Barriers to dental services for older adults

OBJECTIVE

To explore barriers to older adults' accessing dental care.

METHODS

We performed oral exams on 184 community-dwelling older adults; those who needed dental care were contacted 6-12 weeks later to determine if they were able to access treatment. Those who could not access care were interviewed regarding barriers.

RESULTS

Of those examined, 89% needed dental treatment. After 6 weeks, 52% had received treatment, 48% had not. Those unable to access treatment had fewer teeth, were more likely to be referred regarding dentures, and were less likely to have a dentist. Reasons cited for not accessing care among the 35 participants we interviewed included a lack of finances, transportation, or assistance in navigating dental service.

CONCLUSIONS

Older adults have a high burden of oral disease and access barriers remain.

Prosthodontics, care utilization and oral health-related quality of life

The main aim of this thesis was to study the impact of oral health and oral prostheses on oral health-related quality of life (OHRQOL) in an adult Swedish population. Additional aims were to study social inequalities in oral health, attitudes towards the cost for dental care and dental care utilization. The study base was 1294 responses to a questionnaire from a random sample of 1974 persons aged 50-75 years, all of whom were resident in the County of Skine, Sweden. There was an association between impaired dental conditions and poor social conditions. Low dental care utilization covaried with impaired dental conditions and with stating a perceived need to obtain dental care but with no possibility to obtain it because of a cost barrier. In factor analysis, three factors captured 22 variables that aimed to measure OHRQOL. The constituent variables were summed into three index variables interpreted as oral health impact on everyday activities, on a psychological dimension and on oral function. The three variables were set as dependent variables in regression models with the independent variables social attributes, individual attributes, dentures, number of teeth and dental care attitudes. The models were run in three steps taking into account the interaction between the type of denture and the number of remaining teeth. The number of remaining teeth was more important than the type of denture when explaining OHRQOL. The type of replacement, in terms of fixed or removable denture, was less important for those with few or no remaining teeth, than for all others. OHRQOL was also explained by general health in relation to age peers as well as by varying attitudes towards dental care costs. Statistically significant interactions were observed between the number of remaining teeth and the type of denture when explaining OHRQOL. As a whole the thesis shows that social and dental conditions and cost for dental care play a great role for dental care utilization as well as for OHRQOL. Prosthodontics has an important role, where type of replacement interacts with tooth loss in its effect on QOL.

Representative marketing-oriented study on implants in the Austrian population. II. Implant acceptance, patient-perceived cost and patient satisfaction

Oral implantology is an established subspecialty of restorative dental and oral surgery. While an extensive body of evidence on the fundamentals of osseointegration and associated factors has been published, marketing-oriented analyses based on representative public opinion polls of implant acceptance, patient-perceived cost and patient satisfaction are scarce. In this study, an attempt was made to address these points by questioning a representative sample of 1000 adults in the household setting. The interviewees were presented with 14 questions. Of those familiar with implants as one of the treatment alternatives, 61% reported they would accept implants if the need arose. Implant acceptance was highest among males and interviewees below the age of 30 years. The interest in implants increased with increasing family incomes. Four percent of those questioned already had implants. Twenty-five percent knew someone who had undergone implant treatment. All those questioned found implant-supported rehabilitation to be very expensive. Many of them blamed the dentists for the high cost. One detail was particularly evident: satisfaction among implanted patients was clearly higher than satisfaction rates perceived by them from what they were told about implants by others. First-hand experiences with implants proved to be less biased than reported second-hand information.

The value of dentures

Dentures may be boring, but they are a major part of dentistry, and will be for the foreseeable future. While implants are growing in popularity, there will always be patients who opt for dentures. It is your duty to inform patients of the need to have their dentures remade periodically, to ensure excellent oral care. Be sure to manage patient expectation and to create an effective system for prompt payment. This will enable you to help patients achieve good oral health, while maximizing your profit.

Do regular dental visits affect the oral health care provided to people with HIV?

BACKGROUND

Financial factors related to income and insurance coverage have been found to limit access to, and influence use of, oral health care services by people with human immunodeficiency virus, or HIV.

METHODS

The authors determined if visiting a dentist regularly affected the oral health services provided to people with HIV when financial barriers were eliminated as an impediment to access. They analyzed dental claims data for services submitted for payment to the Minnesota Access to Dental Care Program. The analyses focused on comparisons of dental utilization patterns among 273 people classified as regular patients, or RPs, and 222 people classified as nonregular patients, or NRPs.

RESULTS

RPs were found to have been provided more diagnostic and preventive care, and less restorative, endodontic, periodontic, removable prosthodontic and oral surgical treatment than were NRPs. Although the mean submitted cost per patient visit was much higher for NRPs, total mean submitted costs per patient for RPs and NRPs were not significantly different. Even though NRPs underwent fewer procedures and had fewer clinic visits than did RPs, the procedures provided to NRPs were more complex and costly. As indicated by differences in the mix of dental care services provided to RPs vs. NRPs, continuity of primary oral health care for RPs led to a better oral health result at no increase in cost over that for NRPs.

CONCLUSIONS

The study findings provide substantial evidence regarding the value of regular oral health care for people with HIV.

CLINICAL IMPLICATIONS

This study reinforces the need for dentists to educate and encourage people with HIV to integrate regular oral health care into the ongoing maintenance of their overall health and well-being.

Dental care utilization: a study of 50- to 75-year-olds in southern Sweden

This study investigates dental care utilization in an adult population in Southern Sweden in relation to dental and social conditions, attitudes to costs, and perceived need to obtain dental services. The study was based on responses to a questionnaire sent in 1998 to a random sample, 1974 persons, aged 56-75 years. The response rate was 66%. A significantly higher probability of dental care utilization less than once a year was found for men, for those with few remaining teeth, and for those with removable dentures. A higher probability of dental care utilization less than once a year was found for those who stated perceived need to obtain dental care with no possibility because of the cost and for those who stated that the cost had influenced their attendance for dental care. The results showed that there were differences for sex and dental conditions in dental care utilization and that dental care utilization was related to attitudes towards costs of dental care.

Socio-economic characteristics and personal attitudes of patients attending a French prosthodontic teaching clinic

The aims of the study were to define the socio-economic characteristics of patients attending a Teaching Hospital Prosthetics Department and to determine the attitudes and aspirations of such patients. The study was performed on 162 patients who requested prosthetic treatment in a French university dental hospital department. They were asked to complete a questionnaire at the beginning of their treatment. The questionnaire was composed of 2 parts, covering respectively: firstly, social, economic, and demographic data concerning the patients, the source of referral and the primary motivation for their decision to request treatment, and secondly comments concerning their prosthetic treatment. The results show the socio-professional and socio-economic diversity of this population. In most cases, the patients were recommended to the university hospital service by their relatives or friends. Among the criteria proposed, they indicate that cost and quality of treatment were their major motivation. Analysis of the patients' comments identifies some factors responsible for the lack of efficiency associated with care and dental education.

Kentucky legislature releases study on denturism

The Kentucky study goes on to discuss the economic issues surrounding denturism, including the cost of dentures, insurance coverage and governmental savings through Medicaid. The report also includes a section on public health issues. That section covers competency, analysis of risks and oral health. The final section of the research study explores the various policy options open to the Kentucky General Assembly.

Bill would establish pilot project for denturism in Kentucky

HB 238 has been reported favorably to the floor of the House of Representatives by the Committee on Licensing and Occupations, but has not yet been acted upon by the full House. When asked whether he thought his legislation would be approved, Representative Burch said he thought the bill had a "50-50" chance of passing the Kentucky legislature this year. Sources within the Kentucky dental laboratory and dental communities disagree on the legislation's chances for passage. Some within the industry feel the legislation simply does not have enough votes to pass the General Assembly, primarily because of opposition from the Kentucky Dental Association. Others speculate that the bill has a better opportunity to be approved this year than it did in the previous years when it was introduced. The Kentucky General Assembly adjourns its session for the year 2000 on April 12, so there will be a quick answer to the question of whether HB 238 will be approved. The May issue of this column will provide details.

Estimated cost of dental treatment for active duty and recruit U.S. military personnel

This paper estimates the cost of restoring U.S. military personnel to optimal oral health. The data come from a 30-site oral health survey of Army, Navy, Marine Corps, and Air Force personnel conducted from February 1994 to January 1995. A systematic random sample of 2,711 recruits was drawn. From a prestratified, random sample of 15,924 active duty personnel, 13,050 (82% response rate) participated in the survey. Applying their best clinical judgment, one dentist per site charted comprehensive dental treatment needs on each service member. Radiographs were used. After the samples were weighted to reflect the 1994 population of recruits (202,144) and active duty personnel (1,699,662), treatment costs were calculated applying median fees reported by U.S. general dentists in 1995. Results show total estimated costs of $1.9 billion for active duty personnel and $203 million for recruits. Periodontal disease accounts for the greatest proportion (47%) of active duty treatment costs, and oral surgery accounts for the greatest proportion (32%) of recruit treatment costs. The cost of restoring U.S. service members to optimal oral health is substantial.

Dental procedure fees 1975 through 1995: how much have they changed?

A shift toward diagnostic and preventive dentistry in the last two decades is evident from the change in the number of dental procedures performed, as well as the change in the percentage of time spent performing different types of procedures. During the period 1975 through 1995, the average nominal fees for selected dental procedures increased. Once inflation was taken into account, however, the increase in the average real fees charged was more modest.

The effects of denturism: New Zealand dentists' response to competition

The New Zealand Dental Act of 1988 allowed clinical dental technicians to deal directly with the public in fitting and supplying dentures. This study tested the hypothesis that dentists responded to competition from dental technicians by lowering their fees. The results indicate that there was no significant change in the fees charged by dentists for dentures. The apparent failure of deregulation to produce the expected outcome could be due to the competitive pressure imposed by dental technicians practicing illegally prior to 1988, to consumers' lack of information, or to barriers to "consumer search" imposed by the act itself.

Denture fracture--a survey

The fracture of dentures is an unresolved problem. Despite increasing costs incurred by the nation on the repair of these prostheses, very little has been documented on the type of fracture encountered. This survey was carried out to determine the prevalence of type of fracture by the distribution of questionnaires to three different laboratories. Results obtained showed that 33% of the repairs carried out were due to debonded/detached teeth. Twenty-nine per cent were repairs to midline fractures, more commonly seen in upper complete dentures. The remaining 38% were other types of fractures, the majority of which constituted repairs to upper partial dentures. The latter involved detachment of acrylic resin saddles from the metal in metal based dentures and the fractures of connectors in the all-acrylic resin partial dentures.

Cost-conservative dentistry: appropriate dentistry at lower cost

Dental practitioners in both private and public dentistry are faced with patients who for reasons of public or private finance are not able to be treated with the most sophisticated available dentistry. A concept of appropriate dentistry is provided whereby, with reference to available literature, it is shown that cost-conservative treatment can be provided that is likely to be satisfactory to both the client and the practitioner.

Influence of age and gender on oral health and related behaviour in an independent elderly population

Previous studies have been unable to determine the influence of advanced age on oral health because they included relatively few subjects, particularly men, over 75 yr of age. In this study a disproportionate and stratified random sample of subjects over 70 yr and living independently was selected from a list of voters in Vancouver, B.C. The sample of 521 elders was structured to provide similar numbers of men and women in three 5-yr age-groups. All of the subjects were interviewed, and 255 of them, representing a similar distribution of age and gender, were examined to investigate the influence of aging on oral health and related behaviour. In bivariate analyses neither age nor gender was associated significantly with oral health or complaints. The use of dental services during the preceding year was associated with female and younger subjects, while men and older subjects usually went to dentists only to relieve pain. Logistic regression in a multivariate model confirmed the importance of natural teeth in predicting the use of dental services (by improving the prediction from 60% to 73%). Other models offered less useful improvements in predicting complaints (64% to 70%) or oral health (56% to 60%). Overall the study demonstrates that the age and gender of independent elders have very little direct influence on the oral health or related behaviour established early in life.

[Statistical survey of prosthetic restorations--fixed and removable prosthesis]

This is a continued report on the statistical classification of the prosthetic restorations placed in the outpatients in the Tokyo Medical and Dental University Hospital. The data were collected from the laboratory records during the period of January to June of 1986. The results are summarized as follows: 1. Total of 419 bridges, consisting of nearly the same number in the maxillary and mandibular units, were fabricated. A wide variety of designs was observed for those not covered by the health insurance. 2. Approximately 83% of the 265 complete dentures were covered by the health insurance. The number of the maxillary units was slightly more than that of the mandibular units, which was similar to the data collected about 20 years ago. 3. Seven hundred and fifty-four partial dentures were placed and approximately 45% of these were covered by the health insurance. 4. Various designs were observed in the 'Konus-Kronen' type of prosthesis. They were assumed to be applied not only for the restoration of the edentulous areas, but also for the splinting of the remaining teeth. 5. Fixed bridges were placed in more than 90% of the cases with single tooth loss. However, partial dentures were more frequently used than the fixed bridges for the restoration of the two-tooth loss.

Elderly dental care. Needs and costs in three different resident settings

Although the real dental treatment needs of the elderly has been established, the costs for these needs has not been determined. This report compares dental services and costs required for older adults living in three different resident settings. Dental needs and costs have been evaluated from a sample of 305 aged persons living in nursing homes (N = 156), low-cost housing facilities (N = 79) or dependent on home care services (N = 70). This study indicates that the homebound or institutionalized elderly population presents with poor dental and periodontal conditions, a high rate of edentulousness, and inadequate dentures. Dental needs are essentially characterized by the repair or replacement of prosthesis, the screening and treatment of mucosal lesions of prosthetic origin, and scaling/curettage of remaining teeth. The average rehabilitative dental costs was Can. $720 and there was no difference between the three types of residence. Important differences in cost, however, were observed between the dentate and edentulous population. The F-test (P less than .05) and chi-square were used to analyze differences in dental treatment needs and costs between different residences. Maintenance care corresponds to Can. $80/year/person.

The effects of denturism on denture prices

In 1978, the country's first denturism initiative was passed in Oregon, legalizing the independent construction of dentures by non-dentists. The major campaign issue was the effect denturism would have on the cost of dentures. A review of Oregon dental insurance data shows that the costs of dentures, which had been rising at the same rate as other dental services, had a much lower rate of increase after passage of the denturism initiative.