Comparison of use of dental services by Finnish immigrants and Swedes using national health statistics

Dental statistics and treatment information collected by the National Social Insurance Board (NSIB) since the Dental Insurance Scheme was introduced in Sweden in 1974, give a unique opportunity to study the use of dental services by the adult population. Earlier studies showed that adult Finnish immigrants utilized dental services less, and had a greater need of dental care, than the Swedish population. The possible confounding effects of age and social class were not, however, controlled. The aim of this study was to compare use of dental services and dental treatment performed in matched groups of Finnish immigrants and Swedes using central statistics. All Finnish citizens between 17 and 64 yr old born on the 20th of any month and living in the county of Stockholm in 1975, altogether 1378 persons, were selected from the population register. For each Finn a Swedish "social twin" was selected with respect to age, sex and occupation. Information about use of dental services and treatment performed during 1975 was collected from the patient register at the NSIB. The study showed that Finnish immigrants in 1975 visited a dentist less often than the corresponding Swedish group. Those Finnish immigrants who received treatment had had more comprehensive and more expensive care than the Swedish comparison group. The study shows that there were significant differences in use of dental services by and treatment performed on Finnish immigrants and Swedes even when differences in demographic and socioeconomic distribution were controlled.     

Dental health behavior in a migrant perspective: use of dental services of Pakistani immigrants in Norway

The purpose of the present study was to assess the utilization pattern of dental services in a group of Pakistani immigrants in Norway. Use was related to sociodemographic characteristics, level of urbanization in Pakistan, knowledge and belief about dental diseases and evaluated and perceived dental health. A total of 160 immigrants were clinically examined and interviewed by a structured questionnaire. The effect change analysis was performed, and separate analyses were performed for men and women. Altogether 60% had visited the dentist during the last 3 yr. While 69% coming from the cities had been to the dentist in Norway, this was the case for only 38% of those from the villages of Pakistan. Pain was given as the main reason for dental visits, and the data indicated insufficient ability to perform self-assessment of own dental health. The independent variables could explain more of the variance in use of dental services among the Pakistani men (R2 = 40%) than among the women (R2 = 21%). While number of decayed teeth and level of urbanization were among the strongest predictors among the men, dental behavior in Pakistan and number of years in Norway were of importance among the women. The latter variable indicated that the women in terms of dental behavior had a higher degree of acculturation than the men, leading to a change in traditional health behavior.     

The use of dental services among Norwegian adults in 1973

ABSTRACT The dental treatment pattern and its determinants were surveyed in 1973 by interviews with a sample comprising 1,632 persons drawn to cover the total Norwegian population aged 15 and above. In all, 58 % of the interviewees stated having visited a dentist during the year prior to the interview. In contrast, 16 % had not consulted a dentist for at least 5 years. Fifty-five percent of the sample reported having received fillings at the last dental visit and 15 % reported having received some periodontal and/or preventive treatment. Regular (at least annual) treatment attendance, was claimed by 52 % of the sample. However, some respondents had seemingly embellished their treatment behavior, and a relatively valid estimate for the current proportion of regular treatment attenders was considered to be 40 % of the adult population in Norway. Sex and geographic region were found to be the most influential predictors of the recent treatment pattern, whereas school dental treatment had a major influence in youth. Dental conditions including the wearing of dentures was the reason most often given for not seeing a dentist on a regular basis.     

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.     

Access and use of specific dental services in HIV disease

OBJECTIVES: This study examined factors associated with the use of specific dental services by persons with HIV disease. METHODS: The data were derived from 1,588 adults who participated in a series of up to six interviews as part of the AIDS Cost and Service Utilization Surveys. Use of dental services such as examinations, x-rays, cleaning, fillings, extractions, root canals, crown and bridge or dentures, and periodontal procedures were evaluated using logistic regression and generalized estimating equations were applied. RESULTS: Multivariate analyses showed that medical insurance, an education beyond high school, income higher than $1,300 per month, high ambulatory visits, and receipt of psychological counseling were generally associated with higher service use. Blacks, those with an inpatient admission, and CD4+ cell counts less than 500 cells/microL were significantly less likely to use most types of dental services. CONCLUSIONS: The study concludes that disparities exist in the use of several dental services similar to those seen in the general population.     

Use of public and private dental services by adults in Finland

Abstract – The aim of this study was to analyze the factors that affected the choice between public and private dental services in 1979, when 9% of adults had received their dental services in a public health center. In September 1979 the National Board of Health conducted a telephone interview among Finnish adults over 15 yr old. When a representative sample of 1992 adults was drawn, the response rate was 90.4%. All subjects over 17 yr of age who had used dental services within the last 5 yr were included in the study, making a final sample of 1368. According to the logistic function, the greatest differences were between rural and urban areas. Of the subjects living in urban areas, 18% had visited public health centers; and of those living in rural areas, 45% had visited health centers. Of the adults living in an urban selling, 70% and in rural areas 49% visited private dentists. Of the subjects who had used private dental services, nearly half were managers and upper white-collar workers; while of those using communal services, less than one third worked in such jobs. In urban areas managers and upper white-collar workers used private services twice as often as they used public services. In an urban setting, subjects who had visited a dentist during the last 2 yr had received treatment mainly in the private sector; and in a rural setting, subjects had been treated mainly in health centers.     

Investigation of delay in utilization ot government dental services in Malaysia

Although delays in seeking dental care among patients are frequently observed in daily practice, this problem has never been investigated in other utilization studies. This study attempts to establish the magnitude and severity of the problem of delay in a delivery system where cost is not a major barrier to utilization. 555 users of Government dental services were interviewed. Only 37% of them came promptly within 6 days of perceiving a dental need. The majority (63%) had delayed their dental visit for more than 1 week. In fact, the highest frequency of delay was for more than 1 month. Prompt attendance was found to be associated with people who regularly came for asymptomatic check-ups. In contrast, more than 50% of those who thought they needed fillings and extractions had delayed their visit for more than a month. The main causes of delays were attributed to work commitments and the lack of perceived need for urgent care. Barriers related to transport or financial problems were ranked very low. The implications of these findings are discussed.     

Factors influencing the local planning of dental services

Findings from a survey of 796 high school children in four districts constituting a health administrative area were examined to ascertain the factors influencing their dental disease experience, treatment received and attendance pattern. In three of the four districts, over 60% of the children were regular attenders, enjoying the benefit of less active caries than irregular attenders. However, in the remaining district, much of which consisted of depressed, inner city areas undergoing re-development, only one third were regular attenders. Several local factors, such as availability and accessibility of services, probably influenced the numbers seeking regular care, but one of the most important appeared to be the level of provision in the salaried Community Dental Service. The implications of the findings for planning improvements in local services are discussed.     

Dental service trends for older US adults, 1998-2006

This study of the Medicare Current Beneficiary Survey (MCBS) updates trends in utilization of dental services between 1998 and 2006 for community-dwelling U.S. adults of age 65 years and older. Bivariate comparisons were made between dependent variables (annual dental visits and types of dental procedures) and independent variables (age, gender, race, income, education, population density, marital status, U.S. Census Bureau regions, and self-reported health). The estimated percentage of community-dwelling Medicare beneficiaries with a dental visit for the years studied increased from 45.0% in 1998 to 46.3% in 2006. The age group of respondents who were 85 years and older had the greatest percentage increase in dental visits. Those reporting visits with preventive procedures increased from 87.8% to 91.2% whereas those reporting visits with nonpreventive procedures declined from 63.9% to 58.4%. The prevalence of dental visits continues to trend upward for this population of older adults. Increasing delivery of preventive services will likely impact the future mix of dental services as U.S. adults live longer.     

Causal analysis on the use of dental services among old-age pensioners in Norway

Abstract The purpose of the present paper was to establish and evaluate a causal model on the use of dental services in Norwegian old-age pensioners living at home. Data were derived from the Health Survey of 1975. The independent variables sex, age, education and dental status were dichotomized and arranged in this assumed temporal sequence. The dependent variable was also dichotomized into use versus non-use of dental sen-ices last year. The analysis started with the bivariate percentage table for sex and use, and then proceeded stepwise by adding one by one of the independent variables in the order of their lime sequence. In this way the statistical relationship between an independent and the dependent variable was decomposed into direct, indirect and spurious effects. Dental status was the most influential determinant of use of services, having the greatest direct effect (0.40) and mediating indirect effect of the prior variables. Education came second with a direct effect of 0.18 and an indirect effect (0.11) by affecting dental status. There were only negligible differences in use rates between the age groups (< 75≥ 75 years of age) when the other variables were held constant (0.05, P > 0.05). The greater part of the direct effect of sex (0.11) was limited to dentate persons aged 65–74 with low education. Both age and sex affected use of services indirectly through dental status (0.09 and –0.04, respectively).     

Immigrants and a public oral health care service for children in Denmark

The present study was conducted to compare level of dental caries, treatment pattern and contact patterns with the Child Oral Health Care System of children of immigrants. The study comprised 239 Turkish, 117 Pakistani and 91 other immigrants and a control group of 359 Danish children. Data were extracted from the dental records in the clinic where they were treated. All groups of immigrants showed more caries in the primary dentition and less caries in the permanent dentition than Danish children of comparable age. For preschool children a higher number of broken appointments were found for the immigrants as well as a higher number of appointments which were interrupted due to management problems. The consequences for planning preventive and restorative programs for children of immigrants are discussed.     

Shifts between use and non-use of dental services among young Danish adults over a 3-year period

Utilization of dental services among three groups of young adults was studied longitudinally. Each year from age 16 to age 19, participants were defined as users or non-users of alternative dental programs. Dental programs were taking place with public dental health service clinics (n = 386), with private dental practitioners, free of charge (n = 161), and with private dental practitioners, partially reimbursed by health insurance (n = 261). The paper analyzes whether the pattern of utilization of the last two groups might be described by a Markovian model defining use or non-use of dental care each of 3 years as two mutually exclusive Markovian states. Contingency table analysis of the relationships of the utilization status and sex, social group, and delivery program showed that the utilization pattern could not be described by a Markovian model. Conversely, strong relationships between 1-yr user status and 3-yr user status was found. Implications in relation to the prevailing dental health care policy emphasizing regular dental care and continuity between child dental health care and young adult dental programs are discussed.     

Demand for and utilization of dental services among Hong Kong employees with and without dental benefit coverage

Abstract The objectives of the present study were to investigate the effects of employer-provided dental benefits on the pattern of demand for and utilization of denial services among Hong Kong employees and to analyse whether employees' awareness about an existing denial benefit programme influenced their denial service demand and utilization. Staff from 11 selected companies with and without dental benefits responded to questionnaires concerning their personal factors, demand for dental services, and utilization of denial services and about their awareness of their dental benefit coverage. Overall response rate was 67%. The socio-demographic characteristics of those respondents who were covered and those who were not were similar. Forty per cent of the covered respondents were not aware of their dental benefit coverage, so analysis was performed with three groups of respondents, covered and aware, covered and unaware, and uncovered. A larger proportion of employees in the “aware” group had visited a dentist in the previous 12 months and had visited a dentist for asymptomatic reasons. The “aware” group reported more “low expenditure” items and less “high expenditure” items. Those who were aware of their dental benefit coverage irrespective of the type of scheme reported a significantly higher demand than those who were not aware of their coverage. Demand and utilization of the covered, but unaware, group was more similar to the uncovered group than lo the “aware” group. Coverage per se had no apparent effect on the demand for dental services. Further studies will be necessary lo establish that higher dental care demand and utilization induced by third party schemes also leads to improved oral health.     

Validity of information concerning the use of dental services obtained in interviews

Two hundred and fifty-two persons out of a population of 358 were interviewed concerning their use of dental services. The validity of the information was tested by comparing the answers from each respondent with the contents of his/her dental treatment record. Replies to a question about the time interval since the last dental visit showed a high degree of validity. The validity of information concerning the type of treatment received at the last course of dental visits showed high validity for a single treatment and low validity when the treatment services were mixed. Responses about the regularity of treatment attendance demonstrated decreasing degree of validity with increasing number of dental visits during the last 5 years. The demographic and socioeconomic characteristics of the respondents showed little relation to the validity of their answers. However, the degree of validity decreased with increasing number of teeth.