Pre-school child oral health in rural Western Australia

BACKGROUND: In light of the various challenges faced by public dental health services, especially when large geographical areas and isolated communities are concerned, targeting of high risk groups within these populations needs to be investigated. This study aimed to assess caries experience, dental health behaviour and dental service utilization among a sample of pre-school children in a rural community in Western Australia. METHODS: The study was a cross-sectional oral health survey of pre-school children between the ages of 2 and 5 in Carnarvon, Western Australia. RESULTS: In total, 70 pre-school children (representing approximately 15 per cent of the total 2-5 year old population of Carnarvon) were examined. Less than half of the children were caries free. Both caries prevalence and severity (mean dmft) were significantly higher among Aboriginal children than non-Aboriginal children. Caries prevalence and severity were also significantly higher among children who often consumed carbonated drinks. CONCLUSIONS: This survey indicates that some pre-school children in rural areas, and especially Aboriginal pre-school children, are at high risk of developing dental caries. Effective oral health programmes commencing well before the usual first contact with dental services at age 5 are needed for young children at high risk of dental caries.     

Influence of perceived provider performance on satisfaction with oral health care among adolescents

OBJECTIVE: To investigate satisfaction with dental care received at the last dental appointment among adolescents and to analyse factors influencing their satisfaction scores. METHOD: A total of 1146 subjects (mean age 15.8 years) attending secondary schools in Kampala (urban, n = 591) and Lira (rural, n = 555) completed structured questionnaires at school in 2001. RESULTS: A total of 63% and 75% of Kampala and Lira students, respectively, reported attendance to dental clinics during the previous 2 years. The corresponding rates of students who confirmed satisfaction with oral health care services received were 73 and 77. In a logistic regression model, the students of Kampala who attended a dentist more than once, had no painful experience at the visit, evaluated their oral condition positively, were satisfied with the dentist's communication and dentist's information, were more likely to be satisfied with the oral health services received (OR = 1.7, 2.2, 4.1, 2.9 and 4.9, respectively). Regarding rural students, being satisfied with oral condition, dentist's communication and dentist's information were associated with higher odds of being satisfied with oral health care services (OR = 2.9, 1.9 and 2.3, respectively). CONCLUSION: Inter-personal interaction with the dentist is a key determinant in establishing satisfaction with dental care among urban as well as rural adolescents.     

Perceptions and use of dental quacks (unqualified dental practitioners) and self rated oral health in Trinidad

OBJECTIVE: To investigate reasons for use of dental quacks, treatment received, satisfaction with treatment, perceived differences to qualified dentists, and relationships to sociodemographic factors and self rated oral health. METHOD: A 14-item questionnaire including closed and open questions, was administered by interview to adult patients attending government health centres in Trinidad. RESULTS: Data were collected between November 2001 and March 2002. Two hundred and two people from 273 invited to participate, were interviewed (response rate 74%). Sixty seven per cent reported visiting a dental quack. People who had used a quack were older, from lower socioeconomic groups and more likely to be living in an area where there were fewer government dental clinics. The most common reason for visiting a quack was toothache (74%) and extraction was the most common treatment received (61%). Forty three per cent of respondents were dissatisfied with the treatment received from a quack and 83% felt that treatment provided by a qualified dentist was different. Main reasons for using a quack were cost (53%) and availability (20%). People who had used a quack were less likely to rate their oral health as 'Very good' or 'Excellent'. CONCLUSION: Those using the services of dental quacks in Trinidad were more likely to have lower, self rated oral health. Affordability and availability of dental treatment were identified as barriers to care from qualified dentists.     

A typology of models for expanding access to oral health care for people living with HIV/AIDS

Objectives: This article describes a typology of program models for expanding access to dental services for people living with HIV/AIDS (PLWHA). These programs serve communities with limited access and high unmet need for oral health care, such as rural areas, low‐income and racial/ethnic minorities. Methods: Interviews and site visits with dental and program directors were conducted at participating sites, including AIDS service organizations, community health centers, and university‐affiliated medical centers or hospitals. Results: Despite the differences across organizational structure, similar models and approaches were developed to engage and retain PLWHA in dental care. These approaches included: using mobile dental units; expanding the type and availability of previous dental services provided; providing training opportunities for dental residents and hygienists; establishing linkages with medical providers; providing transportation and other ancillary services; using dental case managers and peer navigators to coordinate care; and patient education. Conclusions: This typology can assist program planners, medical and dental care providers with service delivery strategies for addressing the unmet need for oral health care in their area.     

The provision of dental services in the Third World

The primary health care approach has been selected as the basic health care planning philosophy in the developing countries and as oral health is an integral part of general health, this approach could be applied for oral health promotion too. Sri Lanka shares most of the oral health problems common to other developing countries. Dental care is delivered free through hospital dental clinics to adults and school clinics to children. Field medical staff, village health volunteers, religious leaders, school-teachers, traditional medical practitioners and senior students in schools are deeply involved in oral health promotional activities. The traditional concept of health care delivery filtering through a number of layers has been replaced by an upward movement initiated by the people. Every effort is being made to strengthen the base of this structure where non-dental personnel are involved, the dental auxiliary personnel providing the services at the first referral level and the scarce professionals being concerned only with high quality oral care at the final referral level. In addition to preventive and educational services a certain amount of treatment has to be provided. These are supplied in static hospital clinics, in mobile clinics or portable equipment is used to set up temporary dental centres in remote areas. Highly sophisticated equipment imported from industrialized countries is used in the hospital service but this service is disrupted due to frequent breakdowns and lack of spares. Local production of dental equipment should be encouraged and research should be conducted to assess the most suitable equipment for third world countries.     

Sustaining oral health services in remote and Indigenous communities: a review of 10 years experience in Western Australia

In line with findings throughout Australia, rural, remote and Indigenous Western Australians suffer from a higher burden of oral disease and have less access to dental practitioners and care than their urban and non‐Indigenous counterparts. With workforce projections indicating an increase in the shortage of dental practitioners, especially in rural and remote areas, the Centre for Rural and Remote Oral Health (CRROH) in Western Australia set out to establish a sustainable programme to service such increasingly disadvantaged populations. Via the vertical integration of education, service and research CRROH pioneered a sustainable model to deliver much needed oral health services to some of Western Australia's most remote areas, while primarily focused on addressing the oral health needs of Indigenous Australians. One of the key lessons from the programme has been the development of a strong clinical governance framework and a support network to sustain services in remote locations. This study offers one way to provide and sustain dental care for those most in need, yet largely left out.     

A functional natural dentition for all – and for life? The oral healthcare system needs revision

The cost of dental care adds to the costs of the already overburdened health sector. Do we – as patients and as society –receive oral health care that is both aligned with the actual disease experience and also, critically based on up‐to‐date scientific knowledge about the major oral diseases? In many places, the practice of dentistry reflects a response to disease patterns that once existed and is based on diagnostic and therapeutic approaches that are no longer valid. Instead, a new cadre of dental professionals is needed, one that is capable of meeting the actual health needs of our populations. This cadre should ensure that patients maintain a functioning dentition from cradle to grave based on cost‐effective disease control principles. There is an urgent need to: (i) reconsider the roles of the different oral health cadres involved in the provision of oral health care; (ii) integrate oral health into general healthcare services; and (iii) restructure the training of oral health personnel. We advocate a radical reform of the oral healthcare system involving the training of two new types of professionals integrated with the general healthcare system: The oral healthcare provider – a highly skilled professional specialised in the diagnosis and control of oral diseases and with a profound understanding of oral health as part of general health – and the oral clinical specialist – whose role is the provision of advanced oral rehabilitation, able also to treat people with complex chronic diseases and multiple medications.     

Patterns of access to public oral health care in Queensland by gender, indigenous status and rurality

Data were collected on courses of care from all attendances at public sector dental clinics between July 1994 and June 1996 and examined by gender, rurality and indigenous status. Males and indigenous people were more likely to attend dental clinics when a problem with pain existed, resulting in a high need for emergency services, more diagnoses of dental caries, and treatment more often involving oral surgery, including extractions. Similarly, remote area dwellers had more diagnoses of dental caries and oral surgery, although their attendance at clinics was complicated by access.     

辽宁省中老年人群口腔疾病就医观念和行为的调查

目的研究辽宁省居民口腔疾病的就医观念和行为习惯，为卫生行政部门进一步合理分配有限的口腔卫生资源提供依据。方法采用多阶段分层等容量随机抽样的方法．在辽宁省的6个抽样地区随机抽取35～44岁的中年人792例，65～74岁的老年人396例作为问卷调查对象，由问卷调查员面对面询问的方法收集资料并记录。结果中年人就医需要高于老年（x^2=29．41，P〈0．01）．城市老年人就医需要高于农村（x^2=4．675，P〈0．01）。在过去12个月，仅有17．1％的中年人和19．7％的老年人因牙病去医院治疗．城市就医率高于农村。约有84．0％的中老年人就医原因是急慢性牙痛，仅有3．8％的人能定期检查。50％以上的人认为牙病不重或没有时间就不必就医。在农村约有95％．城市有70％的人牙病治疗支付途径为自费。有55．9％的中年人和67．9％的老年人口腔疾病的就医机构是私人诊所。结论加强口腔健康教育和促进．建立包括预防保健项目在内的口腔保险制度．才能充分利用有限的口腔卫生资源．提高我省居民的口腔健康水平。     

陕西省老年人群口腔疾病就医观念行为状况的调查

目的：了解陕西城乡老年人群口腔疾病的就医观念和行为。方法：采用多阶段、分层、等容量随机抽样的方法,随机抽取65-74岁的老年人405例作为调查对象,调查内容包括：老年人看牙的情况、就诊机构、就诊的主要原因等。采用面对面询问的方法进行现场调查。所有数据输入Epidata数据库,采用SPSS13.0统计软件进行分析。结果：城市中会去看牙的老年人高于农村,就医需要亦高于农村。多数老年人在牙疼时选择顺序为：挺一挺就过去、自己找药吃、找医生治疗牙齿、找医生拔牙。在过去的12个月中城乡老年人没有就医的比例为：76.1%、87.5%,多数城市老年人认为牙齿没问题、牙病不严重,因经济困难或附近没有牙医而不能就诊的农村老年人明显的高于城市。就诊机构主要选择在社区卫生院、私人牙科诊所。就诊主要原因是急慢性牙疼,接受的治疗主要是拔、补、镶牙,只有城市中少数老年人接受定期检查、牙齿美容以及牙周治疗。结论：加强老年人口腔健康教育,充分利用陕西省有限的口腔卫生资源,提高老年人口腔健康水平。     

Oral health status of homeless people in Hong Kong

The authors report on an oral health survey among Hong Kong Chinese homeless people. A total of 140 homeless men underwent clinical examination and were interviewed with a structured questionnaire. More than 90% had evidence of caries experience; most (75%) were related to untreated caries. The mean DMFT score was 9.0 (DT=3.2, MT=5.2. FT=0.6). Periodontal disease was highly prevalent, with 96% having periodontal pockets. The dental problems most frequently reported by the homeless were: bleeding gums or drifting teeth (62%), dental pain (52%) and tooth trauma (38%). More than 70% of the study's participants perceived a need for dental care. The population surveyed had poorer oral health compared to the general population. High levels of dental needs, both normative and perceived, were found. There is a need to provide more accessible and affordable oral health services to this group of people.     

The use of the Internet to access oral health-related information by patients attending dental hygiene clinics

Background: The degree to which patients access the Internet for oral health‐related information is unknown. Objectives: This study was designed to determine if patients attending student dental hygiene clinics had: (1) accessed the Internet, (2) used the Internet as a source of information on both general health and oral health, (3) bought oral health care products on‐line, and (4) were interested in being directed to appropriate on‐line oral health resources by dental professionals. Methods: A self‐complete questionnaire was administered to a quota sample of 280 new and returning patients attending the student dental hygiene clinic at either the Cardiff Dental Hospital or a nearby Primary Dental Care Unit. Results: A total of 269 (96%) patients consented to participate in the study. Of these, 147 (54.6%) had accessed the Internet, the majority (61.2%) from home. Internet use was significantly related to both patient age and level of education (P < 0.001). In total, 59 patients claimed accessing the Internet for information on general health topics. Only eight respondents had used the Internet for information on oral health/dental topics, with seven reporting that they found the information useful. On‐line purchase of oral health products was reported by seven patients. However, 117 (43.5% of all respondents) patients indicated that they would be interested in the Internet as a future source of oral health information and 112 (41.6%) would appreciate being directed to appropriate sites by their dentist or dental hygienist. Conclusions: Patients attending student dental hygiene clinics make little use of the Internet for oral health information. However, reported interest in future access is such that dental professionals should develop and harness the potential of the Internet as an educational resource.     

Trends in treatment performed in the Phelophepa Dental Clinic: 1995-2000.

Mobile clinics are a cost-effective method of meeting the dental needs of rural communities in South Africa. Phelophepa, the first primary health care train of its kind world-wide, provides eye care, education, medicine, basic health care and since June 1995 dental treatment to rural communities. All services are rendered by students under supervision of qualified staff. The aim of this study was to analyse and report the data for treatment performed in the dental clinic from June 1995 to May 2000. During its first five years of operation, dental services were provided at 183 towns in all provinces except Gauteng. Of the 42,073 patients treated during this time (an average of 229.9 per town), 67.4% were adults. 71.3% of the 103,283 procedures performed were extractions, 15.7% could be classified as preventive with the remaining 13% as restorative procedures. The average value of the service provided to each patient was R218.53. The exposure of dental, dental therapy and oral hygiene students to rural areas of South Africa serves the important purpose of sensitising students to the realities of oral diseases in these communities.     

Institutional barriers to providing oral health services for underserved populations in New York City

Objectives : We sought to explore institutional barriers to the provision of oral health services for the underserved among inner-city health centers. Methods : Mail-based survey of Medicaid-approved health centers in New York City without oral health services. The importance of four barrier categories was rated: resource issues, dental provider difficulties, referral problems, and low priority of dental care. Results : 36 health centers completed the survey. The most important barriers were resource issues (66.7% agreed), dental provider difficulties (29.4%), referral problems (24.2%), and low priority (15.2%). Top individual barriers were lack of start-up funds (88%), lack of physical space (74%), lack of available funding sources (71%), and low reimbursement rates for dental services (69%). Most centers (78%) identified a need for dental services for their patients. Conclusions : Access to oral health care remains a large problem for the underserved. Institutional barriers will need to be addressed to close the gap.     

Self-perceived oral health status and influencing factors of the elderly residents of a peri-urban area of La Paz, Bolivia

AIM: To assess the self-perceived oral health status of the elderly in Bolivia and explore the relationship between the socio-demographic and subjective factors that influence such perception. DESIGN: A cross sectional study. SETTING: Pampahasi, peri-urban area of La Paz, Bolivia. PARTICIPANTS: A 22.5% (300) sample was selected randomly from the total population (1,336) of 60 years and above. Of the participants, 293 agreed to participate in the survey. METHODS: Information was collected by interviews at home. RESULTS: The mean age was 70 years (SD = 7.7), with more females (57%) than males. Sixty per cent of subjects categorised their oral health as poor. Logistic regression analysis showed that poor self-perceived oral health was associated significantly with not going to school, no/ fair satisfaction with economic status, poor chewing ability, perception of need for dental treatment, and poor self-perceived general health status. CONCLUSIONS: Socio-economic factors seem to contribute to poor oral health among the elderly in Bolivia. Considering that these factors are associated with bad oral health behaviour and few visits to dental clinics, there is a need to design dental education programmes and enhance accessibility to dental clinics for elderly people living in the peri-urban areas of La Paz, Bolivia.     

北京某社区15岁以上居民口腔卫生服务利用情况及影响因素

目的 了解北京社区居民中不同人群口腔卫生服务利用情况,并分析其相关影响因素,以期为今后口腔卫生服务的发展提供依据.方法 采取多阶段整群随机抽样的方法,抽取北京市新街口社区街道居民进行家庭健康询问和健康检查的入户调查,统计分析社区居民口腔卫生服务利用的影响因素.结果 调查社区居民2003户,共计4459人.社区居民1年内口腔就诊率为11.3%(502/4459).Logistic结果显示青年人(OR=2.072)、有医疗保障(OR=2.835)、就诊距离近(OR=3.535)、有就诊意愿(OR=2.595)以及认为自己口腔健康差(OR=2.014)是有利于社区居民口腔卫生服务利用的主要因素.结论 社区居民口腔卫生服务利用率较低,中老年人尤为严重.应提高居民对口腔疾病的认识和对口腔卫生服务的了解,同时完善医疗保障体系.

Abstract：

Objective To investigate the utilization of oral health services and to analyze the factors associated with oral health services for the community residents. Methods Household health interview and oral health condition survey were conducted to obtain information about oral health services. The respondents were recruited by a multi-stage random cluster sampling procedure. Multiple dummy regression analyses were performed for the assessment of the relative effect of behavioural factors on dental attendance. Results A total of 2003 families, 4459 people participated in this study. The people seeking dental treatment accounted for 11.3% (502/4459) per year. Young people ( OR = 2. 072), having medical insurance system ( OR =2. 835 ), short distance to see dentist ( OR = 3. 535 ) , oral health awareness ( OR = 2. 595 ) , poor selfassessment of oral health status (OR =2. 014 ) were the main factors which influenced dental attendance of community residents. Conclusions The utilization of oral health service was low, particularly for middleaged people and the elderly. Oral health education and medical insurance system should be strengthened.     

德阳市成年人的口腔健康知识、态度及行为调查

目的　调查四川省德阳市城市、农村和城郊成年人的口腔健康知识、态度和行为,分析影响人群牙科卫生 服务使用的因素。方法　采用世界卫生组织基本口腔保健成年人问卷对1 010名德阳市城市、城郊和农村的35~ 44岁成年人进行面对面访谈,评价德阳市成年人的口腔健康知识、态度及行为,分析影响成年人2年内看牙医行为 的因素。结果　约半数成年人过去1年牙齿或口腔有疼痛,多数成年人的口腔健康态度较好,但对氟防龋的认识 不足。城市成年人使用含氟牙膏的比例(61·3%)明显高于城郊及农村(6·9%、16·8%)。从来没有看过牙医的比例 农村及城郊最高61·0%,71·5%,城市只有32·0%。Logistic回归分析表明,影响2年内看牙医行为的因素有地区类 别和上1年有无牙痛。有牙痛成年人看牙医的OR值是无牙痛成年人的2·84倍。结论　德阳市成年人对口腔健 康知识认识不足,态度较好,牙科卫生服务使用较低,口腔健康知识和行为亟待改进。     

Factors influencing use of dental services in rural and urban communities: considerations for practitioners in underserved areas

Individuals' utilization of dental services depends upon an array of factors, including access to care, financial restrictions, attitudes toward dental care, and dental fear. These factors, in turn, may vary across geographic locations and demographic groups. The goals of this study were to assess the use of dental services in both rural and urban areas of Kentucky and to examine challenges facing practitioners in rural areas. Individuals sampled from a rural population and patients in rural and urban dental clinics completed questionnaires about use of dental services, self-rated dental health, and dental fear. While these variables were strongly interrelated, differences emerged across locations. Patients in the urban area reported having more dental insurance but not better dental health. Patients in more rural areas reported seeking more emergency dental treatment but not more dental fear. While these factors are important considerations across locations, dental practitioners in rural areas in particular should be aware of barriers to dental care facing individuals in these areas. They have unique opportunities to provide education to their patients regarding the importance of dental care and the role of oral health in overall physical health.     

A baseline study of the demographics of the oral health workforce in rural and remote Western Australia

BACKGROUND: A shortage of dental practitioners in Australia is predicted for the future, and the greatest effect of this will be felt in rural and remote areas. Strategies are needed to increase the recruitment and retention of dental practitioners in these areas. Part of this process is to assess the demographics of the oral health workforce. METHODS: A postal questionnaire survey was undertaken in 2002, that involved all registered dentists, therapists and hygienists in rural and remote Western Australia. RESULTS: Rural dentists are predominantly male, early middle aged, married, UWA trained, Australian born with one to two children. Rural dental therapists are predominantly female, in their mid-thirties, married, Australian born, trained in Western Australia, with two children. Male dentists worked slightly more hours per week than female dentists. The majority of the workforce does have access to email and the internet. Taking leave is a problem for most dentists because of difficulties in finding locums. CONCLUSIONS: The rural dental workforce capacity and demographic distribution need monitoring and analysis. This will determine the dental workforce's future ability to deliver the necessary services in rural and remote regions, where currently there is a dental workforce shortage.