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 50-75 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.     

Dental state and functional capacity in 75-year-olds in three Nordic localities

summary The aims of the study were to compare dental state in three Nordic 75-year-old populations and to evaluate dental state as a marker of functional ageing. The study is part of a Nordic comparative study of 75-year-olds in Glostrup, Göteborg and Jyväskylä. In the dental studies, 411 subjects in Denmark, 308 in Sweden and 310 in Finland participated. Odontological history was obtained from interviews. Other methods, which are described elsewhere, were used to measure various functional parameters. In Goteborg, 23% of the 75-year-olds reported they were edentulous and 27% that they had more than 20 of their own teeth. The corresponding figures in Glostrup were 45% and 15% and in Jyväskylä 58% and 9%, respectively. In all three localities, economic factors and lifestyle factors, such as tobacco smoking, low physical activity and low social activity, were significant predictors for impaired dental health. The number of teeth was significantly associated with, for example, spirometry parameters, reaction time, body extention and body flexion in males. In females, significant associations were obtained with spirometry parameters, reaction time, handgrip, body extension and body flexion. Internordic differences regarding dental state were obvious. Dental state was associated with functional capacities. We suggest that dental state is a marker of functional capacity in elderly populations.     

Outcome of orthodontic care in 19-year-olds attending the Public Dental Service in Sweden: residual need and demand for treatment

The study analyses residual need and demand for orthodontic treatment in 19-year-olds attending the Swedish Public Dental Service (PDS). The general practitioners (GPs) had selected individuals for orthodontic specialist consultation and some were treated by GPs or specialists or not considered to be in need for treatment. Altogether 164 individuals were called for clinical investigation at the age of 19 years and also given a questionnaire asking for residual orthodontic treatment demand and satisfaction with information and orthodontic care. Ninety-one per cent of the individuals who had had an orthodontic consultation and 53 per cent of those who had not seen an orthodontist took part in the investigation. The study revealed that half of the 19-year-olds at the PDS clinic had received orthodontic consultations and one third had received orthodontic appliance treatment. Seven percent of the investigated individuals had a residual subjective demand for treatment. Several individuals with removable appliance treatment had overjet and deep bite and laterally forced cross-bite, but with little remaining subjective demand for treatment. Individuals with fixed appliance treatment showed few malocclusions. Nineteen-year-olds in general were uncertain about their present need for orthodontic treatment. The following conclusions were drawn: the total amount of orthodontic treatment in different areas in Sweden is comparable but the distribution between GP and specialist treatment differs. Interceptive treatment to reduce overjets seemed not successful. Fixed appliances seemed to reduce the majority of the malocclusion traits. The information given in connection with orthodontic consultation or treatment was clearly inadequate.     

Association between level of education and oral health status in 35-, 50-, 65- and 75-year-olds

AIM: The aim of the present study was to evaluate the association between educational level and dental disease, treatment needs and oral hygiene habits. MATERIAL AND METHODS: Randomized samples of 35-, 50-, 65- and 75-year-olds, classified according to the educational level: [low (LE): elementary school or higher (HE)], were identified. In 1091 subjects, a number of characteristics such as (i) number of teeth, (ii) periodontal attachment levels (PAL), (iii) caries and (iv) occlusal function were recorded. Educational level, oral hygiene and dietary habits were self-reported. Non-parametric variables were analyzed by chi2, Mann-Whitney U-Wilcoxon's rank sum tests, and parametric variables by Student's t-test (level of significance 95%). A two-way anova was performed on decayed, missing and filled surfaces to investigate the interaction between age and educational level. All statistical procedures were performed in the SPSS statistical package. RESULTS: The number of remaining teeth was similar for LE and HE in the 35-year olds (25.8 versus 26.6), but in the older age groups LE had significantly a larger number of missing teeth. The LE groups (except in 65-year olds) exhibited significantly more PAL loss. LE had significantly fewer healthy gingival units in all but the 75-year age group. In all age groups, LE had fewer intact tooth surfaces and a significantly poorer occlusal function. The frequency of tooth cleaning measures and dietary habits did not differ between LE and HE. CONCLUSION: Educational level was shown to influence the oral conditions and should be considered in assessing risk, and in planning appropriate preventive measures.     

Dental care of young adults in west Sweden

107 Swedish subjects, all 20 years old, were studied for the first three years (1990-1992) after they had left the organised dental care for children and adolescents (which is free of charge for all youth through the age of 19). They were registered in four different risk-grouping systems in order to estimate the amount of their future dental care. Three of the systems used registrations from the Public Dental Service records and in the fourth one a dentist made a subjective estimation. The follow-up used dental insurance claims to study performed treatments, courses of treatments and cost. The risk group system that used subjective estimations appeared to be the one that most accurately predicted the actual dental care consumption. Approximately 70% of the subjects received some kind of dental care during the three years. The distribution was not confined to any particular risk group. Ten per cent had received complete dental care annually. Twenty-five per cent went to a private dentist and 75% continued to go to the Public Dental Service. Those who went to a private dentist received substantially more treatment and the annual cost was a little more than twice as much as in the Public Dental Service.     

Dental Age Assessment: a comparison of 4- to 24-year-olds in the United Kingdom and an Australian population

Background.  The physiological age of a person is determined by the degree of maturation of the different tissue systems. Children of the same chronological age (CA) can demonstrate different degrees of maturation. Dental age (DA) is based on the maturation of teeth. Tooth formation is a continuous process, where the developmental stages of the tooth can be sequenced and defined depending on the degree of mineralization. These stages can be visualized on a dental panoramic tomograph (DPT).
Aim.  The aim of this study was to use a new method of Dental Age Assessment (DAA) to compare a United Kingdom (UK) and an Australian (AUS) population.
Design.  The DPTs used are from the archives of the Westmead Centre for Oral Health (Westmead, Australia) and the King's College London Dental Institute. From the preliminary sample of 89 DPTs from each population, 77 were suitable for use as matched pairs. The radiographic technique used was developed by Demirjian and describes eight stages of tooth development. This was used in combination with numerical data derived from a meta-analysis of a single UK subject.
Results.  A significant difference was shown between the CA and DA of the AUS patients. The AUS patients were also shown to have a significant 0.82 years delay in their DA compared to the UK patients. The findings indicate a difference in AUS compared to UK patients. These results indicate the need to develop a reference data set for the AUS population for DAA.
Conclusions.  This research is of significance in a number of clinical disciplines and can also be used to assist in age determination of subjects of unknown birth date to assist in forensic dentistry or social deliberations.     

Dental care utilization in a Swedish county in 1993 and 2003

The aim of the present study is to analyse factors influencing the patterns of utilization of dental care in an adult urban Swedish population aged between 30 and 80 in the years 1993 and 2003. This study is part of two large epidemiological dental studies of randomly selected individuals, performed in 1993 and 2003. It comprises clinical and questionnaire data from 555 and 505 individuals in the two studyyears. In 1993, more patients visited the private dental care system more often than the public system. This difference still existed in 2003, but to a 50% lower extent. All age groups had less utilization of dental care in 2003 than in 1993. The largest change was seen in the 30-year age group in utilization patterns of dental care between the two study years. A hierarchical block regression method was performed in four steps, analysing utilization for the two study years separately. The dental service system influenced the utilization patterns significantly for both years. The health factors strengthened this main result. Irrespective of dental health, patients were predicted to visit the private dental care service system more often in both 1993 and 2003. The socio-economic differences between people in Sweden were of no consequence for dental care utilization. As to age and attitude towards treatment costs, a substantial change was observed and might reflect a change in social patterns with greater inequalities, but the overall picture of equal access in dental care in Sweden remains.     

Attitudes to and experience of dental care among 50-year-olds in two Swedish counties.

The aim of this study was to investigate attitudes to and experiences of dental care in a population, born 1942. The following items were studied: opinions of general and oral health, attitudes to and experiences of dental care, dental care habits, experiences of latest visit to a dentist, tobacco habits and use of various dental hygiene articles. A cross-sectional mail questionnaire was sent in 1992 to all 50-year-olds in two Swedish counties, Orebro and Ostergotland, totally 8888 persons; the response rate was 71%. Of the population 89%, indicated good health. Satisfaction with dental care was high, 94%. 26% stated attendance to a dentist twice or more per year, and 64% at least once a year. As to expenses, 78% paid less than 1000 SEK the last year. Concerning the latest visit, 38% reported painless treatment, 37% no inconvenience, and 55% good care. The duration of the latest visit included on an average 27 min in travel time, 7 min in waiting time and 27 min in treatment time. Information about oral hygiene was given to 29% and about cost for treatment to 47% of the interviewed. There were 28% daily smokers. Snuff was daily used by 10% of the males. Toothbrushing twice a day with fluoride toothpaste seemed to be the standard oral hygiene procedure and was reported by 80% of the respondents.     

Dental health in 13-year-olds in V?sterbotten County, Sweden. Changes over twenty years

An epidemiological study of the prevalence of dental caries and gingivitis in 13-year-olds was carried out in the county of V?sterbotten, Sweden, in 1987. Besides providing information on the dental health of this age group, prevalence data were compared with data from earlier surveys of the same age group carried out in 1967 and 1977, covering the same areas and applying the same diagnostic criteria and methods. The results showed a marked decrease in the prevalence of caries and gingivitis. The mean number of DMF surfaces was 4.6, compared to 9.0 in 1977 and 19.0 in 1967. The mean GBI% was reduced from 33% to 21% between 1977 and 1987. In contrast to the results from 1967 and 1977 the differences in mean DMF values between the three areas were nonsignificant in 1987. The decline in dental caries is most probably due to an extended regular dental care with a strong preventive approach. Only slight differences in dental health were found between the three areas in 1987 in contrast to in 1977 and 1967. The most likely reason was probably that larger resources had been allocated to preventive programmes in the rural areas than in the city of Ume?.     

成都市外国人口腔卫生服务利用的影响因素研究

目的 调查中国成都市外国人的口腔卫生服务利用情况及其影响因素,为口腔卫生从业者对口腔卫生服务的国际化发展进行探索,为卫生政策制定者制定移民口腔健康政策提供建议。方法 参照世界卫生组织制定的《成人口腔健康问卷》,结合安德森卫生服务利用模型设计问卷。问卷内容包括口腔健康情况、口腔保健意识、口腔健康保障和基本信息4个部分。采用方便抽样方法选择调查对象。调查结果使用SPSS 20.0统计软件分析,采用Binary Logistic回归和分层分析方法进行统计学分析。结果 共有来自75个国家的654名调查对象完成调查,结果显示有102（15.6%）名外国人在成都曾经遇到过口腔问题却没有就诊。Binary Logistic回归分析显示,女性、长时间在成都居住、过去1年内出现过口腔健康问题、有使用牙线习惯、和家人一起居住在成都者遇到口腔问题或定期口腔体检时,更倾向于到本地口腔科就诊。通过ROC曲线分析,居住在成都10.5个月是外国人选择在成都就诊的临界值。结论 卫生政策制定者可以根据不同居住时间的外国人制定不同的口腔急诊或平诊指南,创造出更方便外国人在成都因口腔问题就诊的环境,以促进外国人在成都的口腔卫生服务利用。     

Effect of preventive measures in 50-60-year-olds with a high risk of dental caries

Salivary and microbial conditions were examined in 124 50-60-yr-old patients attending a dental clinic of the Public Dental Health Service. They were then randomly divided into a control and a test group. Patients with low salivary secretion rate and buffer capacity and high numbers of mutans streptococci and lactobacilli in the test group received special caries preventive measures during 1 yr. In the control group all patients were given prevention according to routine procedures. The incidence of dental caries between the groups was compared. The risk patients in the control group developed 1.67 new carious lesions as compared to 0.19 in the test group. The difference was statistically significant (P less than 0.05). Also the numbers of mutans streptococci and lactobacilli were significantly lower in the risk patients in the test group after 1 yr compared with baseline values. After the experimental year all patients were treated according to routine procedures. Five years after the start of the study a new examination showed increased caries activity in the risk patients in the test group and the gain which had been made during the experimental year was almost lost.     

Traumatic dental injuries in a cohort of 16-year-olds in northern Sweden

Abstract The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age were studied in a cohort of 16 year-olds, born in 1975, and residing in the County of Västerbotten, northern Sweden. The study comprised 3007 dental records from the public denial health service. The general distribution was 50.3% girls and 49.7% boys. The records showed that 35% of the children on one or more occasions had sustained injury to their primary or permanent dentition. The frequency was nearly twice as high for boys (64%) as for girls (36%). Twenty-five percent of the 16-year-olds had met with tooth injury more than once and this group consisted predominantly of boys. The incidence of injury episodes to primary and permanent teeth was 28 per 1000 per year. The boys had sustained trauma to their teeth most frequently when they were 4 years of age and between the ages of 8 and 11. This was also true for girls at 4 and at 9 years of age, although less evidently so. In the primary dentition, the majority of dental injuries had affected the supporting tissue of the maxillary incisors. In the permanent dentition, 75% of the traumatised teeth were upper incisors. Fractures of varying severity constituted 60% of all registered diagnoses in this dentition, followed by subluxation (19%) and concussion (11%).     

Dental health of 12-year-olds in Israel-2002

OBJECTIVE: To gather epidemiological information on caries prevalence and treatment needs of Israeli 12-year-olds. RESEARCH DESIGN: Prevalence survey of a representative sample of 12-year- olds examined according to WHO Oral Health Survey methods. RESULTS: The mean DMFT was 1.66 (DT = 0.91, MT = 0.03 FT = 0.72), a 40% decline since the previous national survey in 1989. DT and DMFT were lower amongst males (p < 0.01). There were no differences between urban and rural communities. Arab subjects had a higher prevalence, higher DT, MT and DMFT (p < 0.01), but lower FT than the Jewish subjects. In fluoridated areas, the mean DMFT was 1.39 compared to 1.83 in the non-fluoridated areas (p < 0.01). SiC (Significant Caries Index which shows the average DMFT of the third of the population with the highest DMFT) was found to be 4.31. CONCLUSIONS: Caries prevalence has declined among 12-year-olds in Israel. However, 53.9% of the children still suffer from caries at this age. There are wide dental health disparities.     

Dental check-ups in 31-year-olds in relation to optimism and life satisfaction

OBJECTIVE: To analyse the impact of optimism and life satisfaction on dental check-ups. BASIC RESEARCH DESIGN: A cross-sectional study. PARTICIPANTS: The data used in this study consists of a postal questionnaire sent to the members of the 1966 Birth Cohort in Northern Finland. The number of replies totalled 8,690, giving a response rate of 75.3%. MAIN OUTCOME MEASURES: The subjects were classified into two categories according to frequency of dental check-ups: those who went for check-ups at least once in two years and those who went more rarely. A Life Orientation Test was used to measure optimism. Life satisfaction was measured using a single question. The other explanatory variables were gender, marital status, education, incomes and employment status. Multivariate analyses were performed using log-binomial regression models. RESULTS: Independent of other factors, life satisfaction among women and optimism among men was associated with dental check-ups. Links between socioeconomic factors and dental check-ups were weaker than anticipated. CONCLUSIONS: The results suggest that not only socioeconomic factors but also psychosocial aspects need to be taken into account in planning successful dental health policy.     

Dental Caries in Rome, 50-100 AD

Scarce information exists on the clinical features of dental caries in the Imperial Roman population and no structural data on caries lesions from this period have so far been published. We report on the findings of 86 teeth (50-100 AD) found during archaeological excavations of the temple of Castor and Pollux in the Forum Romanum. We found that nearly all teeth had large carious cavities extending into the pulp. The distribution and size of the caries lesions were similar to those found in contemporary adult populations in Africa and China living without access to dental care. Most lesions had a hypermineralized zone in the dentin at the advancing front of the carious cavities as revealed by micro-computed tomography. This biological dentin reaction combined with the morphology of the cavities might indicate that some temporary topical pain relief and intervention treatment slowed down the rate of lesion progression. This is indirectly supported by examination of cavities of similar size and depth from a contemporary population without access to dental health care. In contrast to the lesions in the Roman teeth, these lesions did not exhibit a hypermineralized dentin reaction. We investigated whether the Pb isotopic composition of enamel and/or dentin of a single tooth matched that of a sample of an ancient Forum water lead pipe. The Pb isotopic composition of the tooth did not match that of the tube, suggesting that the subjects were exposed to different Pb sources during their lifetime other than the lead tubes.