Usefulness of a psychometric questionnaire in exploring parental attitudes in children's dental care

In this methodological study we investigated the usefulness and reliability of a questionnaire designed to capture 4 aspects of parental dental attitudes: dental knowledge, child oral health behavior, perceived importance of dental related aims, and parental responsibility. The study was undertaken in a group of 140 parents of schoolchildren aged 8-12 years from four comprehensive schools in Sweden. Test-retest reliability, quantified by the intraclass correlation coefficient (ICC) or by Cohen's kappa, varied from acceptable to excellent for different aspects of the questionnaire. The knowledge and responsibility-taking sections were also answered by a group of dental experts who showed a high level of internal agreement. Expert profiles, to which the parental assessments could be compared, were created. Exploration of the 4 aspects showed that this group of parents commonly had a multifocal view on the etiology and prevention of caries. Correlations between their knowledge assessments and the assessments made by the expert group varied from moderately negative to strongly positive. The parents revealed a high degree of dental-related motivation and responsibility, particularly according to oral health behaviors. In conclusion, the results indicate that this 4-part psychometric questionnaire might be a suitable instrument in investigations of priority and responsibility-taking as new aspects of parental dental attitudes, along with dental knowledge and child oral health behaviors.     

Reasons for and parental satisfaction with children's dental care under general anaesthesia

OBJECTIVES: The aim of this study was to describe why healthy children's previous treatment experiences can be reasons for their dental treatment under general anaesthesia (GA), and to describe their parents' experiences and satisfaction with that treatment. SUBJECTS AND METHODS: The data cover those children (n=102) below 16 years of age who, being otherwise healthy, were referred for Public Dental Service GA dental care in Helsinki, Finland, over the course of one year because of serious difficulties in dental treatment. The parents were given a self-administered questionnaire inquiring about their child's previous experiences of dental care, and about their access to and satisfaction with the present GA treatment. Data on the children's dental state were taken from patient records. RESULTS: The children's mean age was 6.4 years (SD=2.6 years), and the mean number of teeth with untreated caries was 7.7 (SD=3.0). Of the total sample, 32% had undergone four or more previous unsuccessful dental visits. At the time of their first difficulties in dental care, 39% were below 3 years of age. The older the child, the more serious was her or his parents' ranking of the difficulties met during dental care (P=0.02). From the parents' point of view, dental fear was the most important reason for treatment failures, followed by pain. Seeking GA treatment had been easy for 93% of parents, and most of them were also satisfied with their child's present GA treatment. CONCLUSIONS: The most important factors leading to the use of GA, as reported by the parents, are dental fear and repeated unpleasant experiences during dental care, and therefore, these should always be properly diagnosed, prevented and controlled.     

Usefulness of two psychometric scales in Swedish patients with severe dental fear

Dental fears and other fears were assessed in 67 patients with dental fear with the Corah Dental Anxiety Scale (CDAS), the Geer Fear Scale (GFS), and a behavioral dentist's rating scale (DR). Patients were selected because of extreme initial dental fear (n = 20), favorable response to treatment for dental fear (n = 23). CDAS change paralleled behavioral change (DR), supporting the usefulness of CDAS in assessing dental fear. GFS scores did not change in either group but were higher among patients who did not respond to treatment for dental fear; these findings are discussed in terms of treatment outcome prediction and treatment specificity.     

Patient attitudes and expectations of dental implant treatment--a questionnaire study

The aim of the present study was to evaluate patient attitudes and expectations relative to dental implant treatment. A questionnaire was mailed to all 400 patients that had received dental implant treatment at a large multi-specialist clinic during 2008. The questionnaire included questions relative to the reasons for dental implant treatment, if the patient earlier had considered dental implants, expectations of the treatment, discomfort during and after surgery, and how the patient perceived the esthetic outcome. The response rate was 61% (114 men/130 women). The stated reason for tooth loss was in 50% of the patients periodontitis,19% caries, 8% accidents,13% other reasons, and 10% no stated reason. Almost all patients (96%) were satisfied with the esthetic appearance and also regarding the information of the treatment (94%). Regarding the time between surgery and completion of prosthetic work, 79% (n = 192) found it to be reasonable. 71% (n = 170) thought the cost was what they had expected. 47% of the patients experienced the implant surgery better than expected and 48% as expected. In conclusion, the present study revealed that almost all patients were satisfied with the function and esthetics of the dental implant reconstruction and most patients were also satisfied regarding the costs and treatment duration.     

Validity of a patient self-completed health questionnaire in a primary care dental practice

1500 patient medical histories derived from self-completed health questionnaires alone and from a combination of questionnaire, structured interview by a dentist, and selective reference to family doctors were compared. In 4.25% of cases, the questionnaire medical history was significantly deficient. Such questionnaires yield an inadequate medical history when used on their own.     

Distribution of NHS resources for children's dental care in general dental practice in England

OBJECTIVE: To determine the relationship between the distribution of NHS resources in general dental practice and dental need and access to services for the population in England under the age of 18 in different socio-economic areas. BASIC RESEARCH DESIGN: A proxy for the oral health of under 18 year olds was made from prevalence surveys undertaken on five year old children in each health authority area in 1999/2000. The level of spending per head of the population was ascertained from Dental Practice Board data. Health authorities were grouped according to the eleven United Kingdom Office of National Statistics socio-economic groups. Access was measured by using registration levels of children. SETTING: General dental practices providing National Health Service treatment for children aged 0-18 in England. RESULTS: There was no correlation (r = -0.03) between increasing need for dental care using mean dmft as a proxy and increasing spending per head of the population for each health authority. There was a correlation (r = 0.38) between increasing registration rates and increased spending per head. The populations under 18 had more spent on their oral health care living in areas classified as Mixed Economies, Services and Education and Most Prosperous. Those in Inner London, Manufacturing, Ports and Industry had proportionately the least. The difference between the highest and lowest group was 33%. The groups of Authorities were not homogenous in their level of resources with variations between Authorities in the same groups. CONCLUSIONS: The distribution of NHS resources to general dental practice for people under 18 does not reflect population need. The higher the registration rate for children the greater the amount resources deployed in an area.     

Dental insurance,attitudes to dental care,and dental visiting

Objective: Dental insurance status is strongly associated with service use. In models of dental visiting, insurance is typically included as an enabling factor. However, in Australia, people self‐select into health insurance (privately purchased) and levels of cover for dental services are modest. Rather than enabling access, insurance status may be a “marker” for unmeasured predisposing attitudes. This study aims to explore associations between dental insurance status and visiting while adjusting for dental care attitudes. Methods: Participants (South Australians aged 45‐54 years) of a 2‐year prospective cohort study (2005‐2007) investigating dental service use were surveyed on their attitudes to dental care and insurance status. Six attitudinal factors were assessed using a 23‐item Likert scale. Bivariate associations between insurance, attitudes, visiting, and other known covariates (age, sex, and household income) were explored. A series of regression models assessed whether prevalence ratios of visiting were attenuated after controlling for attitudinal factors. Results: Response rate was 85.0 percent. Analysis was limited to dentate adults with known dental insurance status (n = 529). The majority had dental insurance (75.2%) and made regular visits (63.7%). Insurance status, visiting, and attitudinal factors were significantly associated. Controlling for covariates, insured adults, compared with the uninsured, were 57 percent more likely to make regular visits. After adjusting for attitudinal factors, the significant association between insurance and visiting persisted. Conclusion: Dental care attitudes did not confound the association between dental insurance and visiting, indicating that dental insurance status was not a “marker” for predisposing attitudes.     

Estimation of prophylactic measures in Swedish public dental health care Results from a questionnaire

The aim of the present investigation was to map the presence of prophylactic measures in organized Swedish dental health care systems, focusing on personnel working with children and adolescents. The study was conducted by sending a questionnaire to all public dental clinics in Sweden (830 clinics in all). The results showed that collectively – performed prophylactic measures were given at 66% of the child health centers/ child day care centers and at 63% of the pre-schools. 51% of all clinics replied that they performed some kind of fluoride administration collectively (mainly fluoride varnish application or fluoride mouthrinses). 34% of all clinics used fluoride varnishes at the ages from 6 to 12 years, and collectively-performed fluoride mouthrinsing in schools at these ages was carried out by 16% of the clinics. 26% of all the clinics answered that they aimed at increasing the time spent on prophylactic measures compared to only 2% that were planning to decrease this time. The remaining 12% aimed at maintaining the time spent at the present. Prophylactic measures were performed individually by 49% of the clinics, whereas 50% of the clinics preferred a combination of individually and collectively performed measures. It can be concluded that the preventive measures against dental caries in Swedish public dental care is mainly focused on individually performed prophylaxis.     

The impact of a state children's health insurance program on access to dental care

BACKGROUND: Access to dental care for low-income children is limited. The authors examined the impact of a new state children's health insurance program, or SCHIP, in North Carolina on children's access to dental care. METHODS: Parents of 639 school-aged children responded to two surveys that asked about their child's access to dental services before enrollment and one year after enrollment in the new program. The authors used two-tailed McNemar tests to detect statistically significant changes within subjects. RESULTS: The percentage of school-aged children with a visit to a dentist in the previous year increased from 48 percent at baseline to 65 percent after one year in the program. Reported unmet dental need decreased from 43 percent at baseline to 18 percent after one year of enrollment. The proportion of children reported to have a usual source of dental care improved after enrollment in the program. CONCLUSION: The SCHIP model in North Carolina is an innovative program that has made a significant impact on access to dental care for school-aged children. PRACTICE IMPLICATIONS: SCHIP dental programs that resemble private insurance models and reimburse dentists at rates close to market rates hold the potential to address problems associated with dental access for low-income children.