Dental decay rates among children of migrant workers in Yakima, WA

The literature documents a significant decline in the prevalence of dental caries among children. Unfortunately, dental decay rates of children of migrant workers remain high. This study collected data from 885 migrant children in central Washington. This community is in the west coast migrant stream. The area is served by a health center funded through the community and migrant health center program. There is an active dental program provided through the health center. The children were found to have a high rate of dental decay. However, there was a high rate of treatment of this decay and a rate of sealants (a preventive measure) nearly three times the rate in the general population. Although dental decay remains a serious problem in the migrant community, the migrant health centers appear to be making a positive impact on the dental health of the children.     

Changes in dental fluorosis and dental caries in Newburgh and Kingston, New York.

OBJECTIVES: This study sought to determine whether the prevalence of dental fluorosis and dental caries had changed in a fluoridated community and a nonfluoridated community since an earlier study conducted in 1986. METHODS: Dental fluorosis and dental caries data were collected on 7- to 14-year-old lifelong residents (n = 1493) of Newburgh and Kingston, NY. RESULTS: Estimated dental fluorosis prevalence rates were 19.6% in Newburgh and 11.7% in Kingston. The greatest disparity in caries scores was observed between poor and nonpoor children in nonfluoridated Kingston. CONCLUSIONS: The prevalence of dental fluorosis has not declined in Newburgh and Kingston, whereas the prevalence of dental caries has continued to decline.     

Brighter Smiles: Service learning, inter-professional collaboration and health promotion in a First Nations community

OBJECTIVE: The goal of Brighter Smiles was to improve children's dental health in a remote First Nations community in British Columbia in the context of a service-learning experience for pediatrics residents. SETTING AND PARTICIPANTS: The provincial Ministry of Health had competitive funds available for collaborations between remote communities and medical educators. Hartley Bay (Gitga'at), a tribe of the Tsimshian Nation, responded by declaring children's dental health to be a primary health concern. This northern community has an on-reserve population fluctuating around 200 people and is accessible only by air or water. INTERVENTION: A convenience sample of children had a baseline dental exam; parents also completed a questionnaire about dental health behaviours. Only 31% (4/13) of pre-kindergarten and 8% (2/26) of kindergarten to Grade 12 children had no dental caries. Planning of the Brighter Smiles intervention involved community leaders, teachers, parents, Elders, health care staff, pediatrics residents, and dental and medical faculty from the University of British Columbia (UBC). Brighter Smiles includes school-based brush-ins, fluoride programs, classroom presentations, and regular visits by UBC pediatrics residents to Hartley Bay to provide well-child care that includes age-appropriate dental counselling to parents at the clinic visits. OUTCOMES: An early success indicator was a significantly increased proportion of dental service provider's time scheduled for preventive maintenance services rather than dental rehabilitation (restorations and extractions). CONCLUSIONS: The goal of providing a service-learning experience for trainee pediatricians in a remote community has been achieved. In addition, early indicators demonstrate improvements in child oral health.     

Planning and implementing the first stage of an oral health program for the Pika Wiya Health Service Incorporated Aboriginal community in Port Augusta, South Australia

The oral health of the Indigenous community in South Australia's mid-north has been a concern for some years. There has been a history of under-utilisation of available dental services by the local community. This is in part due to the services not meeting their cultural and holistic health care needs. The Indigenous community resolved to establish a culturally sensitive dental service within the Aboriginal Health Service already operating in Port Augusta in South Australia's mid-north. To achieve this, a partnership between Pika Wiya Health Service Incorporated, the South Australian Dental Service, the University of Adelaide Dental School and the South Australian Centre for Rural and Remote Health was formed. The aim of the project partners was to establish a culturally sensitive, quality dental service that caters to the needs of the Indigenous community serviced by Pika Wiya Health Service Inc. This article describes the process of planning and implementing the first stage of this project.     

Dental Health Knowledge Tests: Their Development, Implementation And Evaluation

The present study discusses the development of dental health knowledge tests as part of an integrated dental health curriculum in the public school system of a rural community. It is part of a large project designed to test the effectiveness of a school-based dental health delivery system. Cognitive measures of dental health were designed to study the relationship of dental health knowledge to oral health behaviors. A review of the literature revealed no suitable dental health knowledge tests for grades K-6; new assessment measures were then developed by project staff. The tests consisted of 14 objectively scored tests--two parallel forms at each of the seven grade levels, K-6, and were administered four times to 1,942 students. Consistently, the tests have demonstrated high reliability estimates and low standard errors of measurement and indicate that the instruments are functioning as parallel forms and measuring the same dental concepts with equal precision.     

The growing importance of dental services in rural America

As the science of medicine progresses, associations between good oral health and improved health status are being documented. However, the data would suggest that individuals in America's rural communities are experiencing dramatic health problems because they are not receiving dental treatment. This article addresses the importance of dental services in rural communities and highlights the importance of cooperation among hospitals, individual clinical providers, community health care organizations, and governmental entities. It will also discuss why there is a shortage in these rural areas and how the shortage is affecting rural communities and will address some strategies for solving this crisis. This research on the availability of dental care in rural communities will provide a framework for community leaders, elected officials, and health care providers to collect and analyze data to support future decision making in response to community health care needs. Such decisions increase the quality and efficiency of health care services, thereby safeguarding the health status of the population. This study found that the capability for hospital-based dental care services is greater in urban communities, whereas rural communities have significantly less capability for hospital dental care. This would support the premise that the availability of dental services is inconsistent across the United States and that dental care resources could be allocated to provide a consistent level of services across the population. It also emphasizes the importance of building innovative partnerships among local, state, and national organizations to ensure that an appropriate level of dental care is available in rural America. The study has managerial implications on meeting the demand for dental care in rural communities and policy implications on future resource allocation.     

Dental mutilation: rural workers' concepts of responsibility for tooth loss]

Brazilian oral hygiene institutions have promoted tooth extraction as a dental health practice. This article investigates the issue of dental loss within a rural drought area in the State of Bahia. Based on verbal information provided by local inhabitants, the author investigates dental extraction as perceived by the community, i.e., as a commonplace fact. The main goal is to analyze both representations of the oral cavity based on individual experiences and their associations with oral care practices, derived from the social reality in which they are immersed. The author considers the issues of both individual responsibility and that of government agencies and dentists.     

Dental practice location: some aspects of the importance of selection of place

In the past, dentists' decisions regarding location have been characterized as "irrational." With increasing competition, more thought and planning must accompany the dental practice location and development decision. The history of the community and site selection process by dentists is reviewed, and a call for is made for the application of atmospherics to dental site development.     

Factors associated with increased dental care utilization in five urban, low-income areas.

Survey data were used to measure change in dental utilization in five urban low-income areas as a result of increased financial (Medicaid) and facility (community health centers) access to dental care. The average annual dental visit between the baseline and follow-up surveys showed a dramatic increase in four of the five survey areas. With the exception of Roxbury, Massachusetts, where the rate was already high in the earlier survey, the dental visit rate in the remaining areas increased 33 to 80 per cent compared to an increase of only 7 per cent nationally between 1969 and 1975. Both CHC and Medicaid programs made important contributions to increased dental care. Among persons who saw a dentist in the year in these areas, 25 per cent reported CHC as their usual source of dental care and 46 per cent reported that their dental care costs in the year were borne by Medicaid. In spite of recent increases, however, the average annual dental visit rate was only 1.0 in the five areas compared to 1.6 nationally, which is 60 per cent higher. The generally low dental utilization levels among persons covered by Medicaid or served by CHCs may indicate that much of the increased dental utilization which occurred in these areas was limited to taking care of existing dental problems while neglecting preventive dental care.     

Dental practice location: Some aspects of the importance of selection of place

In the past, dentists’ decisions regarding location have been characterized as “irrational.” With increasing competition, more thought and planning must accompany the dental practice location and development decision. The history of the community and site selection process by dentists is reviewed, and a call for is made for the application of atmospherics to dental site development.     

Orale Gesundheitsförderung in Westafrika

Academic dental education and dental services all over the country are hardly provided in less-developed countries. The main diseases in dentistry, caries and periodontitis, can cause severe health conditions after long periods of easy access to treatment. By then the level of social safety and economic survival of extended families can be seriously endangered. By training mid-level medical staff to become community oral health workers, acting as support personnel for basic dental care, acute oral health conditions can be treated early in time or be avoided, if preventive measures are already introduced in (pre) school days. This early sensitization to oral health can be transferred to the family setting and reach a broad population leading to further health promotion. Since 1995 eight oral health wards have been established with community oral health workers in rural areas of the Republic of The Gambia. The concept proved to be effective and can be recommended to other underprivileged areas.     

Some challenges facing dental health education

This paper examines the impact of the decline in dental cariesrates in the developed countries and its implications on dentalhealth education research. The design and implementation ofhealth education programmes in developing nations are investigated.Health education is then discussed in terms of the dental profession,the developments in professional advertising, advances in clinicaldentistry, mass media and the limited success of water fluoridationprojects. It is argued in the conclusions that dentists, otherhealth professionals and behavioural scientists must collaborateon research so as to give dental health education greater academiccredibility and thereby aid its contribution to community dentalhealth.     

The rural dental health program: the effect of a school-based, dental health education program on children's utilization of dental services.

Eighteen-hundred rural children ages five through thirteen were randomly assigned for dental treatment to a school-based practice, and to private practitioners in the community. Simultaneously, five of the nine public schools attended by the children offered an enriched program of dental education while the remaining schools taught the regular health education courses. All children participated in a school based fluoride program and their dental treatment was provided without charge. Data indicating how the children utilized dental services were collected over the three-year treatment phase of the study. Evidence from the third treatment year indicates that children assigned to the school based practice who also attended a school offering enriched dental health education used dental services on a more regular basis than children in the other three groups. Evidence obtained from log-linear modeling supports the hypothesis that dental health education had a positive effect on children's utilization of dental service.     

Dental health care as a focus for health promotion in community pharmacy practice

Eight community pharmacy practices in Northern Ireland participatedin a short dental health promotion investigation. The studywas divided into two parts, a control phase followed by a promotionalphase, each of two weeks duration. During both stages pharmacistskept a record of sales of dental care products and also thenumber and types of requests for dental advice. The promotionalphase differed only from the control period by virtue of a visualdisplay mounted in the pharmacy highlighting the key dentalhealth messages, coupled with the provision of free literature.Over this period the number of health related enquiries increasedfrom 5 to 36. Although the sales of fluoride supplements alsoincreased dramatically during the promotion, the overall valueof dental sales relative to all counter takings in each perioddid not change. In realizing the potential for community pharmaciststo exercise a health promotional role the pharmaceutical profession,in cooperation with the other caring professions and supportedby government, needs to act more incisively in order to providean effective, economic and accessible means whereby membersof the public can, in an informed way, take responsible actionto improve and maintain their own health.     

Universal and targeted policy to achieve health equity: a critical analysis of the example of community water fluoridation cessation in Calgary,Canada in 2011

In May of 2011, a decision was made by city council in Calgary, Canada, to cease community water fluoridation and to re-allocate the annual operating costs to targeted dental programming. The purpose of this study was to critically analyze this decision as an example of a shift from a universal approach (fluoridation) to a targeted approach (dental programming delivered to children in low-income communities). We were especially interested in how the concept of equity played out in the deliberations, and we used Hilary Graham’s three conceptualizations of equity as a framework. We examined publicly available municipal council documents pertaining to this policy decision, with a prominent focus on the 26 January 2011 meeting of the Standing Policy Committee on Utilities and Environment at which Calgarians (citizens and professionals) were invited to speak. We extracted and critiqued statements or exchanges pertaining to equity or related concepts (e.g. poverty). We observed different perspectives on the concept of equity, and the notion of community water fluoridation as equitable. In particular, there was a tendency, expressed strongly by some participants in the debate, to conflate equity and poverty (Graham’s ‘disadvantages’ conceptualization of equity), such that a targeted approach was seen as the only viable way of addressing the dental health needs of children living in poverty. This research is timely considering the apparently increasing frequency of cessation of fluoridation in Canada, the consequent search for alternative approaches to preventive dental health, and the apparently strong appeal of a targeted approach.     

Oral health attitudes and practices among a German Mexican Mennonite farmworker community

The oral health needs of migrant farm laborers are greater and more immediate than those of comparable populations. However, little is known about the conditions of oral health care among German-speaking Mexican Mennonites, a distinctive cultural subgroup of migrant farm laborers. The purpose of this study was to examine the oral health practices, perceived oral health status, and barriers to obtaining dental care among a community of Low German-speaking Mexican Mennonites residing in Southwest Kansas. Interviews were conducted with a sample of 25 individuals, with questions addressing access/barriers to care, oral health practices, and perceived oral health status. The most frequently identified barriers to dental care were limited finances, lack of adequate health/dental insurance, and limited awareness of available dental services. Although the majority of participants reported experiencing no problems related to language or scheduling dental appointments, the results also indicated low utilization levels of oral care services. Findings suggest that: (1) this population is at-risk for periodontal disease, (2) culturally appropriate programs are needed for preventive oral care education, (3) community and statewide support may help improve access to affordable oral health care.     

DEVELOPMENT OF ORAL HEALTH TRAINING FOR RURAL AND REMOTE ABORIGINAL HEALTH WORKERS

ABSTRACT: Research data exists that highlight the discrepancy between the medical/dental status experienced by Aboriginal people compared with that of their non-Aboriginal counterparts. This, coupled with a health system that Aboriginal people often find alienating and difficult to access, further exacerbates the many health problems they face. Poor oral health and hygiene is an issue often overlooked that can significantly impact on a person's quality of life. In areas where Aboriginal people find access to health services difficult, the implementation of culturally acceptable forms of primary health care confers significant benefits. The Aboriginal community has seen that the employment and training of Aboriginal health workers (AHW), particularly in rural and remote regions, is significantly beneficial in improving general health. In the present study, an oral health training program was developed and trialed. This training program was tailored to the needs of rural and remote AHWs. The primary objective was to institute a culturally appropriate basic preventative oral health delivery program at a community level. It is envisaged that through this dental training program, AHWs will be encouraged to implement long-term preventive measures at a local level to improve community dental health. They will also be encouraged to pursue other oral health-care delivery programs. Additionally, it is considered that this project will serve to strengthen a trust-based relationship between Aboriginal people and the health-care profession.     

Provider expectations and consumer perceptions of the importance and value of dental care.

Seventy-eight inner city mothers of third and fourth grade children in three racial groups--white, black, and American Indian--known to need dental treatment for disease on permanent teeth, were interviewed at home by a trained community resident interviewer. Sixty-two per cent of the mothers were on public assistance. Information relating to the mothers' perceptions of the importance and value of dental care both for herself and for her children were collected. Utilization data were obtained via two dental examinations conducted one year apart. Data were also collected from a sample of provider dentists via mail questionnaire. A yield of 315 usable questionnaires was obtained, a return rate of 53 per cent. Provider-dentists felt that low socioeconomic consumers do not value dental services, as compared to other types of consumer goods and services, and that they do not believe dental care is important. Low income mothers in the same city reported that they did value dental care and believed it important. Expectations of and orientations toward the importance of dental care were found discongruent between the two groups of respondents. These discongruities on the dentist-patient relationship are discussed as a barrier to utilization. Although financial resources were available to many of the study families, only 49 per cent of these children received the needed care. It is suggested that the psychological cost to a patient of seeking care in inhospitable settings may act as a barrier to utilization.     

Principles for planning the teaching of dental public health in an MPH course

Dental public health should be presented to MPH students as an integral component in the general promotion of health. Students should be presented with the "dental" component in public health and the "public health" component in dentistry. Dental examples should be utilized to illustrate most of the other disciplines taught in the MPH course. The underlying principals that determine the teaching of dental public health within an MPH course include: the associations between oral and general health; oral health as an integral component in quality of life; basic concepts in the understanding of oral health and disease; the prevalence of oral diseases; oral diseases as a specific characteristic of industrialized-urbanized-developed societies; the methods of measuring dental health in epidemiological surveys; the patterns of changing dental epidemiology around the world; the social component of dental disease; the promotion of oral health as an important, typical, example of successful public health efforts; socio-economic-political aspects of oral health promotion; dental health care delivery systems in different regions; members of the expanded oral health team and the potential of including the general health team; oral health promotion for the geriatric population; specific examples of planning, implementation, monitoring and evaluation of community oral health programs.     

On-center vs off-center dental care for Job Corps members: cost and utilization.

While Job Corps Centers vary in size, location, and administrative structure, they are subject to uniform requirements for health services, established by federal regulation and must make individual decisions about whether to furnish dental care on-site or by some alternative arrangement in the community. Analysis of cost and utilization data indicated that expenditures for on-site dental care are greater than for off-center care. However, on-center care results in more dental visits and a lower cost/visit. These observations hold even for the smallest size centers.