longitudinal studies investigating the impact of dental visiting patterns on oral health across the life course.

METHODS

Five databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) were searched up to March 2023. Results were screened based on eligibility criteria in a two-stage process: title and abstract, and full-text review. A backward search of reference lists and a forward search of citations of the included papers was also conducted. The quality of the included papers was assessed using the Newcastle-Ottawa Scale. Key study information was extracted and a narrative synthesis of the findings was performed.

RESULTS

Eleven papers from five longitudinal studies in five countries (Australia, Brazil, China, New Zealand, Sweden) met the inclusion criteria. Studies of moderate to high quality consistently reported that regular dental attendance was associated with having less dental caries experience, fewer missing teeth and better oral health-related quality of life. Inconsistent findings were observed for decayed teeth, and no association was found for periodontal condition.

CONCLUSIONS

This review highlights an association between regular dental visiting pattern and improved oral health, notably less dental caries experience and better oral health-related quality of life. Dental attendance emerges as an important predictor of oral health across the life course, underscoring the importance of routine dental care.

REGISTRATION INFORMATION

The PROSPERO registration number is CRD42023396380.

Life course social mobility, race and tooth loss in adulthood: The role of dental health services

OBJECTIVES

To evaluate the extent to which dental care factors in adulthood modify and, at the same time, mediate the association between race/ethnicity and social mobility from childhood to adulthood with two oral health outcomes in adults.

METHODS

In 2012, 1222 individuals 20-59 years old participated in the second wave of the Epi-Floripa Study in Florianopolis, Brazil. Exposures included social mobility based on adulthood and childhood events, dental care in previous years, type of dental care coverage, reason for dental visits and race. The number of missing and decayed teeth were dichotomised as MT >0 and DT >0.

RESULTS

The prevalence of missing and decayed teeth was 61.9% and 23.0%, respectively. Age-sex adjusted inequalities in decayed and missing teeth among Black and White individuals were 41.2 percentage points (pp) (95% CI: 3.9-78.7) and 53.1 pp (19.5:86.7), respectively. Inequalities between those persistently higher and lower in socioeconomic position were 42.6 pp (14.6-70.7) and 90.0 pp (62.1-100). The Relative Excess of Risk due to Interaction (RERI) was not statistically significant (p < 0.05). Oaxaca-Blinder decomposition analyses showed that dental care variables accounted for a small proportion of inequalities.

CONCLUSIONS

This result implies that dental care is unlikely to significantly reduce or increase oral health inequalities in this particular population.

Oral health inequalities in Swedish older adults over 25 years of follow-up

OBJECTIVES

The aim of this study was to describe inequalities in tooth loss and dissatisfaction with teeth related to time-invariant and time-variant socio-demographic characteristics and use of dental care across the middle and older life course and to assess whether oral health inequalities remain stable, widen or narrow from age 50 to 75.

MATERIALS AND METHODS

In 1992, 6346 residents, aged 50, consented to participate in a prospective cohort study including postal questionnaire follow-ups every fifth year until age 75. Tooth loss and dissatisfaction with teeth were assessed at each survey wave in addition to socio-demographic factors and use of dental care. Multivariable logistic regression, generalised estimating equations, GEE, and random intercept logistic mixed models were used for estimation of population-averaged and person-specific odds ratio. Interaction terms of each covariate with the time indicator were added to test whether inequalities changed across time.

RESULTS

Person-specific OR and 95% CI estimates for tooth loss varied from 1.29 (1.09-1.53) (unmarried vs married) to 9.20 (6.07-13.94) (foreign country vs native). Estimated ORs for tooth dissatisfaction ranged from 1.33 (1.15-1.55) (unmarried vs married) to 2.59 (2.15-3.11) (smoking vs no smoking). Inequalities in tooth loss according to sex, educational level and country of birth were smaller in magnitude in 2017 than in 1992. Inequality estimates in dissatisfaction with teeth according to use of dental care and perceived health were, respectively, smaller and greater at older than at younger age.

CONCLUSION

Socio-demographic inequalities in oral health persisted from age 50 to 75 and varied in magnitude across time. Both convergence and widening of disparities in oral health occurred towards older ages.

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: a feasibility randomised controlled trial

BACKGROUND

Urgent dental care may be the only place where many people, especially vulnerable groups, access care. This presents an opportunity for delivery of a behavioural intervention promoting planned dental visiting, which may help address one of the factors contributing to a socio-economic gradient in oral health. Although we know that cueing events such as having a cancer diagnosis may create a 'teachable moment' stimulating positive changes in health behaviour, we do not know whether delivering an opportunistic intervention in urgent dental care is feasible and acceptable to patients.

METHODS

The feasibility study aimed to recruit 60 patients in a Dental Hospital and dental practices delivering urgent care within and outside working hours. Follow-up was by telephone, e mail and post over 4 months.

RESULTS

Although the recruitment window was shortened because of COVID-19, of 47 patients assessed for eligibility, 28 were enrolled (70.1% of screened patients provided consent). A relatively high proportion were from disadvantaged backgrounds (46.4%, 13/28 receiving State benefits). Retention was 82.1% (23/28), which was also the rate of completion of the Oral Health Impact Profile co-primary outcome. The other primary outcome involved linking participant details at recruitment, with centrally-held data on services provided, with 84.6% (22/26) records partly or fully successfully matched. All intervention participants received at least some of the intervention, although we identified aspects of dental nurse training which would improve intervention fidelity.

CONCLUSIONS

Despite recruitment being impacted by the pandemic, when the majority of clinical trials experienced reduced rates of recruitment, we found a high recruitment and consenting rate, even though patients were approached opportunistically to be enrolled in the trial and potentially receive an intervention. Retention rates were also high even though a relatively high proportion had a low socio-economic background. Therefore, even though patients may be in pain, and had not anticipated involvement before their urgent care visit, the study indicated that this was a feasible and acceptable setting in which to position an opportunistic intervention. This has the potential to harness the potential of the 'teachable moment' in people's lives, and provide support to help address health inequalities.

TRIAL REGISTRATION

ISRCTN 10,853,330 07/10/2019.

Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study

OBJECTIVE

To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC.

MATERIALS AND METHODS

Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed.

RESULTS

At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae.

CONCLUSIONS

This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth.

CLINICAL SIGNIFICANCE

A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.

Factors influencing the likelihood of dental service checkup: results from a survey in Saudi Arabia

Background

The funding and delivery of healthcare including dental care in the Kingdom of Saudi Arabia (KSA, or Saudi Arabia) is undergoing a process of reform. To inform this process, it is important that policymakers are aware of the relationships between service use, specific types of use, and the factors that influence this. Currently, there is a paucity of research in this area in KSA that examines dental service use for checkups at a national level and none that examines differences in this use across regions or that examines explicitly the role of income.

Aims

This study uses the most recent version of the Saudi Health Interview Survey (SHIS) to examine the relationships between the use of dental services for a checkup and socio-demographic characteristics of respondents. Particular focus is given to the differences between regions in service use and the role of socio-demographics within regions.

Methods

Data were taken from SHIS 2013. Descriptive statistics (means and standard errors) were used to characterize the sample. Logistic regression analyses were used to examine the relationship between checkups in the past 12 months and a range of covariates including income and region. The analysis was repeated for sub-samples based on specific regions. No attempt was made to impute missing values.

Results

A sample of 7603 respondents provided complete data for analysis. Fifty-one per cent of the respondents were male, 29% were educated at least to degree level, 25% reported that they floss at least once per day, 69% reported that they brushed their teeth at least once per day, and 11% reported that they had visited the dentist for a checkup in the preceding 12 months. Logistic regression analyses revealed income, region, and oral hygiene habits to be among the significant determinants of the likelihood of dental checkup in the preceding 12 months. In logistic regression analyses at the regional level, different relationships were evident between checkups and socio-demographic characteristics across regions.

Conclusion

Region and income are significant determinants of dental service use for checkups. Differences exist between regions in the relationship between socio-demographic characteristics and the likelihood of getting checkups. Policy changes should reflect the potential differences they might have across regions for which the role of socio-demographic characteristics varies.

Dental Utilization Stratified by the Purpose of Visit: A Population-Based Study in Japan

BACKGROUND

This study aimed to provide a stratified description of dental visit utilisation by Japanese residents based on patient age, sex, prefecture, and the purpose of the visits.

METHODS

This cross-sectional study used the National Database of Health Insurance Claims of Japan to identify participants visiting dental clinics in Japan (April 2018-March 2019). Dental care utilisation by populations stratified by age, sex, and prefecture was assessed. We estimated the slope index of inequality (SII) and relative index of inequality (RII) to evaluate regional differences based on regional income and education.

RESULTS

Amongst the Japanese population, 18.6% utilised preventive dental care visits; 59,709,084 participants visited dental clinics, with children aged 5 to 9 years having the highest proportion. SII and RII were higher for preventive dental visits than those for treatments in all settings. The largest regional differences for preventive care were observed in SII of children aged 5 to 9 years and in RII of men in their 30s and women aged 80 years and older.

CONCLUSIONS

This nationwide population-based study revealed that the proportion of people utilising preventive dental care in Japan was low, with regional differences. Preventive care needs to be more easily accessible and available to improve the oral health of residents. The above findings may provide an important basis for improving policies related to dental care for residents.

Parents and guardians perceptions of primary school students accessibility to dental health services in Riyadh City, Saudi Arabia: A cross-sectional study

The success of healthcare delivery systems depends on accessibility. This study aimed to assess parental and guardian perceptions of dental health service accessibility among primary school students in Riyadh, Saudi Arabia. A descriptive cross-sectional survey was conducted among the parents and guardians of primary school students. A 23-item questionnaire was developed on the basis of previous studies. Demographic information, accessibility details, and barriers to dental services were recorded. A total of 385 participants responded to the questionnaire. Approximately 46.2 % of students encountered barriers to accessing dental services. Eighty (20.8 %) male students visited dental facilities more often than female students (72 [18.7 %]) within a 6-month period. Approximately 21 % of students had never visited a dental facility. The lowest number of preventive treatments were administered (15.4 %). Parents and guardians reported that private dental facilities were more accessible (185 [48 %]) than government dental facilities. There was an association between dental facilities and difficulties in accessing dental care services (χ2(4) = 42.753; p < 0.001). In conclusion, parents and guardians reported experiencing difficulties accessing dental services. However, parents and guardians must change their perspectives on accessibility, particularly for preventative care, because primary school children received the lowest.

Toothbrushing and Access to Dental Services in Peruvian Children

Objective. The aim was to determine the association between access to dental services and toothbrushing in Peruvian children under 12 years old. Methods. This was a cross-sectional study with a population of 2021 database of the Demographic and Family Health Survey. Records of children under 12 years old who provided answers about their toothbrushing were included. Variables were evaluated descriptively and followed by a bivariate analysis; multivariate tests were performed using Poisson regression with a multilevel regression analysis. Results. General toothbrushing was 96.32% (n = 34 198), and daily toothbrushing was 88.05% (n = 28 444). Access to dental services was associated with general toothbrushing (aPR: 1.18; 95% CI: 1.14-1.22; P < .001), daily toothbrushing (aPR: 1.08; 95% CI: 1.04-1.12; P < .001) and minimum toothbrushing 2 times a day (aPR: 1.12; 95% CI: 1.07-1.17; P < .001). Conclusion. Access to dental services was associated with general toothbrushing, daily toothbrushing and toothbrushing at least twice a day.

Payment Methods and Demographics Influence Patterns of Dental Service Utilization

OBJECTIVE

To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM).

DESIGN

This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis.

SETTING

Nine dental clinic sites across the state of North Carolina.

PARTICIPANTS

In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study.

MAIN OUTCOME MEASURES

In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method.

RESULTS

Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay ( P < .001). Payment method is associated with the dental service type utilized by an individual ( P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants.

CONCLUSIONS

Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.

Does domestic violence legislation reduce permissive attitudes about intimate partner violence? Longitudinal evidence from men and women from 61 countries

Background

Intimate partner violence (IPV) is highly prevalent and has substantial implications for women's health. Changing IPV attitudes is one pathway to reduce IPV. While evidence suggests that interventions targeting individuals may change IPV attitudes, the effect of wider-scale interventions, such as legislation, remain unknown.

Methods

We used individual-level IPV attitudes information collected between 1997 and 2020 by the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), which we linked with national-level domestic violence (DV) legislation information. We evaluated the effect of adoption of DV legislation on changes in IPV attitudes using a difference-in-differences study design that controlled for time-varying country-level confounding and accounted for staggered timing of legislation adoption.

Findings

Our sample included 2,184,047 women from 60 countries and 390,877 men from 40 countries. After controlling for country-level confounders, adoption of DV legislation reduced IPV acceptability among women (average treatment effect among treated (ATT) = -0.07, 95% CI: -0.16, 0.06) and men (ATT = -0.11, 95% CI: -0.22, 0.03) although estimates were imprecise and included the null.

Interpretation

DV legislation may reduce permissive IPV attitudes, especially among men, although conclusions should be interpreted cautiously due to imprecise estimates.

Funding

Eunice Kennedy Shriver National Institute of Child Health and Human Development (5R00HD104896).

Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults

Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.

Identifying racial disparities in hereditary hemorrhagic telangiectasia

BACKGROUND

Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder characterized by recurrent epistaxis (nose bleeds), mucosal telangiectasias (spider veins), and arteriovenous malformations. Although HHT affects all racial groups, few studies have explored racial disparities among patients with HHT.

METHODS

We performed a retrospective chart review of HHT patients who were seen at a single academic center between July 1, 2014 and January 1, 2022. The primary outcomes of this study were the Epistaxis Severity Score (ESS) and the presence of pulmonary, cerebral, gastrointestinal, spinal, and hepatic arteriovenous malformations (AVMs). We analyzed racial differences using t-tests and analysis of variance (ANOVA) for continuous variables, and chi-squared tests for categorical variables. We then performed multivariable linear and logistic regressions on outcomes.

RESULTS

Our review identified 35 Asian, 6 Black or African American, 72 Hispanic or Latino, and 244 White or Caucasian patients who met the inclusion criteria. Through an analysis of variance model, race/ethnicity was not significantly associated with ESS. Two univariable logistic regression models between race and both pulmonary and brain AVMs showed that race was associated with the incidence of pulmonary AVMs (p<0.01), with Asian patients at a 2.3-fold increased risk of pulmonary AVMs compared with White patients (p=0.03). Race was also associated with the incidence of cerebral AVMs (p<0.01) with Hispanic or Latino patients at a 4.8-fold increased risk compared with White patients (p<0.01).

CONCLUSION

Patients who identified as Asian may have higher rates of pulmonary AVMs while patients identifying as Hispanic or Latino may have more cerebral AVMs. The correlations may be important for identifying risk factors in certain patient populations.

Effects of universal oral healthcare coverage in an adult population: A long-term nationwide natural experiment

OBJECTIVES

A large and long-term natural experiment occurred in Finland from the late 1980s-2000, when adults' entitlement to subsidized oral healthcare was strongly dependent on the arbitrary classification based on their year of birth: people born in 1956 or later were entitled to subsidized care, while people born before 1956 were not. The aim of this study was to investigate the effect of this expanded universal oral healthcare coverage on service use and oral health outcomes.

METHODS

Data from annual nationally representative cross-sectional postal surveys among 15-64-year-olds between 1990 and 2014 were used. For this study, the following outcome variables were formed: experiencing toothache during the past month (yes/no), the number of missing teeth with three different thresholds (over 10, over 5 or at least 1 missing tooth), brushing more than once a day and the number of visits to the dentist. Regression discontinuity plots and bias-corrected local polynomial regression discontinuity estimators measuring the effect of the extended universal coverage on the outcomes at the year-of-birth cut-off of 1956 were generated separately from the data from 1990 to 2000 and from 2002 to 2014.

RESULTS

Between 1990 and 2000, the number of visits to the dentist (0.2 visits, 95% CI, confidence intervals: -0.03; 0.43) and the proportion of those who visited the dentist during the past 12 months (4.2%, 95% CI: 0.1%; 8.3%) increased at the year-of-birth cut-off of 1956. There were minor drops (1.5%-1.9%) in the number of missing teeth across all thresholds (over 10, over 5, or at least 1 missing teeth) at the cut-off. Analyses with the data from the surveys from 2002 to 2014 showed that there were no discontinuities in these outcomes at the cut-off of 1956. Regression discontinuity estimates related to toothache experience and toothbrushing frequency were inconclusive due to high variability in the underlying data and the likely small effect of the more universal coverage on these outcomes.

CONCLUSIONS

The current study provided evidence of the beneficial effects of universal oral healthcare coverage on the oral healthcare service use and teeth preservation from a large and long-term natural experiment occurred in Finland from the late 1980s to 2000.

Cost-effectiveness of school-based caries screening using transillumination

OBJECTIVES

School-based screening for caries lesions usually only employs visual-tactile detection means (standard of care). Near-infrared-light-transillumination (NILT) could be used to support school-based screening and to identify early proximal caries, facilitating referral and appropriate non- or micro-invasive management in dental practice.

METHOD

We assessed the cost-effectiveness of NILT for school-based caries screening. A German mixed-payers' perspective was adopted. A Markov model was used to simulate the consequences of true and false positive and negative detections and the subsequent decisions over the lifetime of initially 12 years old patients. Our health outcome was tooth retention in years. Costs were measured in Euro 2020. Monte-Carlo-microsimulations, univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness-acceptability at different willingness-to-pay-thresholds were quantified.

RESULTS

NILT was minimally more effective (tooth retention for a mean (2.5-97.5%) 56 (53-59) years) and minimally less costly (515 (416-616) Euro) than standard of care (56 (50-59) years; 526 (427-628 Euro)). The ICER was -503 Euro/year, i.e. school-based caries screening using NILT saved money at higher effectiveness in the modelled population. The cost-effectiveness of NILT increased for payers with a willingness-to-pay for additional tooth retention time. The biggest driver of costs were (avoided) tooth replacements later in life.

CONCLUSIONS

NILT-based screening is likely to yield limited effectiveness gains and cost savings in the modelled populations. In countries where regular practice-based screening of children is less common than in Germany, the cost-effectiveness of NILT for school-based caries screening is likely higher.

CLINICAL SIGNIFICANCE

NILT-based caries screening in German schools is unlikely to be cost-effective. In countries with different utilization patterns or generally higher caries prevalence and risk, this may differ.

Using Andersen's behavioural model to examine individual and contextual factors associated with dental service utilization in Brazil

OBJECTIVES

The study aimed to examine individual and contextual factors associated with the frequency of dental service utilization among adolescents, adults and older adults Brazilians.

METHODS

This cross-sectional study used secondary data from the Brazilian 2019 National Health Survey (94 114 individuals). The outcome 'when was your last dental appointment?' was categorized into three groups: up to 1 year, more than 1 year and never had a dental appointment. Andersen's behavioural model was used to select contextual and individual variables. Multinomial logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence intervals (95% CI).

RESULTS

The following variables showed increased probability to the outcome had the last dental appointment more than 1 year ago: older adult, illiterate or incomplete primary school, and without private dental insurance. The outcome never had a dental appointment was significantly associated with illiterate (OR 26.65; 95% CI 17.63-40.29), male (OR 2.38; 95% CI 2.17-2.61), without private dental insurance (OR 5.20; 95% CI 3.48-7.76), self-rated oral health as bad or very bad (OR 2.67; 95% CI 2.31-3.09), household not enrolled in primary care teams (OR 1.29; 95% CI 1.11-1.49), household in a rural area (OR 1.86; 95% CI 1.69-2.05), high household crowding (OR 1.08; 95% CI 1.04-1.14) and low household income per capita (OR 0.99; 95% CI 0.99-0.99).

CONCLUSIONS

This study showed that contextual and individual factors induce inequity in dental appointments. Moreover, Andersen's behavioural model demonstrated inequitable access for dental services in Brazil, in which social structure and enabling characteristics, rather than the need for the service, determine who receives health care. Living in a household enrolled in primary care teams favoured regular dental appointments. Thus, these findings may help policymakers improve health access by expanding coverage of dental services in primary health care.

Rural-urban disparities in the incidence and treatment intensity of periodontal disease among patients with diabetes

Background

Diabetes threatens population health, especially in rural areas. Diabetes and periodontal diseases have a bidirectional relationship. A persistence of rural-urban disparities in diabetes may indicate a rural-urban difference in periodontal disease among patients with diabetes; however, the evidence is lacking. This retrospective study aimed to investigate rural-urban discrepancies in the incidence and treatment intensity of periodontal disease among patients who were newly diagnosed with type 2 diabetes in the year 2010.

Methods

The present study was a retrospective cohort design, with two study samples: patients with type 2 diabetes and those who were further diagnosed with periodontal disease. The data sources included the 2010 Diabetes Mellitus Health Database at the patient level, the National Geographic Information Standardization Platform and the Department of Statistics, Ministry of Health and Welfare in Taiwan at the township level. Two dependent variables were a time-to-event outcome for periodontal disease among patients with type 2 diabetes and the treatment intensity measured for patients who were further diagnosed with periodontal disease. The key independent variables are two dummy variables, representing rural and suburban areas, with urban areas as the reference group. The Cox and Poisson regression models were applied for analyses.

Results

Of 68,365 qualified patients, 49% of them had periodontal disease within 10 years after patients were diagnosed with diabetes. Compared to urban patients with diabetes, rural (HR = 0.83, 95% CI: 0.75-0.91) and suburban patients (HR = 0.86, 95% CI: 0.83-0.89) had a lower incidence of periodontal disease. Among 33,612 patients with periodontal disease, rural patients received less treatment intensity of dental care (Rural: RR = 0.87, 95% CI: 0.83, 0.92; suburban: RR = 0.93, 95% CI: 0.92, 0.95) than urban patients.

Conclusion

Given the underutilization of dental care among rural patients with diabetes, a low incidence of periodontal disease indicates potentially undiagnosed periodontal disease, and low treatment intensity signals potentially unmet dental needs. Our findings provide a potential explanation for the persistence of rural-urban disparities in poor diabetes outcomes. Policy interventions to enhance the likelihood of identifying periodontal disease at the early stage for proper treatment would ease the burden of diabetes care and narrow rural-urban discrepancies in diabetes outcomes.

A prospective, randomized, single-blind study to compare two methods of treating cystic lesions in the jaw

OBJECTIVE

The study aimed to assess the usefulness of a bovine bone substitute material in treating cystic lesions in the jaw with a maximum diameter of <4 cm.

MATERIAL AND METHODS

In this prospective, randomized, single-blind intervention study of 116 patients, 61 underwent cystectomy with a subsequent filling of the defect using a bovine xenograft, and 55 underwent cystectomy alone. Volumetric measurement of the cysts was performed preoperatively and 6 and 12 months postoperatively using the available digital volume tomography data sets. Follow-up appointments were made 14 days and 1, 3, 6, and 12 months postoperatively.

RESULTS

Almost complete regeneration was seen in both treatment groups within 12 months, with no significant difference in absolute volume loss between the 2 groups (P = .521). Examination 14 days after surgery revealed a tendency for more wound healing disorders with the use of a bone substitute (P = .077). It was no longer possible to detect any further differences in later examinations.

CONCLUSION

Using bovine bone substitute material has no radiologically measurable advantage over cystectomy alone without defect filling regarding bone regeneration. In addition, there was a tendency for more wound-healing disorders to occur in the bone substitute group.

Explaining public dental service utilization: A theoretical model

OBJECTIVES

Constructing and validating a theoretical model of relationships between dental services use and socioeconomic characteristics, oral health status, primary care coverage, and public dental services.

METHODS

The first stage of the study consisted of developing a theoretical-conceptual model to demonstrate the expected relationships between variables based on the literature. In the second stage, we tested the proposed theoretical model using the Partial Least Squares Structural Equation Modeling (PLS-SEM) technique, using data from the Brazilian National Health Survey conducted in 2019 with a sample of 41,664 individuals aged 15 or older.

RESULTS

This study successfully defined a theoretical model that explains the systematic relationships involving public dental services utilization. Socioeconomic status was negatively associated with oral health status (β = -0.376), enrollment in primary care facilities (β = -0.254), and the use of public dental consultations (β = -0.251). Being black, indigenous, or living in a rural area was directly associated with lower socioeconomic status and greater use of public dental services.

CONCLUSIONS

The identified relationships, establishing a theoretical basis for further investigations, also provide evidence of a public access policy's effect on oral health services on equity, supporting the construction of more effective and equitable public policies.

The duration of intervals on the oral cancer care pathway and implications for survival: a systematic review and meta-analysis

Introduction

Previous studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival.

Materials and methods

We conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist.

Results

Twenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31-73), k = 18, of the diagnosis interval 35 days (95% CI = 21-38), k = 11, and of the treatment interval 30 days (95% CI = 23-53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates.

Conclusion

Interval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.

Applying an equity lens to hospital safety monitoring: a critical interpretive synthesis protocol

INTRODUCTION

Hospital safety monitoring systems are foundational to how adverse events are identified and addressed. They are well positioned to bring equity-related safety issues to the forefront for action. However, there is uncertainty about how they have been, and can be, used to achieve this goal. We will undertake a critical interpretive synthesis (CIS) to examine how equity is integrated into hospital safety monitoring systems.

METHODS AND ANALYSIS

This review will follow CIS principles. Our initial compass question is: How is equity integrated into safety monitoring systems? We will begin with a structured search strategy of hospital safety monitoring systems in CINAHL, EMBASE, MEDLINE and PsycINFO for up to May 2023 to identify papers on safety monitoring systems generally and those linked to equity (eg, racism, social determinants of health). We will also review reference lists of selected papers, contact experts and draw on team expertise. For subsequent literature searching stages, we will use team expertise and expert contacts to purposively search the social science, humanities and health services research literature to support the development of a theoretical understanding of our topic. Following data extraction, we will use interpretive processes to develop themes and a critique of the literature. The above processes of question formulation, article search and selection, data extraction, and critique and synthesis will be iterative and interactive with the goal to develop a theoretical understanding of equity in hospital monitoring systems that will have practice-based implications.

ETHICS AND DISSEMINATION

This review does not require ethical approval because we are reviewing published literature. We aim to publish findings in a peer-reviewed journal and present at conferences.

Does using the sociodental approach in oral health care influence use of dental services and oral health of adolescents living in deprived communities? a one-year follow up study

BACKGROUND

Oral health needs assessment is important for oral health care planning. This study compared dental treatment needs between normative and sociodental needs. We also longitudinally examined the relationships of baseline sociodental needs measures and socioeconomic status with one-year follow up measures of use of dental services, dental caries, filled teeth, and oral health-related quality of life (OHRQoL).

METHODS

A prospective study was conducted with 12-year-old adolescents from public schools in deprived communities in the city of Manaus, Brazil. Validated questionnaires were used to collect adolescents' sex and socioeconomic status, OHRQoL (CPQ_11 - 14) and behaviours (sugar intake, frequency of toothbrushing, regular use of fluoridated toothpaste and pattern of dental attendance). Normative need was assessed according to decayed teeth, clinical consequences of untreated dental caries, malocclusion, dental trauma, and dental calculus. The relationships between variables were tested thorough Structural equation modelling.

RESULTS

Overall 95.5% of adolescents had normative dental treatment needs. Of these, 9.4% were classified as high level of propensity. Higher normative/impact need and greater propensity-related need directly predicted use of dental services at one-year follow up. The latter mediated the association of normative/impact need and propensity-related need with incidence of dental caries and filled teeth. Normative/impact need and use of dental services were directly associated with filled teeth at one-year follow up. Poor OHRQoL at one-year follow-up was directly predicted by higher normative/impact need at baseline and less filled teeth at one-year follow up. Greater socioeconomic status was directly associated with better propensity-related need. Socioeconomic status indirectly predicted incidence of dental caries and filled teeth via propensity-related need and use of dental services.

CONCLUSIONS

Sociodental needs measures were related to use of dental services, dental caries, filled teeth and OHRQoL after one year among adolescents living in deprived communities. Adolescents with dental needs treatment priorities according to the sociodental approach had more filled teeth via use of dental services. Dental services utilisation did not attenuate the impact of normative and impact-related need on dental caries incidence and poor OHRQoL after one year. Our findings suggest the importance of developing oral health promotion and enhancing access to dental care to improve oral health of adolescents living in deprived communities.

Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study

The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.

Socio-economic inequality and healthcare costs over the life course - A dynamic microsimulation approach

OBJECTIVES

Although there is well-established evidence for the existence of socio-economic inequalities in virtually all dimensions of health, little is known about the implications of these socio-economic disparities for healthcare costs from a cumulative life course perspective. Accounting for differentials in healthcare use patterns and mortality, we assess how lifetime costs differ between socio-economic groups.

STUDY DESIGN

This study used dynamic microsimulation modelling.

METHODS

Combining price weights for healthcare services with information on healthcare consumption from the 2014 Austrian Health Interview Survey (n = 15,771), we calculated average cost profiles by gender, age and education consistent with aggregate System of Health Accounts. A dynamic microsimulation model was used to project cumulative healthcare costs over the entire lifecycle for the 2019 birth cohort in four different scenarios to illustrate the influence of the different cost determinants on lifetime costs.

RESULTS

Before considering social inequalities in mortality, men with compulsory education have close to 66% higher lifetime costs than men with tertiary education; for women, the difference is close to 20%. Accounting for longevity differentials reduces this gap to approximately 40% for men and 10% for women. Closing the gap in healthcare use and in longevity between socio-economic groups would reduce lifetime healthcare expenditure by 4.1% in the 2019 birth cohort and by 19% in the whole population.

CONCLUSIONS

Accounting for mortality differentials between socio-economic groups has a large impact on estimated lifetime healthcare costs. Reducing social inequalities in health can contribute to containing healthcare expenditures against the backdrop of rising life expectancy.

Sociobehavioural Factors Associated With Child Oral Health During COVID-19

OBJECTIVES

The aim of this study was to identify the sociobehavioural factors that influenced children's oral health during the COVID-19 pandemic.

METHODS

The online cross-sectional study was conducted in Al Jouf Province in the northern region of Saudi Arabia. A total of 960 parents of children aged 5 to 14 years were invited by multistage stratified random sampling. Descriptive, multinomial, and multiple logistic regression analyses were performed to estimate odds ratios and determine the relationship between independent and dependent variables. P < .05 was considered statistically significant.

RESULTS

Of the 960 participants, 693 (72.1%) reported that their child had 1 or more untreated dental decay. The children of uneducated parents were 1.6-fold more likely to have 1 or more untreated dental decay (adjusted odds ratio [AOR], 1.66; 95% CI, 0.74-3.73; P < .001). The children of unemployed parents were 4.3-fold more likely to have a financial burden for a child dental visit (AOR, 4.34; 95% CI, 2.73-6.89; P < .001). Parents from a rural area were 26.3-fold more likely to have spent a lag period of over 2 years since their child's last dental visit (AOR, 26.34; 95% CI, 7.48-92.79; P < .001). Nursery-level children were 5.4-fold more likely to need immediate care (AOR, 5.38; 95% CI, 3.01-9.60; P < .001).

CONCLUSIONS

The present study demonstrated a very high prevalence of 1 or more untreated dental decay in our cohort. Children of rural areas, uneducated, unemployed, widow/divorced, low- and middle-income parents and nursery school children were linked to poorly predictive outcomes of child oral health during the pandemic.

Retrospective cross-sectional study examining the association between loneliness and unmet healthcare needs among middle-aged and older adults using the Canadian Longitudinal Study of Aging (CLSA)

OBJECTIVES

Our primary objective was to estimate the association between loneliness and unmet healthcare needs and if the association changes when adjusted for demographic and health factors. Our secondary objective was to examine the associations by gender (men, women, gender diverse).

DESIGN, SETTING, PARTICIPANTS

Retrospective cross-sectional data from 44 423 community-dwelling Canadian Longitudinal Study on Aging participants aged 45 years and older were used.

PRIMARY OUTCOME MEASURE

Unmet healthcare needs are measured by asking respondents to indicate (yes, no) if there was a time when they needed healthcare in the last 12 months but did not receive it.

RESULTS

In our sample of 44 423 respondents, 8.5% (n=3755) reported having an unmet healthcare need in the previous 12 months. Lonely respondents had a higher percentage of unmet healthcare needs (14.4%, n=1474) compared with those who were not lonely (6.7%, n=2281). Gender diverse had the highest percentage reporting being lonely and having an unmet healthcare need (27.3%, n=3), followed by women (15.4%, n=887) and men (13.1%, n=583). In our logistic regression, lonely respondents had higher odds of having an unmet healthcare need in the previous 12 months than did not lonely (adjusted odd ratios (aOR) 1.80, 95% CI 1.64 to 1.97), adjusted for other covariates. In the gender-stratified analysis, loneliness was associated with a slightly greater likelihood of unmet healthcare needs in men (aOR 1.90, 95% CI 1.64 to 2.19) than in women (aOR 1.73, 95% CI 1.53 to 1.95). In the gender diverse, loneliness was also associated with increased likelihood of having an unmet healthcare need (aOR 1.38, 95% CI 0.23 to 8.29).

CONCLUSIONS

Loneliness was related to unmet healthcare needs in the previous 12 months, which may suggest that those without robust social connections experience challenges accessing health services. Gender-related differences in loneliness and unmet needs must be further examined in larger samples.

Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature

BACKGROUND

Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.

OBJECTIVE

There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level.

SEARCH STRATEGY

Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021.

INCLUSION CRITERIA

Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review.

DATA EXTRACTION AND ANALYSIS

Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status.

RESULTS

A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%-64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%-79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%-33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%-37.00%).

CONCLUSION

This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations. Please cite this article as: Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: a scoping review of the literature. J Integr Med. 2023; Epub ahead of print.

Connections Lab: a case study exploring a web-based innovation designed to advance shared risk and protective factor approaches to preventing injuries and violence

BACKGROUND

Injuries and violence share many of the same risk and protective factors, which are rooted in the social determinants of health (SDOH) and the social determinants of equity. Addressing shared risk and protective factors (SRPFs)-common factors that make it more or less likely that a population will experience injuries or violence-is critical prevention efforts. The Safe States Alliance created the Connections Lab-a suite of web-based resources to help injury and violence prevention public health practitioners and their partners understand, describe, implement and evaluate SRPF approaches.

DESIGN

A mixed-methods approach using the Diffusion of Innovation Theory assessed how the Connections Lab influenced users' knowledge, abilities and work related to SRPF approaches. A web-based survey was administered to 234 participants in April-May 2021. Semistructured virtual group discussions were conducted with a subset of 15 survey respondents who volunteered to participate.

RESULTS

The case study revealed three key findings. The Connections Lab: was diffused among practitioners across sectors within and outside of public health; it increased practitioners' perceived proficiency across 10 skill sets related to describing, planning, implementing and evaluating SRPF approaches; and it increased understanding of the importance of upstream and structural drivers of injuries and violence.

CONCLUSION

The Connections Lab was a critical first step to expand the definition of SRPF approaches, connect SRPFs to concepts of equity and the SDOH, and provide strategies for engaging partners in public health and across other sectors in SRPF approaches.

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.

Moderating effects of resilience and self-esteem on associations between self-reported oral health problems, quality of oral health, and mental health among adolescents and adults in Nigeria

BACKGROUND

There is an intersection between oral and mental health though the studies on these intersections are few. This study investigated associations between self-reported oral health problems, quality of oral health, and depression and general anxiety among adolescents and adults in Nigeria; and analysed the moderating effects of resilience and self-esteem on these associations.

METHODS

In this secondary analysis, data were extracted from the database of an online survey conducted among participants 13 years and older and living in Nigeria about their self-reported psychological wellbeing. The data was collected between September and October 2020. Dependent variables were self-reported presence of oral health problems (yes/no) and self-reported quality of oral health (using a five-item scale ranging from "very good" to "very poor"). Independent variables were depressive and anxiety symptoms. Moderating factors evaluated were resilience and self-esteem. Multivariable logistic regression analysis was used to determine the associations between the dependent and independent variables after adjusting for confounders (age, sex, employment status and educational status). A path analysis was conducted to determine the moderating effects of self-esteem and resilience on associations between dependent and independent variables.

RESULTS

We extracted data for 2,757 adolescents and adults aged 13 to 62 years, of which 2,062 (74.8%) reported having oral health problems and 925 (33.6%) reported poor quality of oral health. Higher levels of depressive symptoms were significantly associated with higher odds of oral health problems (AOR: 1.07; 95% CI: 1.04-1.10; p<0.001). Higher levels of depressive symptoms (AOR: 1.05; 95% CI: 1.03-1.07; p<0.001), and higher levels of anxiety symptoms (AOR: 1.07; 95% CI: 1.04-1.11; p<0.001) were significantly associated with poor quality of oral health. Resilience significantly moderated the association between anxiety symptoms and oral health problems (AOR = -0.004; 95% CI: -0.006 --0.001; p = 0.002).

CONCLUSION

Depression may be a risk indicator for self-reported oral health problems, while depression and anxiety appear to be risk indicators for self-reported poor quality of oral health. These factors could be included as confounders in future studies on oral health problems and quality of oral health among adolescents and adults in Nigeria.

Racial and ethnic disparities in periodontal health among adults seeking dental care in rural North Carolina communities: A retrospective study

BACKGROUND

Population studies consistently demonstrate a greater prevalence of chronic diseases, including oral diseases, among underrepresented minorities. This retrospective study aimed to measure and describe the prevalence and extent of periodontitis among adults seeking dental care within an academic practice-based network in rural North Carolina.

METHODS

This study used de-identified electronic health record (EHR) data from 2011 to 2017 of adult dentate patients (aged ≥30 years) seeking dental care who received a comprehensive periodontal examination at one of nine networked clinical centers. Periodontitis prevalence was calculated using CDC/AAP case definitions, along with extent (%) scores for periodontal parameters. Comparisons focused on age, sex, race, ethnicity, tobacco use, diabetes status, payer or insurance status, plaque scores, and the number of teeth.

RESULTS

EHR data for 10,544 adult patients (60.5% female) indicated 79.8% had some form of periodontitis. This patient population was diverse: 22.6% Black, 4.4% American Indian, and 53.8% White, with 4.8% self-identified as Hispanic. Patients 50 years and older showed greater mean extent scores for clinical attachment levels relative to patients 30 to 49 years. Males exhibited greater periodontitis than females (p = 0.001). Blacks showed significantly (p < 0.001) greater periodontitis prevalence relative to Whites. Hispanics also showed a greater prevalence of periodontitis (p < 0.001) relative to non-Hispanics. Significantly greater periodontitis was also noted for tobacco users (p < 0.001) but not for diabetes or payer status. A multiple logistic regression analysis of periodontitis prevalence confirmed significant associations for periodontitis for age, sex, race, ethnicity, tobacco use, high plaque scores, and the number of teeth (p < 0.001), but not diabetes or payer status.

CONCLUSIONS

The data document that racial and ethnic inequalities in periodontal health occur within the population of adults residing in rural communities in North Carolina and seeking dental 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.

Effect of the COVID-19 Mitigation Measure on Dental Care Needs in 17 Countries: A Regression Discontinuity Analysis

Objectives

The effect of COVID-19 mitigation measures on different oral health care needs is unclear. This study aimed to estimate the effect of COVID-19 mitigation measures on different types of oral health care utilization needs and explore the heterogeneity of such effects in different countries by using real-time Internet search data.

Methods

Data were obtained from Google Trends and other public databases. The monthly relative search volume (RSV) of the search topics "toothache," "gingivitis," "dentures," "orthodontics," and "mouth ulcer" from January 2004 to June 2021 was collected for analysis. The RSV value of each topics before and after COVID-19 was the primary outcome, which was estimated by regression discontinuity analysis (RD). The effect bandwidth time after the COVID-19 outbreak was estimated by the data-driven optimal mean square error bandwidth method. Effect heterogeneity of COVID-19 on dental care was also evaluated in different dental care categories and in countries with different human development index (HDI) rankings, dentist densities, and population age structures.

Results

A total of 17,850 monthly RSV from 17 countries were used for analysis. The RD results indicated that advanced dental care was significantly decreased (OR: 0.63, 95% CI: 0.47-0.85) after the COVID-19 outbreak, while emergency dental care toothache was significantly increased (OR: 1.54, 95% CI: 0.99-2.37) 4 months after the COVID-19 outbreak. Compared to the countries with low HDI and low dentist density, the effect was much more evident in countries with high HDI and high dentist density.

Conclusions

COVID-19 mitigation measures have different effects on people with various dental care needs worldwide. Dental care services should be defined into essential care and advanced care according to specific socioeconomic status in different countries. Targeted health strategies should be conducted to satisfy different dental care needs in countries.

Racial and Ethnic Differences in Short- and Long-term Mortality by Stroke Type

BACKGROUND AND OBJECTIVES

Racial and ethnic disparities in stroke outcomes exist, but differences by stroke type are less understood. We studied the association of race and ethnicity with stroke mortality, by stroke type, in a national sample of hospitalized patients in the Veterans Health Administration.

METHODS

A retrospective observational study was performed including non-Hispanic White, non-Hispanic Black, and Hispanic patients with a first hospitalization for stroke between 2002 and 2012. Stroke was determined using ICD-9 codes and date of death was obtained from the National Death Index. For each of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), we constructed a piecewise multivariable model for all-cause mortality, using follow-up intervals of ≤30 days, 31-90 days, 91 days to 1 year, and >1 year.

RESULTS

Among 37,790 patients with stroke (89% AIS, 9% ICH, 2% SAH), 25,492 (67%) were non-Hispanic White, 9,752 (26%) were non-Hispanic Black, and 2,546 (7%) were Hispanic. The cohort was predominantly male (98%). Compared with White patients, Black patients experienced better 30-day survival after AIS (hazard ratio [HR] 0.80, 95% CI 0.73-0.88; 1.4% risk difference) and worse 30-day survival after ICH (HR 1.24, 95% CI 1.06-1.44; 3.2% risk difference). Hispanic patients experienced reduced risk for >1-year mortality after AIS (HR 0.87, 95% CI 0.80-0.94), but had greater risk of 30-day mortality after SAH compared with White patients (HR 1.61, 95% CI 1.03-2.52; 10.3% risk difference).

DISCUSSION

Among US Veterans, absolute risk of 30-day mortality after ICH was 3.2% higher for Black patients and after SAH was 10.3% higher for Hispanic patients compared with White patients. These findings underscore the importance of investigating stroke outcomes by stroke type to better understand the factors driving observed racial and ethnic disparities.

Inequalities in the profile of using dental services in Brazil

This study aimed to examine the influence of socioeconomic factors on inequality in the use of dental services within the Brazilian population. The methodology was based on a sectional study, using secondary data from the 2013 National Health Survey (PNS, in Portuguese). The database contains information on 60,202 individuals over 18 years of age. The dependent variables were "frequency of dental appointments" and "type of dental treatment performed in the last appointment". The independent variables were sex, age group, education, social class measured using the Brazil criterion, and geographic region. The odds-ratio of outcomes were evaluated in the multivariate analysis using a multinomial logistic regression model. It was noticed that the population subgroups comprising Blacks and those residing in the North/Northeast, with lower social class and education, had a greater chance of having irregular follow-up and never having been to the dentist. In addition, this population stratum also had a greater chance of undergoing surgical or emergency dental procedures in the last dental appointment. Data from the 2013 PNS reveal a picture of social inequality in access to dental services in Brazil.

The interactive effects of oral health literacy and acculturation on dental care use among Hispanic adults

Objective

Assess whether there is an interactive effect between oral health literacy and acculturation on dental care use for Hispanic adults.

Methods

Self‐identifying Hispanic adults participated in this observational study (N = 338). Oral health literacy (low vs. high) was measured using the Comprehensive Measure of Oral Health Knowledge (CMOHK). Acculturation (low vs. high) was measured using the Short Acculturation Scale for Hispanics (SASH) and operationalized a second way by the language in which the survey was completed (English or Spanish). The outcome was dental care use in the past year (yes/no). Confounder‐adjusted modified Poisson regression models were run to generate risk ratios (RR) and to test the hypothesis that participants with high oral health literacy and high acculturation would be more likely to have used dental care in the past year than participants with low oral health literacy and low acculturation.

Results

About 65% of participants used dental care in the past year. The final models failed to show that participants with high oral health literacy and high acculturation were more likely to have used dental care than other participants. However, in the language proxy interaction model, participants with high oral health literacy and low acculturation were significantly more likely to have used dental care than participants with low oral health literacy and low acculturation.

Conclusion

There may be an interaction between oral health literacy and acculturation when modeling dental care use for Hispanic adults that should be further explored.

Difference of income inequalities of denture use by co-payment rates: A JAGES cross-sectional study

OBJECTIVES

Studies suggest that wearing dentures to restore missing teeth can have a positive impact on health status. However, income inequalities in denture wearing exist. The aim of this study was to investigate how differing co-payment rates under the current Japanese Universal Health Insurance Coverage System affect income inequalities in denture non-use among older adults with severe tooth loss.

METHODS

This cross-sectional study used data from the 2019 Japan Gerontological Evaluation Study (JAGES). Self-administered questionnaires were mailed to 345 356 independent people who did not receive long-term care insurance benefits and were aged ≥65 years. The dependent variable was denture non-use, and the independent variable was the equivalent annual household income. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were used with regression-based approaches to determine both absolute and relative inequalities in denture non-use by co-payment rates. The covariates were sex, age, years of education, number of teeth and comorbidities.

RESULTS

Of the 240 889 responses received (response rate =69.9%), we analysed 21 594 participants who fulfilled the inclusion criteria. The mean age was 72.8 years (standard deviation =4.1), and 57.6% were men. For 30 per cent, 20 per cent and 10 per cent co-payment rates, the percentages of people who did not use dentures and had severe tooth loss (≤9 teeth) were 18.3%, 13.3%, and 8.5%, respectively. All analyses confirmed significant inequalities in denture non-use. The lower the co-payment rate, the smaller the inequalities. SIIs for each co-payment rate were as follows: 30 per cent =13.35% (95% confidence interval [CI] = 9.61-17.09); 20 per cent =7.85% (95% CI = 4.88-10.81); and 10 per cent =4.85% (95% CI = 2.55-7.16). Inclusion of interaction term between income and co-payment rate significantly lowered the inequalities by co-payment rate in logistic regression analysis and SII. For RII, although the interaction was not statistically significant, a similar trend was observed.

CONCLUSIONS

Income inequalities in denture use existed among older adults with severe tooth loss in Japan, and the inequalities appeared to be greater when the co-payment rate was higher.

Periodontal care attendance in Denmark in 2012-2016 - a nationwide register-based study

OBJECTIVE

Planning and evaluation of oral healthcare systems rely on monitoring of care patterns. Monitoring periodontal care patterns provide information on the burden and occurrence of periodontitis in the population and on the direct financial cost. The aims of the study were to describe patterns in periodontal care among dental care attenders that might incite subsequent investigation and revised treatment guidelines. Secondly, to estimate the direct societal costs of periodontal care.

MATERIAL AND METHODS

A retrospective register-based study utilising data from the Danish Public Health Insurance which includes all dental care attenders in 2012-2016, three years before and one year after a national risk-based recall maintenance program was rolled out in Denmark.

RESULTS

The 2.7 million yearly dental care attenders corresponded to ∼60% of the eligible population and in the range of 20-24% received periodontal care. Total expenditure for periodontal care in Denmark increased by 13% from 2012 to 2016, from €78 to €88 million. The proportion of total healthcare funding spent on periodontal care was 0.61% in 2016.

CONCLUSIONS

Patients with periodontitis have large out-of-pocket yearly expenses for periodontal care. Despite small changes in periodontal clinical practice that may indicate improved targeting of patients in need of periodontal care, challenges of reaching non-attenders and non-adherence to care are unsolved. More research into outcomes from periodontal therapy in daily practice, seen from both normative and patient perspectives, would help establish knowledge of the efficiency of existing periodontal care systems and help identify barriers and facilitators for attending care in Denmark.