Individualizing recall intervals in child dental care

Abstract Individualizing and extending recall intervals for children have been recommended in Norway to target resources efficiently. Recall intervals were changed for children aged 3–18 years in Drammen from 1991. Clinical time spent by dentists and dental hygienists, dental health status and length of recall intervals were registered from 1990 to 1993. For the child population, the mean recall interval changed from 12.5 to 13.7 months and the annual time spent per child was reduced by 14% from 1990–91 to 1992–93. Adjusted for the decline in number of new decayed teeth, the reduction in time spent was 11%. Children with intervals of 17 to 20 months had fewer new decayed teeth and their care required less personnel time than other children. For children with new decayed teeth, time spent for dental care was not associated with recall interval, while for children without new decayed teeth, longer recall intervals were associated with shorter time for dental care. The variation in number of decayed teeth and time spent for dental care was substantial at all intervals. Individualizing and extending recall intervals to some extent targeted resources at children with more dental disease. However, in the short run, inequality in dental health persisted. Limited extension of recall intervals did not interrupt the long-term trend toward better dental health in the children and substantial resources were saved in the dental services.     

Utilization of alternative delivery programs in youth dental care in Denmark

Three groups of young adults were offered three different dental programs from ages 16 to 19: one group of 386 persons continued preventive and curative dental care in the Public Child Dental Health Service (Public group), one group of 161 persons was offered dental care with private dental practitioners of own choice with care paid by the municipality and the health insurance (Mixed group), and one group of 261 persons entered the general young adult dental program under the National Health Insurance with free choice of private dental practitioner with reimbursement of about 75% from the insurance (Private group). Almost 100% of the Public group used the dental services continuously. Less than half of the Mixed group and about two thirds of the Private group went regularly to a dentist, women more than men. Discrepancies were found between the expected utilization and actual utilization, and a tendency was noted to overrate self-reported utilization in relation to actual utilization. It is concluded that continuity of dental care and unambiguous organizational affiliation is a prerequisite for a high utilization rate, but it also seems that the outreaching work done by the child dental health service is effective with regard to utilization.     

Increasing dental care utilization by Medicaid-eligible children: a dental care coordinator intervention

Objectives: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.
Methods: One hundred and thirty-six children enrolled in Medicaid aged 4 to 15 years at baseline in 2004 who had not had Medicaid claims for 2 years, were randomly assigned to intervention or control groups for 12 months. Children and caregivers in the intervention group received education, assistance in finding a dentist if the child did not have one, and assistance and support in scheduling and keeping dental appointments. All children continued to receive routine member services from the dental plan administrator, including newsletters and benefit updates during the study.
Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.
Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.     

口腔医疗服务利用水平的影响因素

口腔医疗服务利用水平的影响因素主要包括以下四方面:社会经济因素、口腔与全身健康因素、口腔健康相关意识因素和口腔健康相关行为因素.本文对以上四方面重要的影响因素进行综述,以期为提高人群口腔健康状况、促进人群积极、及时、便利地利用口腔医疗服务提供参考.     

Use of dental hygienists and returns to scale in child dental care in Norway

Abstract The purpose of this study was to investigate, in the provision of dental care for children, technically and economically efficient combinations of dentists and dental hygienists and to study returns to scale by analyzing production functions. Data from 137 dental health clinics were analyzed. Output was registered as the number of 3–18-yr-old children to whom the clinic delivered complete dental care. Resource input was registered as hours spent by dentists, denial hygienists and dental assistants to deliver care to the children. The average clinic that employed dental hygienists used one hygienist hour per three dentist hours for child dental care. It would save dentist time, but not costs, to extend the use of hygienists. Increased use of dental hygienists might be economically efficient if the work distribution between the personnel groups were changed, for example, by delegating more examinations and preventive care to hygienists. There were technical opportunities for further substitution of dental hygienists for dentists both by introducing dental hygienists in the clinics that only used dentists in child dental care and by extending use of hygienists in clinics that already employed hygienists. This study found no productivity gain from centralizing treatment of children in large dental clinics.     

Mobile dental vans: planning considerations and productivity

OBJECTIVES: Many children, especially those from lower socio-economic families, have limited access to dental care, transportation problems and poor appointment attendance. Mobile dental clinics have been implemented in many communities to address these issues. METHODS: Structured surveys were sent to the three mobile programs in Connecticut to collect information on the age of the program, issues encountered in planning and implementation, and ongoing costs and productivity. RESULTS: Each mobile clinic had two operatories and operated 140-200 days per year. Programs provided 2921-3417 diagnostic and preventive procedures and 359-721 treatment procedures per year for an average daily production of 18-24 procedures. All programs required external funding to remain financially solvent. CONCLUSION: Implementation and management of these programs is complicated. However, they provide an innovative solution to bringing dental care to underserved children and when operated in conjunction with schools can eliminate transportation problems and missed appointments.     

Reasons preventing regular dental care

The aim was to determine what reasons restrict people's daily cleaning of their teeth and yearly attendance for a dental check-up, using as a theoretical background the ideas of Eichholz & Rogers on the rejection of innovation. The series consisted of young and middle-aged persons, 207 women and 183 men, who filled in a questionnaire on the above topics. The questions were phrased so as to cover different reasons for rejecting innovations. Factors analysis revealed the following factors: reasons preventing daily brushing, practical reasons, unpleasant experiences of dental care, laziness, and lack of appreciation. The reliability of the questionnaire was found to be good. Sex showed a significant correlation with reasons preventing daily brushing. Those for whom a long time had elapsed since the last visit to a dentist had more barriers relating to daily brushing, unpleasant experiences and laziness. The more educated the participants were, the fewer barriers they had in relation to the factors appreciation, unpleasant experiences, and daily brushing.     

Oral health care delivery in Denmark: a system of private enterprise and public accountability

Abstract The Danish oral health care delivery system is a publicly funded, predominantly school based system of care for children and adolescents and a private practice copayment national health insurance mode for adults. Study of this dualistic system can provide useful information to dental public health practitioners. Interviews with experts in the Danish oral health care system and a selected review of the literature demonstrate that improvement trends are occurring in the oral health status of both adults and children. These improvement trends can be directly related to a combination of treatment and preventive measures undertaken by the country as a whole, and to specific interventions for certain subpopulation groups, such as preschoolers. Four key variables can be defined which have contributed to the success of the Danish oral health care delivery system (DOHCDS). These include 1) the role of private sector input into the development of the DOHCDS, 2) demography, 3) the Danish value system, and 4) the structure of the DOHCDS.     

Intrinsic motivation in dental care

The aim of this work was to develop a method based on the idea of intrinsic motivation for analyzing motivation problems in dental care. A questionnaire dealing with intrinsic motivation was filled in by 207 women and 183 men. Factor analysis of the scale revealed the following dimensions of internal-external motivation: independence, responsibility, vs. non-independence, interest in preserving one's own teeth as long as possible vs. preference for tooth extraction, satisfaction from brushing teeth vs. brushing for others' sake, and critical evaluation of diet vs. improper diet with carbohydrates. The reliability of the questionnaire was good (standardized item alpha .69). The individual's own sense of independence and responsibility and the idea of preserving one's own teeth for as long as possible were found to be more important for the women than for the men. A longer education was also found to be related to preserving one's own teeth as long as possible. The time of the last dental visit was positively related to independence, responsibility and the far-reaching idea of preserving one's own teeth. It can be concluded that aspects of intrinsic motivation can give additional information when trying to understand dental health behavior.     

Chronicling the dental therapist movement in the United States

There have been three attempts to introduce dental therapists (DTs) to the US dental workforce. This account will review early failed attempts to develop DTs, the recent successful Alaska initiative, the Minnesota legislature's authorization of DTs, state dental associations' deliberations on therapists in the workforce, and the efforts of national advocacy groups, foundations, and state legislatures to promote workforce innovation. It concludes with a discussion of the opposition to therapists from elements of organized dentistry.