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.     

Reliability and validity of the Dental Indifference Scale in a population of 18-year-olds in Norway

OBJECTIVES: The aims of this study were to estimate the reliability and validity of the Dental Indifference Scale (DIS) (Nuttall, 1996) in a population of 18-yr-olds in Norway. METHODS: The DIS-scale was mailed to a sample of 1119 18-yr-olds in two Norwegian counties. Nearly 87% completed the questionnaire and consented to the collection of data from their dental records. Ten percent of the sample, drawn at random, was asked to complete the questionnaire a second time, after a time delay of 15 weeks (response rate 83%). The reliability estimation of the sum-scores of DIS was based on Pearson's correlation between test-retest scores and internal consistency (Cronbach's alpha). The frequency of missed appointments from age 12, recorded in the dental treatment records, was used as the validating criterion. The validity was analyzed by Pearson's correlation, and step-wise multiple regression. RESULTS: The correlation coefficient (Pearson) for the test-retest comparison was 0.43. The correlation coefficient between the DIS-scores and the frequencies of missed dental appointments was 0.24. The Cronbach's Alpha coefficient for the eight DIS-questions was 0.35 (n=868). Only two of the eight DIS-questions entered the stepwise regression model and explained 15% of the variance of the frequency of missed appointments. CONCLUSIONS: The Dental Indifference Scale (DIS) was found to have a low reliability and validity in this study population, and it is recommended that it should not be used without further investigation. It may be necessary to design an alternative instrument if further work into the hypothesized trait of dental indifference is to be undertaken.     

Reliability and validity of the Dental Satisfaction Questionnaire in a population of 23-year-olds in Norway

OBJECTIVE: The aim of this study was to explore the internal structure, reliability, and construct validity of the Dental Satisfaction Questionnaire (DSQ) in a population of young adults in Norway. METHODS: The DSQ scale was mailed to a representative sample of 968 subjects aged 23 years in two Norwegian counties. The reliability assessment of the instrument was based on internal consistency analysis (Cronbach's alpha). A factor analysis (principal component) was used to confirm the internal structure of the scale. The construct validity of the DSQ was indicated by: (i) its correlation with the patients' beliefs regarding the way dentists deliver care, indexed by the Dental Beliefs Survey (DBS); and (ii) differences in DSQ scores between subjects who had dropped out from dental care at the age of 23 years and regular attenders. RESULTS: The response rate was 69%. The alpha (Cronbach's) coefficient for the overall construct of DSQ was 0.81 (n = 655), and 0.65 or more for the subscales pain management, quality, and access. The correlation coefficient between the sum-scores of DSQ and DBS for the entire sample was r = -0.69. Subjects in the dropout group had significantly lower satisfaction with dental care than the rest of the group (P < 0.001). CONCLUSIONS: This study generally confirms the structure of the DSQ instrument and indicates that it is a reliable and valid instrument in cultures other than the one for which it was previously tested.     

Treatment time of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden

The aim of the present study was to account for treatment time and number of visits required for treatment of traumatic dental injuries in a cohort of 16-year-olds, born in 1975, and residing in the county of Västerbotten, Sweden, and to analyze the correlation between total treatment time and background factors. The study material comprised 1012 dental records from the Public Dental Health Service containing information on dental injuries to primary and/or permanent incisors or canines. The mean total treatment time per individual was 1.3 h, with a range of 0.1 to 27.5 h. For injuries to the primary dentition, the mean number of visits per individual was 2.2. One visit was sufficient in 21% of the trauma episodes. In the permanent dentition, each trauma episode required a mean of 3.4 visits, and 90% of the patients had to return for follow-up visits. The correlation between explanatory variables and total treatment time was described and analyzed by linear multiple regression analyses. Degree of severity and number of injured teeth were two parameters of major significance to treatment time. Treatment by a specialist had an impact on time in the permanent but not in the primary dentition. In the permanent dentition, the treatment time increased if the dental injury occurred before the age of 11 years. Treatment time was not dependent on where the clinic was located or on gender of the injured child. Different diagnoses could explain 33% of the variation in treatment time in the permanent dentition.     

北京市城乡居民口腔医疗服务利用与费用分析

目的 对北京市城乡居民口腔医疗服务利用和费用进行定量研究，为口腔医疗保障制度的制定提供依据。方法 采用分层、整群、随机抽样方法抽取城区人口1517人，农村人口1878人，利用人户调查方式进行口腔医疗服务利用和费用的调查。结果 城乡居民口腔疾病就诊率均处于较低水平，但次均费用较高。农村居民就诊率为城区居民的1／3，次均费用约为城区居民的1／2。农村居民口腔费用支出占年收入的2．07％，城区居民为1．77％。不同人口、社会经济学背景的人群费用支出差异有显著性。结论 北京市居民的口腔医疗费用水平较高，在收入中占相当比重，并且农村居民的费用负担要重于城区居民。本研究中所调查的费用水平可为北京市口腔医疗保险覆盖提供一定参考依据。     

Epidemiological assessment of predictors of caries increment in 7-10-year-olds: a 2-year cohort study

Objective

The aim of this 2-year cohort study (2003 to 2005) was to investigate how caries experience, at initial lesions (early or non-cavited lesions) and cavited stages, predicts caries increment in permanent teeth in 7-10- year-olds.

Material and Methods

The random sample of 765 children attending public schools in the city of Piracicaba, SP, Brazil, was divided into two groups: 423 children aged 7-8 years and 342 children aged 9-10 years. All subjects were examined by a calibrated examiner, using dental mirror and ball-ended probes, after tooth brushing and air-drying in an outdoor setting, based on the World Health Organization criteria. Active caries with intact surfaces were also recorded as initial lesion (IL). Univariate analysis was used for statistical analysis (Odds Ratios and Chisquare).

Results

The association between the DMFT (decayed, missing and filled teeth) increment and the presence of IL was significant only for 9-10-year-old children. The children with DMFT>0 at baseline were more prone to have DMFT increment, with the highest risk for caries increment occurring in children aged 7-8 years.

Conclusion

The predictors of caries increment were the presence (at baseline) of caries experience in permanent teeth for both age groups (7-8; 9-10-year-olds) and the presence of the IL (at baseline) for 9-10-year-olds.     

Outcome of orthodontic care in 19-year-olds attending the Public Dental Service in Sweden: residual need and demand for treatment

The study analyses residual need and demand for orthodontic treatment in 19-year-olds attending the Swedish Public Dental Service (PDS). The general practitioners (GPs) had selected individuals for orthodontic specialist consultation and some were treated by GPs or specialists or not considered to be in need for treatment. Altogether 164 individuals were called for clinical investigation at the age of 19 years and also given a questionnaire asking for residual orthodontic treatment demand and satisfaction with information and orthodontic care. Ninety-one per cent of the individuals who had had an orthodontic consultation and 53 per cent of those who had not seen an orthodontist took part in the investigation. The study revealed that half of the 19-year-olds at the PDS clinic had received orthodontic consultations and one third had received orthodontic appliance treatment. Seven percent of the investigated individuals had a residual subjective demand for treatment. Several individuals with removable appliance treatment had overjet and deep bite and laterally forced cross-bite, but with little remaining subjective demand for treatment. Individuals with fixed appliance treatment showed few malocclusions. Nineteen-year-olds in general were uncertain about their present need for orthodontic treatment. The following conclusions were drawn: the total amount of orthodontic treatment in different areas in Sweden is comparable but the distribution between GP and specialist treatment differs. Interceptive treatment to reduce overjets seemed not successful. Fixed appliances seemed to reduce the majority of the malocclusion traits. The information given in connection with orthodontic consultation or treatment was clearly inadequate.     

Association between level of education and oral health status in 35-, 50-, 65- and 75-year-olds

AIM: The aim of the present study was to evaluate the association between educational level and dental disease, treatment needs and oral hygiene habits. MATERIAL AND METHODS: Randomized samples of 35-, 50-, 65- and 75-year-olds, classified according to the educational level: [low (LE): elementary school or higher (HE)], were identified. In 1091 subjects, a number of characteristics such as (i) number of teeth, (ii) periodontal attachment levels (PAL), (iii) caries and (iv) occlusal function were recorded. Educational level, oral hygiene and dietary habits were self-reported. Non-parametric variables were analyzed by chi2, Mann-Whitney U-Wilcoxon's rank sum tests, and parametric variables by Student's t-test (level of significance 95%). A two-way anova was performed on decayed, missing and filled surfaces to investigate the interaction between age and educational level. All statistical procedures were performed in the SPSS statistical package. RESULTS: The number of remaining teeth was similar for LE and HE in the 35-year olds (25.8 versus 26.6), but in the older age groups LE had significantly a larger number of missing teeth. The LE groups (except in 65-year olds) exhibited significantly more PAL loss. LE had significantly fewer healthy gingival units in all but the 75-year age group. In all age groups, LE had fewer intact tooth surfaces and a significantly poorer occlusal function. The frequency of tooth cleaning measures and dietary habits did not differ between LE and HE. CONCLUSION: Educational level was shown to influence the oral conditions and should be considered in assessing risk, and in planning appropriate preventive measures.     

北京市城乡居民口腔卫生服务利用与费用模型的研究

目的 建立北京市城乡居民口腔卫生服务利用预测模型，进行精确性研究，为开展口腔医疗保险提供依据。方法 采用分层、整群、随机抽样方法，抽取城乡居民共3395人进行调查，利用Logistic回归拟合就诊概率模型；利用对数线性回归拟合利用者的就诊频率和费用模型。利用平均预测偏差、预测残差均方和相对预测偏差进行模型预测效果评价。结果 城乡居民口腔卫生服务利用三部模型拟合较好，就诊概率模型的调整决定系数较高．城乡分别为0．621和0．642，而就诊频率和费用的调整决定系数较低。就诊概率模型预测精确度分别为城区83．7％，农村89．6％。就诊频率和费用相对预测偏差为8．85％～14．10％。结论 分解模型法是建立口腔卫生服务利用预测模型的较好方法，预测准确性较高，通过对数转换可改善资料的偏态性。预测模型可用来进行影响因素分析和保险基金与保险因子的测算。     

Changes in masticatory mandibular movements in growing individuals: a six-year follow-up

The pattern of mandibular movement during chewing is influenced by several central and peripheral factors. The aim of the present study was to determine whether changes in masticatory function, characterized by mandibular velocity and displacement, occurred during individuals' normal growth. Forty-seven children, 9-15 years of age, were followed over a 6-year period. All had an Angle Class I occlusion with no obvious orthodontic problems. Oral motor function with respect to mandibular displacement, duration, and velocity was monitored 3-dimensionally with an opto-electronic method. The chewing cycle was divided into an opening, closing, and occlusal phase. Total body height was measured. During the follow-up period, all masticatory variables except the 3-dimensional opening distance showed significant changes. The total chewing cycle duration, the opening and occlusal time of the chewing cycle, and the 3-dimensional closing distance increased during the growth period, while the closing time of the chewing cycle, the 2-dimensional lateral and vertical distances and both the opening and closing velocity decreased. The children who grew proportionally most in height during the 6-year period, i.e. the youngest children in the group studied, showed a significantly larger decrease in the opening velocity. From this study it becomes evident that the variables of the chewing cycle undergo a continuous process of change during growth. This is possibly a reflection of anatomical changes, maturation of the central nervous system, and altered functional demands.     

Dental health professionals' treatment of children with disabilities: a qualitative study

As children and adolescents with disabilities may be difficult to treat, there is a risk that the disability may constitute a barrier preventing these children from receiving good odontological treatment in the same conditions as other children. Objectives: To describe Swedish dental care professionals' understanding and knowledge of orofacial problems and treatment needs in children with disabilities. Methods: In‐depth interviews focusing on orofacial function, and carried out with 18 informants (dentists, dental hygienists, dental assistants), were transcribed verbatim and analysed in open and focused (selective) coding processes in accordance with grounded theory. Results: A core category labelled variability in treatment with the dimensions professional uncertainty and professional commitment emerged from the data in the analysis. Variability in treatment could be described as forming a continuum between two end‐points captured in the dimensions. The dental teams' treatment of children with disabilities and their families could be placed anywhere along this continuum depending on contributing individual strategies and/or organizational conditions. Conclusions: The dental treatment for children with disabilities varied greatly, implying a risk for inequalities in treatment as well as in oral health. There is a need for more educational opportunities, better financing, and more support on the organizational level in order to improve odontological care for young special care patients.     

Dental malpractice lawsuit cases in Saudi Arabia: A national study

IntroductionOver the past twenty years, dental practice in Saudi Arabia has developed considerably, along with increase in population’s knowledge of their rights. However, there is a lack of evidence and research on dental malpractice lawsuit cases in Saudi Arabia. The aim of this study was to assess the prevalence and content of legal suits regarding dental malpractice in Saudi Arabia, and to explore the factors and circumstances that were associated with these cases.MethodsThis was a retrospective study on dental malpractice litigation cases between January 2017 and December 2020. Only cases with final court verdicts were included. The cases were collected from 13 Medico-Legal Committee (MLC) across Saudi Arabia while practitioners’ data were retrieved from the General Directorate of Healthcare Licensing at Ministry of Health (MOH). A designed data sheet was used, which was categorized into three main sections: plaintiff demographic data, defendant demographic, data case details in the court.ResultsDuring the four years period, 864 cases with verdicts were studied. Most of the cases were against general dental practitioners, and majority of complaints involved prosthodontic procedures followed by endodontics. The majority of the malpractice lawsuit cases (93 %) were against non-Saudi dental practitioners and 72 % were against experienced practitioners with more than ten years of experience. Almost all cases were in the private sector. Only 10 % of cases had a consent form previously provided to the patients before treatment, and most of cases lacked proper medical documentation. The mean average trial period was 3.3 months and 76 % of defendants were found guilty.ConclusionThe number of cases is rising since 2017. Good documentation, compliance to informed consent protocols and dental privileges helped practitioners to avoid being found guilty.     

钛75牙种植体犬颌骨种植的实验研究

目的 进一步研究钛75（铝钼锆钛合金）牙种植体的生物相容性。方法 在4条成年种犬下颌骨的缺牙区,植入全埋入式和半埋入式钛75(AlMoZrTi)牙种植体,6个月、12个月后,进行X线检查、松动度测定、含种植体的颌骨不脱钙切片光镜观察。结果 牙种植体存留率：全埋入式100％（4／4）,半埋入式91．7％（11／12）。所有存留种植体均稳固、无松动,牙周测试仪（Periotest)测定值略低于健康的自然邻牙测定值,但两者相差不显著。除1枚发生种植体周围炎外,所有半埋 种植体均牙龈健康,龈袋深＜2mm。两类种植体与颌骨间均发生骨性结合。结论 钛75是良好的种植材料,Periotest牙周测试仪对于种植体植入后骨性界面观察可能有重要作用。     

Dental arch dimensions in the mixed dentition: a study of Brazilian children from 9 to 12 years of age

Objective

This study evaluated dental arch dimensional changes of Brazilian children.

Material and methods

Dental casts were taken from 66 children (29 males; 37 females) with normal occlusion selected among 1,687 students from public and private schools aged 9, 10, 11 and 12 years, according to the following criteria: Class I canine and molar relationships; well-aligned upper and lower dental arches; mixed dentition; good facial symmetry; no previous orthodontic treatment. Dental arch dimensions were taken by one examiner using the Korkhaus’ compass and a digital pachymeter. ANOVA test was applied to compare the arch dimensions at the different ages and the t-test was used to compare the arch dimensions of male and female subjects. Arch forms were compared by means of chi-square tests.

Results

Only the maxillary anterior segment length showed a statistically significant increase from 10 to 12 years of age. Males had a significantly larger maxillary depth than females at the age range evaluated. The predominant dental arch form found was elliptical.

Conclusion

In the studied age range, anterior maxillary length increased from 10 to 12 years of age, males had larger maxillary depth than females and the predominant arch form was elliptical.     

Adverse Childhood Experiences and utilization of dental care: A cross sectional study of children in the United States

ObjectivesTo examine the relationship between Adverse Childhood Experiences (ACEs) and utilization and delay of dental care among children.MethodsUsing data from the 2018–2019 National Survey of Children's Health (n = 53,963) we examined the association between ACEs and 1) dental health; 2) use of dental care; 3) use of preventive dental care; 4) delaying needed dental care. Logistic regressions were used to calculate odds of each outcome, with nine ACEs and the cumulative number of ACEs as the independent variables each in separate models.ResultsAfter accounting for confounders, most ACEs were associated with higher odds of having poorer dental health. Similarly, most ACEs were associated with lower odds of using dental care and higher odds of delaying needed dental care.ConclusionsThis study expands the research showing a deleterious impact of ACEs on utilization of health care by showing that dental care is also adversely impacted. Efforts must be undertaken to improve access to dental care for children with a history of ACEs.     

Dental Age Assessment: a comparison of 4- to 24-year-olds in the United Kingdom and an Australian population

Background.  The physiological age of a person is determined by the degree of maturation of the different tissue systems. Children of the same chronological age (CA) can demonstrate different degrees of maturation. Dental age (DA) is based on the maturation of teeth. Tooth formation is a continuous process, where the developmental stages of the tooth can be sequenced and defined depending on the degree of mineralization. These stages can be visualized on a dental panoramic tomograph (DPT).
Aim.  The aim of this study was to use a new method of Dental Age Assessment (DAA) to compare a United Kingdom (UK) and an Australian (AUS) population.
Design.  The DPTs used are from the archives of the Westmead Centre for Oral Health (Westmead, Australia) and the King's College London Dental Institute. From the preliminary sample of 89 DPTs from each population, 77 were suitable for use as matched pairs. The radiographic technique used was developed by Demirjian and describes eight stages of tooth development. This was used in combination with numerical data derived from a meta-analysis of a single UK subject.
Results.  A significant difference was shown between the CA and DA of the AUS patients. The AUS patients were also shown to have a significant 0.82 years delay in their DA compared to the UK patients. The findings indicate a difference in AUS compared to UK patients. These results indicate the need to develop a reference data set for the AUS population for DAA.
Conclusions.  This research is of significance in a number of clinical disciplines and can also be used to assist in age determination of subjects of unknown birth date to assist in forensic dentistry or social deliberations.     

Dental caries related to quality of life in two Brazilian adolescent groups: a cross-sectional randomised study

Objectives: To analyse dental caries‐related quality of life (QoL) in adolescent (15–19‐year‐old) subjects in a suburban area (SA) and a downtown area (DA) of Bauru, São Paulo, Brazil, in 2009. Methods: This was a cross‐sectional, randomised study. The sample consisted of 185 and 147 adolescents from the SA and DA, respectively. The caries index used was that for decayed, missing and filled teeth (DMFT) (World Health Organization criteria). The 14‐item Oral Health Impact Profile (OHIP‐14) was used to assess QoL. The non‐parametric Mann–Whitney test, Spearman’s correlation coefficient and chi‐squared test were used in the statistical analysis. Results: The DMFT index, Significant Caries (SiC) Index and percentage of caries‐free students were similar (P > 0.05) between these populations, but findings on the Care Index differed (P < 0.05). There was a correlation between the DMFT index and OHIP‐14 score in SA subjects (mean DMFT index = 3.01) in the dimensions of physical pain (r = 0.25; P < 0.01) and psychological disability (r = 0.17; P = 0.02). The DMFT index in DA subjects (mean DMFT index = 2.95) showed a correlation with functional limitation (r = 0.19; P = 0.02). The correlation in SA subjects between the caries component (mean = 1.22) of the DMFT index and OHIP‐14 was significant only for the physical pain dimension (r = 0.16; P = 0.03). In DA subjects, correlations between the caries component (mean = 0.37) and all dimensions of OHIP‐14 were statistically significant (P < 0.05). Conclusions: Despite the similarities in means in the DMFT index, the SiC Index and the caries‐free percentage of subjects in both localities, access to dental treatment proved to be less effective for SA adolescents. Physical pain and psychological disability were the most frequent negative manifestations of impact on QoL. The SA adolescents were more negatively affected by dental caries in terms of QoL.