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 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.     

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.     

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。     

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.     

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.     

Attitudes to and experience of dental care among 50-year-olds in two Swedish counties.

The aim of this study was to investigate attitudes to and experiences of dental care in a population, born 1942. The following items were studied: opinions of general and oral health, attitudes to and experiences of dental care, dental care habits, experiences of latest visit to a dentist, tobacco habits and use of various dental hygiene articles. A cross-sectional mail questionnaire was sent in 1992 to all 50-year-olds in two Swedish counties, Orebro and Ostergotland, totally 8888 persons; the response rate was 71%. Of the population 89%, indicated good health. Satisfaction with dental care was high, 94%. 26% stated attendance to a dentist twice or more per year, and 64% at least once a year. As to expenses, 78% paid less than 1000 SEK the last year. Concerning the latest visit, 38% reported painless treatment, 37% no inconvenience, and 55% good care. The duration of the latest visit included on an average 27 min in travel time, 7 min in waiting time and 27 min in treatment time. Information about oral hygiene was given to 29% and about cost for treatment to 47% of the interviewed. There were 28% daily smokers. Snuff was daily used by 10% of the males. Toothbrushing twice a day with fluoride toothpaste seemed to be the standard oral hygiene procedure and was reported by 80% of the respondents.     

Stability of Dental Anxiety Scale scores: a longitudinal study of older adults

Abstract With the exception of studies of children, how dental anxiety changes with aging has not been the topic of research. Studies of non-patient populations have been cross-sectional in design and no truly longitudinal data have been reported. In this study, 272 adults aged 50 yr and over completed the Dental Anxiety Scale at baseline and at a 3-yr follow-up. The main finding was that DAS scores showed a high degree of stability in this group of subjects. At baseline the mean DAS score was 7.6 and at follow-up it was 7.4. The proportion classified as having high levels of anxiety declined marginally from 7.0% to 5.4%. While 9.0% of subjects showed changes in DAS scores of 4 or more, it is not certain that this represents real change or a degree of unreliability in the measure. The only subject characteristic associated with change in scores was gender. The mean scores for men decreased while the mean scores for women increased. Overall, the magnitude of these changes was very small. However, for a minority of subjects more substantial changes were observed which may be clinically significant.     

北京市各级医院口腔器械消毒方式调查

目的 通过2次问卷调查评价北京市各级医院常用口腔器械消毒方法的情况,并针对存在问题给予规范.方法 2002、2005年对北京市各级医院常用口腔器械消毒方式进行问卷调查,将填写内容进行统计学处分析.结果 2005年北京市各级医院口腔诊疗器械存在多种消毒方式,其中采用压力蒸汽灭菌的比例提高,采用消毒剂浸泡、擦拭及其他方法处理口腔器械的比例下降.结论 2005年各级医院口腔器械消毒方式较2002年更为符合要求,但一、二级医院有待进一步提高.     

无锡市中学生龋病的发生、未治率和牙科畏惧症的调查分析

目的　初步掌握龋病的发生、未治率和牙科畏惧症三者间的关系。方法　采用整群抽样的方法从无锡市 5 5所中学中抽出 7所 ,每校各年级中再抽出一个班的学生进行调查 ,内容包括龋病的检查 ,牙科就诊和畏惧情况的询问。结果　 1998名学生 (男 10 4 8,女 95 0 )中 ,龋病发病率为 30 90 % ,男性 (31 5 8% )稍高于女性 (30 2 0 % ) ,但差异无显著性 (P >0 0 5 ) ;一年牙科未就诊率 6 2 2 1% ,女性 (6 4 11% )稍高于男性 (6 0 5 0 % ) ,但差异无显著性 (P >0 0 5 ) ;牙科畏惧症发生率为 2 9 0 3% ,女性(38 4 2 % )高于男性 (2 0 5 1% ) ,差异有显著性 (P <0 0 1)。结论　牙科畏惧症对龋病的早期就诊率可能有一定影响     

Precautions reported to be used against cross-infection and attitudes to the dental treatment of HIV-positive patients in routine clinical dental practice in Scotland

The purpose of this study was to ascertain the precautions against cross-infection currently employed in routine practice by Scottish dentists, to relate these to current recommendations and to determine Scottish dentists' views on how dental treatment should be provided for patients known to be HIV positive. The subjects were 926 general dental practitioners and 201 clinical community dental officers among respondents to a questionnaire sent to a list of 1726 dental practitioners in Scotland. The results suggest that while some dentists are prepared to take an element of personal risk (in spite of recent improvements 18 per cent are still unvaccinated against hepatitis B, 66 per cent do not wear surgical gloves during routine treatment and 21 per cent claim not to wear gloves during procedures involving ‘bloodletting’), the vast majority (95 per cent) are nevertheless taking steps to protect their patients from cross-infection by using autoclave and dry heat sterilization. One-quarter of general dental practitioners and one-half of clinical community dental officers felt that HIV-positive patients should generally be treated in the branch of the dental service in which they worked, although greater proportions (52 per cent and 69 per cent respectively) said they were prepared to treat a regular patient who became HIV positive.     

Ti—75合金作为复合种植体基底材料的实验研究

目的：观察复合种植体（CI）基底材料Ti-75合金（TA）的生物学特性和TA－涂层结合强度在种植体骨界面结合强度中的表现。方法：应用穿皮质骨种植模型。在双侧犬股骨内种植TA和CI共32枚;在术后3个月和6个月,处死动物取材;种植体骨界面进行组织学观察和推出试验,并对断裂后的种植术骨界面进行扫描电镜观察。结果：TA与CI均与骨组织形成了骨柱结合;CI骨界同的剪切强度高度于TA（P＜0．01）;CI骨界面断裂在部分在涂层骨组织界面和涂层内部,很少在涂层TA界面。结论：TA与CI均具有良好的生物相容性;TA涂层界面具有足够的结合强度,是值得进一步研究的复合种植体基底材料。     

Traumatic dental injuries in a cohort of 16-year-olds in northern Sweden

Abstract The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age were studied in a cohort of 16 year-olds, born in 1975, and residing in the County of Västerbotten, northern Sweden. The study comprised 3007 dental records from the public denial health service. The general distribution was 50.3% girls and 49.7% boys. The records showed that 35% of the children on one or more occasions had sustained injury to their primary or permanent dentition. The frequency was nearly twice as high for boys (64%) as for girls (36%). Twenty-five percent of the 16-year-olds had met with tooth injury more than once and this group consisted predominantly of boys. The incidence of injury episodes to primary and permanent teeth was 28 per 1000 per year. The boys had sustained trauma to their teeth most frequently when they were 4 years of age and between the ages of 8 and 11. This was also true for girls at 4 and at 9 years of age, although less evidently so. In the primary dentition, the majority of dental injuries had affected the supporting tissue of the maxillary incisors. In the permanent dentition, 75% of the traumatised teeth were upper incisors. Fractures of varying severity constituted 60% of all registered diagnoses in this dentition, followed by subluxation (19%) and concussion (11%).     

Dental case management: increasing access to oral health care for families and children with low incomes

BACKGROUND: Medicaid beneficiaries have lower rates of dental visits and higher rates of dental disease compared with the rest of the population. Beneficiaries ascribe their low use of services to difficulties finding dentists who treat patients with Medicaid. Dentists cite low reimbursement rates, excessive paperwork, and patients' not keeping appointments and poor oral health literacy as reasons for not accepting patients with Medicaid. The authors pilot-tested the effectiveness of a dental case management program (DCMP) in increasing dentists' participation in Medicaid and Medicaid beneficiaries' use of services. METHODS: A dental case manager recruits dentists to participate in the Medicaid program, arranges training in billing procedures, resolves billing and payment problems, educates clients about the use of dental services and keeping appointments, links clients to dental offices, identifies potential barriers to care and helps clients obtain transportation to appointments. The authors evaluated the levels of participation of dentists in the DCMP in Medicaid and Medicaid beneficiaries' use of services. RESULTS: Dentists accepting new Medicaid patients increased from two to 28, with 145 dental visits a month provided to Medicaid beneficiaries. The percentage of Medicaid beneficiaries receiving dental services increased from 9 to 41 percent after the DCMP was implemented. CONCLUSIONS: The authors found that the DCMP was effective in increasing Medicaid beneficiaries' use of services, increasing dentists' participation in Medicaid, minimizing administrative burdens related to Medicaid participation, and increasing oral health literacy and treatment compliance among clients with low incomes.