Utilization of dental health services among middle-aged people in Sweden and Denmark

In 1999, questionnaires were sent to random samples of 1001 Swedish citizens aged 55-79 years and 1175 Danish citizens aged 45-69 years. Various questions were asked concerning dental conditions, dental visit frequency per year, and money spent annually on dental care, etc. The objectives were to assess differences in the utilization of dental services and to compare out-of-pocket costs for dental care in Sweden and Denmark with control for age, gender, dental conditions and income. More than 80% of the subjects reported that a dentist had examined them less than 1 year previously. However, 77% of the Danes reported dental visits twice a year or more compared to 28% of the Swedes. Although the Danes reported a more frequent use of dental services, they had poorer dental conditions compared to the Swedes. Even though the Swedes used dental services less often than the Danes did, more subjects reported high 12-month out-of-pocket costs. In the present study, separate models were constructed for the two countries because there could be different mechanisms at play, as indicated by the results. The different insurance systems along with different degrees of commercialization in the two countries might be the most decisive factors in this context.     

Dental care utilization: a study of 50- to 75-year-olds in Southern Sweden

This study investigates dental care utilization in an adult population in Southern Sweden in relation to dental and social conditions, attitudes to costs, and perceived need to obtain dental services. The study was based on responses to a questionnaire sent in 1998 to a random sample, 1974 persons, aged 50-75 years. The response rate was 66%. A significantly higher probability of dental care utilization less than once a year was found for men, for those with few remaining teeth, and for those with removable dentures. A higher probability of dental care utilization less than once a year was found for those who stated perceived need to obtain dental care with no possibility because of the cost and for those who stated that the cost had influenced their attendance for dental care. The results showed that there were differences for sex and dental conditions in dental care utilization and that dental care utilization was related to attitudes towards costs of dental care.     

Social background and dental care habits and attitudes of Finnish immigrants in Sweden

Foreign citizens today constitute 5% of the Swedish population. While several epidemiological investigations have dealt with dental care habits in the Swedish population, very little is known about the dental care habits of immigrants. This constitutes a factor of uncertainty in the planning of dental care. A random sample of 170 Finnish immigrants, 20-80 years old, in the community of Huddinge was selected. They were summoned to the Faculty Clinics for interview and clinical and radiographic examination. 143 persons appeared for examination. The interview showed that 46.6% of the subjects had never visited a dentist in Sweden though 80% of them intended to remain in Sweden. 19.8% still made more or less regular use of dental services in Finland. The low frequency of utilization of dental services is mainly due to the difficulty in obtaining dental care, lack of knowledge of Swedish, lack of interest and fear of pain. According to the present study Finns in Sweden utilize dental services to a smaller extent than Swedes. The decision of principle adopted by the Swedish parliament in 1968 that immigrants shall be able to live under the same conditions as the Swedes seems not to be fully achieved with regard to the dental care of Finnish immigrants.     

Dental care utilization: a study of 50- to 75-year-olds in southern Sweden

This study investigates dental care utilization in an adult population in Southern Sweden in relation to dental and social conditions, attitudes to costs, and perceived need to obtain dental services. The study was based on responses to a questionnaire sent in 1998 to a random sample, 1974 persons, aged 56-75 years. The response rate was 66%. A significantly higher probability of dental care utilization less than once a year was found for men, for those with few remaining teeth, and for those with removable dentures. A higher probability of dental care utilization less than once a year was found for those who stated perceived need to obtain dental care with no possibility because of the cost and for those who stated that the cost had influenced their attendance for dental care. The results showed that there were differences for sex and dental conditions in dental care utilization and that dental care utilization was related to attitudes towards costs of dental care.     

Changing dentate status of adults, use of dental health services, and achievement of national dental health goals in Denmark by the year 2000

OBJECTIVES: This study analyzes the current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, assesses the impact on dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and highlights the changes over time in dental health conditions among adults. Finally, the intention of the study was to evaluate the Danish dental health care system's level of achievement of the official goals for the year 2000 as formulated by the World Health Organization and the National Board of Health. The subjects of this study included a national representative sample of 16,690 Danish citizens aged 16 years and older (response rate=74.2%). A subsample (n=3,818) took part in a survey of dental care habits in childhood and prevalence of removable dentures; 66 percent of persons selected responded. METHODS: Personal interviews were used to collect information on dentate status, use of dental health services and living conditions; data on dental care habits in childhood and prevalence of removable dentures were collected by self-administered questionnaires. RESULTS: In all, 8 percent of interviewed persons were edentulous, while 80 percent had 20 or more natural teeth. At age 65-74 years, 27 percent were edentulous and 40 percent had 20 teeth or more; 58 percent wore removable dentures. Dentate status and prevalence of dentures were highly related to educational background and income, particularly for older age groups. Among persons interviewed, 80 percent paid regular dental visits and visits were most frequent among persons of high education and income. At age 35-44 years 95 percent had participated in regular dental care in childhood compared to 49 percent of 65-74-year-olds. Multivariate analyses revealed that sociobehavioral factors had significant effects on dentate status. CONCLUSIONS: Compared to similar studies carried out in 1987 and 1994, the present survey indicates a positive trend of improved dentate status in adult Danes in general and regular use of dental health services increased considerably over time. The WHO goals for better dental health by the year 2000 were achieved for 35-44-year-olds, whereas the goal of more people with functional dentitions at age 65 years or older was not achieved. It remains a challenge to the Danish dental health system to help even out the social inequalities in dental health.     

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 attendance of some of the common immigrant groups in Sweden

The aim of this study was to see how Greek, Polish, Turkish, Yugoslavian and Finnish immigrants utilized dental services offered, as compared to Swedes. The study covered the years 1976-79, using figures from the National Social Insurance Board (NSIB). All foreign citizens of the aforementioned groups born on the 20th of any month and living in the country of Stockholm were selected, together with a comparison group of Swedish citizens. During the 4 yr in question, only 31% of the Greeks, 50% of the Poles, 28% of the Turks, 40% of the Yugoslavs and 75% of the Finns visited a dentist in Sweden, while 87% of the Swedes did. Few immigrants except some Finns went annually. A great majority of all Greeks, Turks and Yugoslavs either saw a dentist only once or else not at all during the whole period. Emergency treatment was significantly more common for these groups than for Poles, Finns or Swedes. The study revealed a fragmentary and episodic use of the dental services offered to most common immigrant groups in Sweden.     

Dental visiting patterns of Finns and Swedes in Sweden, 1976-1980

Information on treatment provided to a random (cluster) sample of all adult patients treated under the dental insurance scheme in Sweden since 1974 is stored at the National Social Insurance Board (NSIB). In this study the use of dental services by settled Finnish immigrants and Swedes over a 5-year period (1976-80) was compared, using this information. The material consisted of 1152 17- to 64-year-old Finnish immigrants, selected in accordance with the same criteria as the NSIB sample, registered on the population register of Stockholm county in 1975 and still on the register in 1982, and a comparison group of individually matched Swedes. Standard NSIB computer programs and a special program for recurrent use of dental services in 1976-79 were used. Because of regulations on confidentiality of personal information, comparisons were based on inter-group differences. Each year about 40% of Finnish immigrants and 50% of Swedes had been to a dentist. In both groups women visited a dentist more frequently. The proportion of persons in the different groups who had used dental services in the period 1976-80 varied only slightly from year to year. In the 4-year period 1976-79, 74% of Finnish immigrants and 87% of Swedes in the studied groups had been to a dentist at least once. Significantly more Swedes than Finnish immigrants had seen a dentist annually. Of those who had been to a dentist, a significantly greater proportion of Finnish immigrants than Swedes had received acute treatment and dentures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Determinants of oral health care utilization among diverse groups of immigrants in New York City

BackgroundFew studies have examined utilization of oral health care services among immigrants. The authors examined the determinants of utilization of oral health care among a diverse group of immigrants in New York City.MethodsThe authors examined and interviewed 1,417 foreign-born people, aged 18 to 65 years, who were residents of New York City. They conducted examinations by using criteria established by the National Institute of Dental and Craniofacial Research, Bethesda, Md. The authors used unconditional logistic regression to estimate odds ratios (ORs) and 95 percent confidence intervals for having visited a dentist within the previous year for each of the independent variables.ResultsMore than 70 percent of the participants lacked dental insurance and only about 31 percent reported that they had visited a dentist within the previous year. Flossing (OR = 1.18), dental insurance (OR = 1.58), having a regular source of dental care (OR = 4.76) and more filled teeth (1.33) were independent predictors of utilization of services.ConclusionsHaving a regular source of dental care and having dental insurance are important predictors of immigrants' utilization of oral health care services in New York City.Clinical ImplicationsThe study results suggest the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of vulnerable populations.     

Elderly dental care. Needs and costs in three different resident settings

Although the real dental treatment needs of the elderly has been established, the costs for these needs has not been determined. This report compares dental services and costs required for older adults living in three different resident settings. Dental needs and costs have been evaluated from a sample of 305 aged persons living in nursing homes (N = 156), low-cost housing facilities (N = 79) or dependent on home care services (N = 70). This study indicates that the homebound or institutionalized elderly population presents with poor dental and periodontal conditions, a high rate of edentulousness, and inadequate dentures. Dental needs are essentially characterized by the repair or replacement of prosthesis, the screening and treatment of mucosal lesions of prosthetic origin, and scaling/curettage of remaining teeth. The average rehabilitative dental costs was Can. $720 and there was no difference between the three types of residence. Important differences in cost, however, were observed between the dentate and edentulous population. The F-test (P less than .05) and chi-square were used to analyze differences in dental treatment needs and costs between different residences. Maintenance care corresponds to Can. $80/year/person.     

Assessing Patterns of Restorative and Preventive Care Among Children Enrolled in Medicaid,by Type of Dental Care Provider

BackgroundThe authors investigate the relationship of preventive dental treatment to subsequent receipt of comprehensive treatment among Medicaid-enrolled children.MethodsThe authors analyzed Medicaid dental claims data for 50,485 children residing in Wayne County, Mich. The study sample included children aged 5 through 12 years in 2002 who had been enrolled in Medicaid for at least one month and had had at least one dental visit each year from 2002 through 2005. The authors assessed dental care utilization and treatment patterns cross-sectionally for each year and longitudinally.ResultsAmong the Medicaid-enrolled children in 2002, 42 percent had had one or more dental visits during the year. At least 20 percent of the children with a dental visit in 2002 were treated by providers who billed Medicaid exclusively for diagnostic and preventive (DP) services. Children treated by DP care providers were less likely to receive restorative and/or surgical services than were children who were treated by dentists who provided a comprehensive mix of dental services. The logistic model showed that children who visited a DP-care provider were about 2.5 times less likely to receive restorative or surgical treatments than were children who visited comprehensive-care providers. Older children and African-American children were less likely to receive restorative and surgical treatments from both types of providers.ConclusionsThe study results show that the type of provider is a significant determinant of whether children received comprehensive restorative and surgical services. The results suggest that current policies that support preventive care–only programs may achieve increased access to preventive care for Medicaid-enrolled children in Wayne County, but they do not provide access to adequate comprehensive dental care.     

Subjective need for implant treatment among middle-aged people in Sweden and Denmark

Background: The use of oral implants in prosthodontics has become widespread and regarded as a predictable treatment modality. However, there is a lack of knowledge among the general population about the prevalence and need for implant treatments. Purpose: This study was undertaken to register and compare the prevalence of dental implants and the subjective need for implant treatment among people in Sweden and Denmark. Materials and Methods: Random samples taken from the national population registers in Sweden and Denmark comprised 1001 Swedish subjects aged 55 to 79 years and 1175 Danish subjects aged 45 to 69 years. Subjects were requested to fill out questionnaires regarding dental conditions, subjective need for implant treatment, whether they had received treatment with dental implants during the previous 10 years, and so on. Results: Of the Swedes, 4.8% reported that they had dental implants, compared with 2.5% of the Danes. In the Swedish sample, age was significantly associated with subjective need for implant treatment. In the Danish sample, women showed a significantly higher subjective need for implant treatment than did men. Conclusions: Compared with the Swedish sample, the subjective need for treatment with dental implants was higher in the Danish sample, although the patient fees were substantially higher in Denmark.     

Utilization of dental services in the adult Danish population 1975

Lack of information on the dental behavior of adults in Denmark has become a major problem in the national planning of dental services. The purpose of this study was to establish the pattern of utilization of dental services among adult Danes (aged 15 and above). A three-stage cluster sampling design covering the total adult population of Denmark was used to draw a representative sample comprising 1,600 persons. Household interviews by trained interviewers were carried out. Of the adults interviewed, 58% reported yearly dental visits the last 5 years, 32% had not seen a dentist or only when in pain, and 10% went irregularly. Differences according to place of living, age, sex, occupation and school dental care were found. 63% of those who had seen a dentist reported bad teeth or were edentulous with or without dentures. 10% reported fear, 9% had good teeth and 5% reported economic difficulties. The most frequent treatments at the latest dental visit were cleaning and filling for the regular patients and extractions and dentures for the nonregular patients. A multiple classification analysis revealed that the number of teeth was the strongest predictor for dental services, with the following predictors in descending order: age, occupation, place of living, economy, sex and school dental care. These variables could explain 58% of the variation in utilization.     

National estimates of out-of-pocket dental costs for HIV-infected users of medical care

BACKGROUND: Out-of-pocket costs for U.S. dental care in 1996 were dollar 157 per person at the poverty level and dollar 229 for people with higher incomes. This article examines out-of-pocket expenditures for dental care in HIV-infected patients who took part in the HIV Cost and Services Utilization Study (HCSUS), conducted by a consortium of private and government institutions centered at the RAND Corp. METHODS: The HCSUS used a probability sampling design. The authors used a weighted sample of 2,466 HCSUS respondents to estimate the national population of HIV-infected users of medical care. The patients were asked to report how much they had spent on their dental care in the preceding 12 months, including payments made by them, their family or their friends--but not by insurance companies--for their dental care. RESULTS: In 1996, 135,000 HIV-infected subjects spent dollar 20.5 million on dental care, averaging dollar 152 per user. Whites spent dollar 220, African-Americans dollar 55 and Hispanics dollar 101. People receiving dental care from private dentists spent dollar 232 compared with dollar 7 spent by those who received care in AIDS clinics. CONCLUSIONS: More than one-half of the HIV-infected users of medical care identified private dentists as their source of dental care and spent the vast majority of the dollar 20.5 million. The remaining subjects identified public dental programs as their source of care and had low expenditures. The explanation for these low expenditures is the subsidization of public programs and the likelihood that fewer and less costly services are provided by such programs. PRACTICE IMPLICATIONS: Dentists should be aware of out-of-pocket funds spent by the HIV-infected population in private practices and public programs. Any policy change reducing public funding may result in higher out-of-pocket costs for disadvantaged groups or in increasing disparities in access to dental services.     

Access and utilization of dental services by Alabama Medicaid-enrolled children: a parent perspective

PURPOSE: The purposes of this survey were to assess barriers to utilization of dental services among Medicaid-enrolled Alabama children and identify families who used or did not use Medicaid-covered dental services. METHODS: A random sample of 4,500 parents of Medicaid-eligible children ages 3 to 19 years was surveyed. Participants came from Medicaid enrollment data stratified by area of residence into 3 groups: (1) large urban; (2) town; and (3) rural. Univariate and multivariate analyses were conducted. RESULTS: The overall response rate was 40% (N = 1,766). Most respondents (71%) reported that their child had a dental visit in the past year. Compared to parents who had a dental visit, those who reported no visits were more likely to: (1) be non-Hispanic African American; (2) be less educated; (3) live in rural settings of Alabama; (4) have more children younger than 6 or older than 12; (5) have more children with disabling conditions; and (6) report poor perceived oral health. Respondents with no dental visits were grouped into 3 categories-those who: (1) believed they did not need dental care (46%); (2) thought dental care was hard to find (34%); and (3) tried but could not get dental care (20%). The first group had significantly less respondents with a high school or greater education, more reporting perceived good to excellent oral health, and more living in rural areas, compared to the other 2 groups. CONCLUSIONS: Families who did not use Medicaid-covered dental services include: (1) a group with high perceived need and barriers to care; and (2) a group with little perceived need. Interventions must target both groups.     

Public dental service utilization among adults in South Australia

Background:  Longitudinal patterns of public dental service use may reflect access issues to public dental care services. Therefore, patterns of dental service use among South Australian adult public dental patients over a 3½-year period were examined.
Methods:  Public dental patients (n = 898) initially receiving a course of emergency dental care (EDC) or general dental care (GDC) at baseline were followed for up to 3½ years. Patient clinical records were accessed electronically to obtain information on dental visits and treatment received at those visits.
Results:  Some 70.7 per cent of EDC and 51.3 per cent of GDC patients returned for dental treatment post-baseline. EDC patients returned within a significantly shorter time period post-baseline, received significantly more courses of care and were visiting more frequently than GDC patients. A greater proportion of EDC patients received oral surgery, restorative, endodontic and prosthodontic services, but fewer received periodontic services. EDC patients received significantly more oral surgery and fewer preventive services per follow-up year, on average, than GDC patients. Large proportions of EDC (52.4 per cent) and GDC (63.8 per cent) patients who returned sought emergency care post-baseline.
Conclusions:  Patients appeared to be cycling through emergency dental care because of lack of access to general care services, highlighting access problems to public dental care.     

Use of dental services by immigrant Canadians

Although the health status and health behaviour of foreign-born residents of Canada have been well documented, little is known about their use of dental services. The authors, hypothesizing that foreign-born people would have lower utilization of dental care services than native-born Canadians, undertook this study to identify the factors associated with dental visits by Canadians aged 12 years and older and to compare the use of dental services by foreign-born and native-born populations. According to data derived from Statistics Canada"s 1996-97 National Population Health Survey, foreign-born people were somewhat more likely than native-born Canadians to have visited a dentist within the previous year. Higher levels of education, greater income adequacy, and the presence of dental insurance were associated with greater use of dental services, whereas increasing age was associated with lower use. Although immigrants reported greater use of dental services than native-born Canadians, a variety of barriers to care may be present in this population.     

Social, demographic, clinical and lifestyle determinants of dental care visits in an urban sample of Portuguese adults

PURPOSE: To describe the use of dental care services in an urban sample of adults from Porto, and to quantify the association between dentist visits and social, demographic, clinical and lifestyle factors. MATERIALS AND METHODS: Participants were selected by random digit dialling, and interviewed with a structured questionnaire to obtain information on socio-demographic, clinical and lifestyle variables. Crude, and age- and education-adjusted Odds Ratios (ORadj) were computed by unconditional logistic and multinomial logistic regression to quantify the association between the use of dental care and each exposure. RESULTS: In the year preceding the interview, 51.1% of the subjects visited a dentist at least once. Dental visits were less frequent in subjects aged > or =70 years compared to those aged 18-29 years (ORadj = 0.66, 95% Confidence Interval [CI]: 0.45-0.98), and increased with education (from 23.8% in subjects with 0-3 school years to 67.9% in those with > 12 years of education, p < 0.001 for trend). The use of dental care services at least once in the previous year was more frequent in white-collar workers (ORadj = 0.69, 95% CI: 0.52-0.91), when a private doctor was the usual source of medical care (ORadj = 1.38, 95% CI: 1.06-1.79) and in those who visited a medical doctor in the previous year (ORadj = 1.96, 95% CI: 1.57-2.45). Diabetics were less likely to seek dental care (ORadj = 0.67; 95% CI: 0.48-0.93). CONCLUSION: Nearly half the adults from Porto had not visited a dentist in the previous year. Education was the factor most strongly associated with dentist attendance. No differences were observed regarding the determinants of one or two or more dental visits in the previous year.     

Older Americans' access to oral health care

To determine whether older Americans have difficulty obtaining access to dental care, we studied 7,265 adults nationwide. The objectives of this analysis are to: (1) determine the proportion of older Americans receiving dental services, (2) identify the types of services received, and (3) examine barriers to access to dental care in this population. Almost half of the respondents over the age of 60 reported a dental visit in the past year. This is consistent with the national trend of increasing utilization of dental services by older adults in the United States. However, older respondents reported significantly fewer dental visits in the past year than respondents aged 25-59. The mean time since the respondent's last dental visit increased with increasing age. Minority elders and those older adults with lower incomes, lower educational achievement, poorer perceived health status, chronic diseases, transportation problems, and those living in rural areas had disproportionately fewer dental visits than more socially advantaged respondents. In multivariate analyses, less education, lower income, increasing age, and poorer self-perceived health status were identified as independent risk factors for not having a dental visit, suggesting that certain subpopulations of older Americans are at risk for not receiving necessary oral health services.     

Financing oral health services for people with special needs: projecting national expenditures

Low-income people with disabilities or who are elderly have more dental disease, more missing teeth, and more difficulty obtaining dental care than other members of the general population. These realities lead to untreated infection, increased medical costs and needless suffering for the most vulnerable members of our society. It is critical we provide adequate reimbursement for oral health services in order to avoid the tragic and costly consequences of oral neglect. This article focuses on the financial implications of delivering oral health services to low-income individuals who are "aged, blind, and disabled" in the United States. The experience of providing oral health services in California for these populations is extrapolated to predict the cost implications of a national reimbursement system for ABD adults under Medicaid and reform Medicaid oral health programs for vulnerable children. The new federal dollars required to implement this legislation would be more than offset by a conservatively estimated 0.5 percent reduction in costly emergency room and hospital charges for the treatment of serious dental problems, as well as a reduction in the prevalence and severity of several general health conditions. Treating and/or preventing oral infection and disease for the ABD populations in our country will significantly reduce overall health care costs, improve quality of life, and end needless suffering for America's most vulnerable citizens. Treating and/or preventing oral infection and disease for this population simply is the right thing to do.