Determinants of Postponed Dental Visits Due to Costs: Evidence from the Survey of Health, Ageing, and Retirement in Germany

Factors associated with regular dental attendance by aged adults: A systematic review

OBJECTIVES

To determine factors influencing regular dental attendance in aged adults 65 and over according to Andersen's Behavioural Model.

BACKGROUND

Regular attendance for dental visits is vital to improve and maintain oral health, quality of life and general well-being. Aged adults 65 years and older experience barriers to regular dental attendance, which in turn leads to an increased risk for oral diseases.

MATERIALS AND METHODS

An electronic search was undertaken in April 2021 in Cochrane, Embase, Medline, Cinahl, Dentistry & Oral Science Source via EBSCOhost and Embase for papers on factors influencing the frequency of attendance by older people. Risk of bias was assessed according to the Newcastle-Ottawa Scale for cohort and case-control studies, and with modified version of this tool for cross-sectional studies. Frequency effect size was calculated for factors described in Andersen's Behavioural Model (predisposing, enabling and needs-related).

RESULTS

Twenty-one studies were eligible for inclusion. Factors frequently investigated affecting regular dental attendance included: age, gender, education (predisposing); income, and social support (enabling); and remaining teeth, pain, perceived health (needs-related). Income was the only factors with a 100% positive association with regular dental attendance.

CONCLUSIONS

This systematic review confirms the complex interconnectedness of several factors and dental attendance in older adults. A number of factors were identified which warrant further investigation to improve access to dental care to socio-economically vulnerable older populations.

Determinants of dental treatment avoidance: findings from a nationally representative study

BACKGROUND

Oral health care of older adults is of rising importance due to ongoing demographic changes. There is a lack of studies examining the determinants of dental treatment avoidance in this age group. Therefore, the objective of this study was to identify those determinants.

METHODS

Cross-sectional data were drawn from the second wave (year 2002) of the German Ageing Survey which is a population-based sample of community-dwelling individuals ≥ 40 years in Germany (n = 3398). Dental treatment avoidance was quantified using the question "Did you need dental treatments in the past twelve months, but did not go to the dentist?" [no; yes, once; yes, several times]. Socioeconomic and health-related determinants were adjusted for in the analysis. Multiple logistic regressions were performed.

RESULTS

In terms of need, 6.7% of individuals avoided dental treatment in the preceding twelve months. Multiple logistic regressions revealed that dental treatment avoidance was associated with younger age (total sample [OR 0.978; 95% CI 0.958-0.998] and men [OR 0.970; 95% CI 0.942-0.999]), unemployment (total sample [OR 1.544; 95% CI 1.035-2.302] and men [OR 2.004; 95% CI 1.085-3.702]), lower social strata (women [OR 0.814; 95% CI 0.678-0.977]), increased depressive symptoms (men [OR 1.031; 95% CI 1.001-1.062]), and increased physical illnesses (total sample [OR 1.091; 95% CI 1.006-1.183] and men [OR 1.165; 95% CI 1.048-1.295]). The outcome measure was not associated with income poverty, marital status and physical functioning.

CONCLUSIONS

The present study highlights the association between dental treatment avoidance and different socioeconomic and health-related factors. These results suggest that it is necessary to promote the importance of dental visits.

Factors Associated with Dental Service Use Based on the Andersen Model: A Systematic Review

Background: A systematic review synthesizing studies examining the determinants of dental service use drawing on the (extended) Andersen model is lacking. Hence, our purpose was to fill this knowledge gap; Methods: Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies focusing on the determinants of dental service use drawing on the Andersen model were included; Results: In sum, 41 studies have been included (ten studies investigating children/adolescents and 31 studies investigating adults). Among children, particularly higher age (predisposing characteristic), higher income (enabling resource) and more oral health problems (need factor) were associated with increased dental service use. Among adults, findings are, in general, less consistent. However, it should be noted that one half of the studies found an association between increased education (predisposing characteristic) and increased dental service. In general, study quality was rather high. However, it should be noted that most studies did not report how they dealt with missing data; Conclusions: Our systematic review revealed that all components (i.e., predisposing characteristics, enabling resources and need factors) of the Andersen model tend to be associated with dental service use among children, whereas the findings are more mixed among adults. In conclusion, beyond need factors, dental service use also tend to be driven by other factors. This may indicate over—or, more likely—underuse of dental services and could enrich the inequality discussion in dental services research.

Development and implementation of a patient assistance fund: a descriptive study

BACKGROUND

The purpose of this descriptive study is to outline the Roseman University of Health Sciences (RUHS) College of Dental Medicines' Patient Assistance Fund development, organization and outcomes. The description and reported results provide insight to others considering similar health professions programs.

METHODS

The Patient Assistance Fund (PAF) affords dental students an opportunity to petition for and obtain financial assistance for their most disadvantaged patients. In this study, two sources of data were collected and used with a quantitative analysis for data collected as part of the PAFs operation and a qualitative analysis to evaluate the patient experiences.

RESULTS

A total of 16 student advocates, consisting of 6 males and 10 females from the D3 and D4 classes made 26 presentations to the PAF board committee. The combined amount requested from the PAF was $47,428.00 ("Cost of Treatment Plan") representing an average request per patient of $1824.15 (range $324.00 to $4070.00). The approved procedures and treatment plans totaled $21,278.36 ("Cost of Approved Procedures") with an average of $818.40 (range $204.00 to $2434.00) per patient. Patients and students expressed a high degree of satisfaction with the program.

CONCLUSIONS

This study provides an overview of the structure, funding sources, expenditures and patient services supported by a dental student managed patient assistance fund. The experiences at RUHS College of Dental Medicine (CODM) suggest that other healthcare professions schools can develop similar type programs that yield benefit both to students and to patients in need.

Postponed Dental Visits during the COVID-19 Pandemic and their Correlates. Evidence from the Nationally Representative COVID-19 Snapshot Monitoring in Germany (COSMO)

(1) Background: The COVID-19 pandemic is accompanied by various societal and economic challenges. Furthermore, it is associated with major health challenges. Oral health is a key component of health. Therefore, both curative and preventive dental visits are important during pandemics. Since there is a lack of nationally representative studies focusing on postponed dental visits and their correlates during the COVID-19 pandemic, we aimed to fill this gap in knowledge; (2) Methods: Cross-sectional data (wave 17) were collected from a nationally representative online-survey (COVID-19 Snapshot Monitoring in Germany (COSMO)) conducted in July 2020. The analytical sample consisted of 974 individuals (average age was 45.9 years (SD: 16.5, from 18 to 74 years)). The outcome measure was postponed dental visits since March 2020 (yes; no) due to the COVID-19 pandemic. Furthermore, the type of postponed dental visits was recorded (check-up/regular dental examination; pain/dental complaints; planned therapy); (3) Results: 22% of participants reported to have postponed dental visits due to the COVID-19 pandemic since March 2020, whereas 78% of individuals did not report postponed visits (“no, attended as planned”: 29.2%; “no, examining pending”: 44.9%; “no, other reasons”: 3.9%). Among individuals who reported postponed dental visits, 72% postponed a “check-up/regular dental examination”, whereas 8.4% postponed a dental visit despite “pain/dental complaints” and 19.6% postponed “planned therapy”. Furthermore, multiple logistic regressions showed that the likelihood of postponed dental visits was positively associated with being younger (aged 65 and older, OR: 0.43, 95% CI: 0.22–0.85; compared to individuals 18 to 29 years), and higher affect regarding COVID-19 (OR: 1.36, 95% CI: 1.13–1.64); (4) Conclusions: Our study showed that more than one out of five individuals postponed a dental visit—particularly check-ups and regular dental examination—due to the COVID-19 pandemic since March 2020. Several correlates of these postponed visits have been identified. This may help identify and address individuals at risk for deterioration of oral health amplified by postponed dental visits.