Effect of a single dental health care instruction and prophylaxis on gingivitis

This study was conducted to evaluate the effect of a single dental health instruction on gingivitis in an adult population. Ninety-eight army recruits from two military camps were randomly allocated to four groups: a control group, a group that received a professional prophylaxis, a group that received dental health care instruction and a group that had both a prophylaxis and dental health care instruction. Treatment effects were measured 1 week, 1 month and 3 months after the initial examinations. The single prophylaxis resulted in a small temporary improvement. The effect of the single dental health care instruction was also small, but lasted until the end of the trial. A single instruction plus prophylaxis resulted in the clearest improvement, which was still present after 3 months. It can be concluded that any single treatment should at least consist of dental health care instruction plus a prophylaxis.     

Assessing the association between receipt of dental care, diabetes control measures and health care utilization

BackgroundThe literature contains few studies regarding the relationships between receipt of regular dental care and medical outcomes for people with type 2 diabetes.MethodsThe authors compared hemoglobin A_1c (HbA_1c) levels (< 7 percent versus < 7 percent), low-density lipoprotein cholesterol levels (< 100 milligrams/deciliter versus ≥ 100 mg/dL) and diabetes-specific hospital admissions and emergency department (ED) visits (one or more visits versus no visits) in 493 people with type 2 diabetes who received regular dental care (≥ two prophylactic visits, periodontal treatment visits or both during a 12-month period) with measures in 493 people with type 2 diabetes who did not receive any dental care. The authors matched patients, all of whom had private medical and dental insurance benefits during the study period, with regard to age, sex and previous utilization of ED visits and hospital admissions, and they followed them for three years.ResultsThe authors analyzed the data by using multiple logistic regression, which showed that receipt of regular dental care was associated with lower diabetes-specific ED utilization (odds ratio [OR] = 0.61, 95 percent confidence interval [CI] = 0.40–0.92) and hospital admissions (OR = 0.61, 95 percent CI, 0.39–0.95) after they adjusted for age, sex, previous hospital admissions, previous ED utilization, race, baseline HbA_1c values, Charlson comorbidity index score, body mass index status, periodontal risk status and primary care utilization. The authors found no significant association between receipt of dental care and control of HbA_1c levels.ConclusionsThe study results show an association between regular receipt of dental care and reduced diabetes-specific medical care utilization (that is, ED visits and hospital admissions).Clinical ImplicationsAlthough the results of this study could not show causality, they suggest that receipt of dental care may reduce diabetes-specific health care utilization. Prospective studies are needed to better understand the relationship of receipt of dental care with diabetes control and health care utilization measures.     

The impact of the affordable care act's Medicaid expansion on dental care use through 2016

Objective

To examine the impact of the Affordable Care Act on dental care use among low‐income adults ages 21‐64.

Methods

Our analysis uses national survey data from the 2010‐2016 Gallup Wellbeing‐Index. We use a differences‐in‐differences analysis to assess changes since the end of 2013 in dental care use among low‐income adults. We compare changes in states that expanded Medicaid and offer adult Medicaid dental benefits versus changes in other states.

Results

Relative to the pre‐reform period and other states, in Medicaid expansion states with adult dental benefits, dental care use increased 3‐6 percentage points in 2016.

Conclusions

In Medicaid expansion states with adult dental benefits, evidence suggests that low‐income adults have greater access to dental care.     

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.     

Oral health needs and access to dental care of homeless adults in the United States: a review

The homeless population in the United States is one of great diversity that continues to increase in number. Although data on the oral health status of individuals who are homeless is limited, studies consistently report both the perception and clinical evidence of dental needs among this population as well as a low utilization rate for dental services. This article reviews the oral health needs of people who are homeless as reported in literature, barriers to receiving dental care, and methods used to deliver dental care to this population. Many rehabilitation centers for adults who are homeless consider the establishment and maintenance of a state of good general and oral health as a priority and a key factor in helping homeless adults to return to the workforce and mainstream society.     

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.     

Access to dental care – experiences of men with HIV infection in the United Kingdom

Abstract – A piloted self-complete questionnaire enquiring about dental experiences was administered to a consecutive sample of men with asymptomatic HIV infection attending a dedicated clinic in London. Forty-seven men completed questionnaires. Despite a high level of dental attendance before diagnosis of HIV infection, 60% of the men had not visited a general dental practitioner since diagnosis. Nineteen men had visited a dentist since diagnosis; 15 had been refused or deterred by members of the dental team and 5 had attended without disclosing their HIV status. These data indicate that despite professional guidance to dentists, the perceptions of dentists held by people with HIV and the behaviours of dentists act as barriers to care. Dedicated dental clinics act as an important safety-net for people with HIV infection.     

Oral health care needs among the middle-aged and the elderly in Hong Kong

Abstract A sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35–44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.     

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.     

Conundrums in health care reform: current experiences across the North Atlantic

Objective: To assist stakeholders (policy makers, dentists and patients) implementing the Patient Protection and Affordable Care Act of 2010 in the United States by providing information on conundrums arising from previous polices of the UK Labour government and emergent policies of the recently elected Coalition Government. Methods: The authors provide a background to the development of National Health Service dental services contrasted with US provision. Considerations are given from the different perspectives of stakeholders involved (policy makers, dentists, and patients). Conclusions: Policy makers must work under pressure for services to remain within boundaries of finite economic resources and what people are willing to pay for. The importance is stressed that they respond to public demands and workforce capability by clearly determining what the priorities should be, what services will be delivered, and defining responsibilities.     

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.     

Equality in satisfaction, perceived need, and utilization of dental care in a 50-year old Swedish population

Abstract Satisfaction with dental care, perceived need for dental care, and dental care utilization were analyzed as to equality in geographical, socio-economic, and gender distributions. The study base was a cross-sectional mail questionnaire sent in 1992 to all 50-year old persons (totally 8890) in Örebro and Östergötland counties in Sweden. Measures of the variables were all based on self-assessments. The response rate was 71.3%. The results showed no large inequalities as to satisfaction, except the aspect travel time for rural residents. They also had higher perceived need for dental care. For utilization of dental care, workers were relatively fewer among “high” consumers. Controlling for socio-economic group, there were twice as many men than women among “low” consumers. In conclusion, there was relative equality in the dental care delivery in this 50-year old Swedish population, with some remaining social differences, primarily socio-economically contingent.     

Reasons for seeking dental care in a Malaysian urban adult population: an analysis by sex and ethnic group

Different groups of people will view and use modern dental services differently. This is determined by their traditional beliefs and cultural background. The aim of this study is to identify variations in utilization among adults in the three major ethnic groups in Malaysia. Dental records of 500 adults attending the University dental center were randomly selected and analyzed by sex and ethnic group. Results from this pilot study clearly indicate that different ethnic groups tend to use certain types of services more than others. Similarly, there is evidence of variation in the type of dental service preferred between males and females. The implications of these findings for dental health educators, program planners and further research is emphasized in order to promote a more positive pattern of utilization among the various ethnic groups.     

Dental knowledge, attitudes towards oral health care and utilization of dental services among male industrial workers with or without an employer-provided dental benefit scheme

Abstract In industrialized countries various dental benefit schemes have been implemented to improve the utilization of dental services, though few studies have demonstrated that effect. Prior to a comprehensive clinical study in southern Finland, a postal questionnaire survey of male industrial workers (age 38–65 yrs) was conducted to investigate knowledge and attitudes concerning oral health care and whether access to an employer-provided dental benefit scheme was associated with the utilization of dental services. The response rate was 81% (n=325) in the subsidized group and 69% (n=174) in the control group. In both groups, 60% of the subjects had had their last dental visit within a year but 91% of the subsidized workers compared to 79% of the controls had visited a dentist in the past two years (p<0.001). The subjects had similar attitudes towards the importance of regular dental care and its implications for dental and general health. Subsidization explained the disparity in the current dental visiting pattern between the groups better than the possibility of using working hours for dental visits. Backward stepwise logistic regression revealed that the probability of a dental visit within the past two years was positively associated with access to an employer-provided dental benefit scheme, tooth brushing to maintain dental health, and number of teeth, and negatively associated with number of carious teeth. Our results demonstrate a positive impact of subsidization on the utilization of dental services.