Use of dental services by the middle-aged and the elderly in Hong Kong

Abstract The objectives of this analysis were to describe the dental service use pattern of the 35–44- and 65–74-yr-old age groups and to determine to what extent this pattern could be explained by selected sociodemographic and attitudinal variables. The study populations comprised 398 35–44-yr-old and 559 65–74-yr-old Hong Kong Chinese. Use of dental services was determined on the basis of the respondents' own perception of the regularity of their dental visits and by the time since the last denial visit. The younger groups was categorized into regular users, irregular users, and nonusers, and the older group was categorized into three groups according to last dental visit (within 2 yr, 2–5-yr, 5 yr or more). A modification of the Andersen and Newman model for individual determinants of health care use was used as the framework for a logistic regression analysis. Predisposing variables were sex, education, occupation, altitudes, knowledge, preventive orientation, and dental anxiety; enabling variables were Family Possession Index, income, family support and access to a dental programme; need variables were perceived conditions of teeth, denial problems, denial pain, need for treatment, normative need for treatment, and denture wearing. In general, use of denial services was low. For the 35–44-yr-olds, the best regression model (sensitivity: 62%, specificity: 95%, overall correct classification: 88%) indicated that there was an increased probability of having a regular dental care pattern if respondents were prevention oriented, had access to a dental benefit programme, had not experienced pain, had a higher income, perceived their teeth as fair or poor, and perceived a need of treatment. For the 65–74-yr-olds, three variables remained in the final model (sensitivity: 51%, specificity: 68%, overall correct classification: 61%). Respondents who had not seen a dentist within the last 2 yr were more likely to have had pain and to know less about dental caries. As the number of teeth in need of treatment increased by 1, respondents were 1.09 times more likely not to have seen a dentist within 2 yr.     

Dental health knowledge and attitudes among the middle-aged and the elderly in Hong Kong

Abstract Previous studies on adult Hong Kong Chinese have indicated that their level of knowledge of and attitudes toward dental health might be a potential barrier to effective oral preventive efforts. The knowledge and attitudes of elderly Chinese have not previously been studied. The objectives of this study were to describe Hong Kong adults' knowledge of the causes of the two main oral diseases, caries and periodontal disease, and possible preventive measures, and to analyse possible relationships between knowledge and attitudes and selected sociodemographic and utilization variables. Two populations aged 35–44 yr (n= 398) and 65–74 yr (n= 559) were selected for the study, which was conducted as structured interviews. A knowledge score was constructed from questions on caries and periodontal disease development and prevention. Attitudes were measured in the younger group by beliefs and evaluations of those beliefs according to the theory of reasoned action (the higher the score, the more positive the attitude). Knowledge scores were almost normally distributed in the younger respondents, but were heavily skewed toward 0 in the older group. In both age groups, increased level of education and regularity or recency of dental visits were strongly associated with dental knowledge. Women, regular dental care users, and prevention-oriented respondents had higher attitude scores. There was no correlation between knowledge and attitudes. Some improvement in knowledge seems to have taken place, especially on the cause of caries, with fewer 35–44-yr-old respondents claiming lack of knowledge of the causes of caries and gum disease than in a previous study. In the older group, around half of the respondents were unaware of the causes of dental caries and gum disease.     

Oral health care needs among the middle-aged and the elderly in Hong Kong

Abstract A sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35–44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.     

Chinese health beliefs and oral health practices among the middle-aged and the elderly in Hong Kong

Abstract The purpose of this paper was to study possible relationships between traditional Chinese health beliefs and health practices in adult Chinese in a modernized society. The study populations comprised 398 35–44-yr-old and 559 65–74-yr-old Hong Kong Chinese. The respondents were categorized into three groups with weak, moderate, or strong Chinese beliefs on the basis of interview questions on the causes of gum disease. Chinese preventive practices and Chinese pain practices were defined according to respondents' reported use of recommended traditional cures. Questions on generally accepted oral practices were phrased in terms of frequency of daily brushing of teeth, use of toothpicks the previous day, and whether or not teeth were flossed the previous day. Around one-third of the respondents had weak, almost one-half had moderate, and around one-quarter expressed strong Chinese health beliefs. No significant differences in Chinese health beliefs were found between men and women in either age group, or between the age groups. In the 35–44 age group, more of those with a higher education were in the “weak” Chinese health belief category, whereas, conversely, more of those with a lower education expressed stronger Chinese health beliefs (P<0.05). Women in both age groups reported significantly more frequent brushing. Toothpicks were used by around three-quarters of both age groups, but flossing was extremely rare. Chinese preventive practices were reported significantly more frequently by those in the older group who held strong Chinese health beliefs than those with moderate or weak beliefs, whereas the trend in the younger group was not significant. Chinese pain practices were reported very infrequently. Chinese health beliefs did not correlate with use variables. In the older group, Chinese health beliefs correlated strongly with preventive practices and with knowledge.     

Attitudes toward National Health Insurance: dentists, dental students, and dental hygiene students

The attitudes toward National Health Insurance held by 126 second year dental students and 108 second year dental hygiene students enrolled in the state of Wisconsin, U.S.A., were measured and compared with the attitudes held by practicing dentists in the U.S.A. Although some similarities were noted, marked differences were revealed, with students, generally, preferring broader coverage and more government involvement than practicing dentists. There is virtually no published data in this area, and more research is needed, as the success or failure of any National Health Insurance plan depends critically on the altitudes of both health care providers and those studying to become health care providers.     

Periodontal conditions among the middle-aged and the elderly in Hong Kong

Abstract The aim of this study was to describe the periodontal conditions in 372 35–44-yr-old and 537 noninstitutionalized 65–74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (≥6, ≥9, and ≥12 mm, respectively). The mean numbers of teeth with loss of attachment at the ≥6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths ≥6-mm, while al the ≥9-mm threshold only 2–3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds ≥4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65–74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as “healthy” (CPI code 0) or had “bleeding only” (code 1) as their highest score. While most subjects scored CPI code 2 or 3 us their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4. Differences in the mean number of sextants affected by CPI codes between the two cohorts were mainly due to a greater number of excluded sextants in the older cohort. CPI findings for 35–44-yr-olds differed little from those reported in 1984.     

Tooth spaces in and prosthetic treatment received by the middle-aged and the elderly in Hong Kong

Abstract The purpose of this study was to describe the state of the dentition of middle-aged and elderly Chinese in Hong Kong in terms of teeth present, tooth spaces, and prosthetic treatment received. In an oral health survey conducted in 1991 in Hong Kong, a sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds was interviewed and clinically examined. In all dentate subjects, each tooth was scored for the presence/absence of that tooth, a tooth space of 5.5 mm which had not been treated, or the presence of a denture or pontic replacing that tooth. Each denture was assessed according to a set of criteria. None of the 35–44-yr-olds were edentulous and the mean number of teeth present was 27.5. About 40% of the third molars and about 35% of the mandibular first molars were missing. For only 1% of the missing teeth had space closure resulted in missing teeth not being recorded as tooth spaces or treated tooth spaces. Overall, 72% of the 35–44-yr-olds had no prosthesis. 17% had a bridge or bridges, 12% had a denture or dentures, and 1% had both. Of the 65–74-yr-olds, 12% were edentulous, and the dentate subjects had a mean number of 17 teeth present. About 70% of the molars were missing. Overall, only 29% of the elderly had no prosthesis, 52% had a denture or dentures, 33% had a bridge or bridges, and 13% had both. Only 35% and 28%, respectively, of the middle-aged and elderly denture wearers had no complaint about their dentures. There were more assessed problems in the dentures of the elderly than in those of the younger adults, over one-third of the partial dentures and half of the mandibular complete dentures being unstable and unretentive.     

The distribution of dentists and the uptake of dental treatment by schoolchildren in England

The uptake of treatment by 508 14-year-old children in different social classes in two towns in England with different dentist:population ratios was investigated. In the town with the unfavorable dentist:population ratio (Town U) the uptake of treatment was considerably higher in the higher social classes. In the town with the favorable dentist:population ratio (Town F) the uptake was similar throughout the social scale. The results suggest that the availability of dentists rather than sociologic attitudes to dental health is largely responsible for the differential uptake of treatment by children in the different social classes.     

Tooth and root conditions in the middle-aged and the elderly in Hong Kong

Abstract In an oral health survey of Hong Kong Chinese conducted in 1991, a sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were interviewed and clinically examined. The examination procedures, instruments, and diagnostic criteria used to detect coronal caries followed those recommended by the World Health Organization (1987). The diagnostic criteria used to assess root-surface caries were based on those used in a national oral health survey of US employed adults (National Institute of Denial Research. 1987). Calibration of examiners was conducted before the survey and the interexaminer reliability was found to be very high; the kappa statistics were 0.93 and 0.91 for the younger and older age groups, respectively. None of the 35–44-yr-olds were edentulous and 96% had 21 teeth or more. The prevalence of edentulousness among the elderly was 12%. The DMFT indices of the younger and older age groups were 8.7 and 18.9, respectively. In both age groups, MT was the major component of the DMFT index, and female subjects had a slightly higher score. The prevalences of decayed/filled roots were 7% and 26%i for the 35–44- and 65–74-yr-olds, respectively. As compared with previous surveys conducted in Hong Kong, there has been a 40% reduction in the DMFT index of the 35–44-yr-olds since 1968, but little change in the tooth and root conditions was noted between 1984 and 1991.     

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

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

Determinants for dental visit behavior among Hong Kong Chinese in a longitudinal study

OBJECTIVES: The aim of this research was to study the major determinants for dental services utilization among middle-aged Hong Kong Chinese in a longitudinal study using an expanded Andersen and Newman model as the theoretical framework. METHODS: A random sample of 372 middle-aged Hong Kong Chinese were interviewed and clinically examined in an oral health survey. The findings were explained to the subjects and they were advised to seek care from their own dentist as appropriate. RESULTS: A total of 322 subjects were interviewed over the telephone after 12 months. About half had visited a dentist within the study period. Results of the bivariate analysis showed that proportionally more subjects who had dental benefit coverage, had prevention-oriented attitudes, were regular users of dental services, had received counseling from a dentist, or had more filled teeth at the baseline examination had visited a dentist within the study period. Logistic regression analysis produced a final model consisting of seven factors and three interaction terms that was able to classify 68 percent of the subjects into the correct user category. CONCLUSION: The expanded Andersen and Newman model was useful as a theoretical framework in studying the dental services utilization behaviors of the Hong Kong adults.     

Knowledge of Brazilian general dentists and endodontists about the emergency management of dento-alveolar trauma

Abstract –  The purpose of this study was to determine Brazilian dentists' knowledge of emergency management of dento-alveolar trauma. A two-part questionnaire containing questions on demographic data and knowledge were mailed to 230 general dental practitioners (GDPs) and 70 endodontists. Questionnaires were returned by 42.6% of the GDPs and 62.8% of the endodontists. The survey data were statistically analyzed using Mann–Whitney U -test for practitioners' knowledge and Pearson's correlation coefficient for association between knowledge scores and practitioner age or years since graduation. The mean knowledge score of endodontists was significantly greater than for GDPs ( P  < 0.0001). Dentists with trauma experience in their practices and those who had attended postgraduate courses on dental trauma had a significant higher mean knowledge score. In contrast, there was a poor correlation between the knowledge score and the ages of the respondents ( r  = 0.086) or the years since graduation ( r  = 0.108). In conclusion, this survey showed a poor knowledge of dental trauma management among the surveyed dentists and highlights the need to develop strategies to improve the knowledge base in this area of dentistry for the benefit of the dental trauma patient.     

Attitudes among dentists and dental hygienists towards extended scope and independent practice of dental hygienists

Aims: Attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice are described in several studies, but the results are heterogenous. The purpose of this systematic review was to compare the attitudes of dentists and dental hygienists towards extended scope and independent dental hygiene practice. Methods: PubMed, AMED and CINAHL were screened by two independent assessors to identify relevant studies. Only quantitative studies that reported the percentages of dentists'' and dental hygienists'' attitude towards extended scope and independent dental hygiene practice were included. The random-effects model was used to synthesise possible heterogenous influences. Results: Meta proportions with regard to a positive attitude towards extended scope of practice are 0.54 for dentists and 0.81 for dental hygienists. Meta proportions of a positive attitude towards independent practice are 0.14 for dentists and 0.59 for dental hygienists. A meta analysis with regard to negative attitudes could only be performed on extended scope of practice and did not reveal a difference between the two professions. We obtained homogeneous outcomes of the studies included regarding negative attitudes of dentists . A minority of dentists hold negative attitudes towards extended scope of dental hygiene practice. Study outcomes regarding negative attitudes of dental hygienists were heterogeneous. Conclusions: Positive attitudes are present among a majority of dentists and dental hygienists with regard to extended scope of dental hygiene practice, while for independent dental hygiene practice this holds for a minority of dentists and a majority of dental hygienists.Key words: Dental practice, general dental practice, hygienist, oral health policy, primary oral health care     

Attitudes of Italian dental and dental hygiene students toward tobacco-use cessation

Objective:  The aim of this study was to investigate the smoking habits of Italian dental and dental hygiene students and to assess their knowledge on the health effects of cigarette smoking and their attitudes toward tobacco-use cessation (TUC) in dental practice.
Materials and methods:  Data was collected from 220 students attending the Dental and Dental Hygiene Schools (DS and DHS, respectively) at the University of Palermo (Italy).
Results:  The percentage of smokers amongst DS and DHS students was similar (32.78% vs. 32.5%) with 67.77% of DS students and 77.5% of DHS agreeing that the damages to health caused by smoking were covered in their didactic course work. A high percentage of DS (63.33%) and DHS (67.5%) students reported the relationship between smoking and a number of associated health conditions. Both DS and DHS students showed poor knowledge of TUC interventions. Both DS and DHS students reported to be conscious of their own role as a counsellor, with DHS students feeling more comfortable in approaching counselling in clinical practice. Although DS and DHS students reported a positive attitude toward TUC interventions, almost half of the students had some concerns about the effectiveness of smoking cessation activities.
Discussion:  The introduction of a comprehensive tobacco education curriculum in DS and DHS programs could further improve students' perceptions and attitudes and provide knowledge and clinical experience which would lead to the incorporation of TUC into subsequent professional practice.     

Dental care of HIV-infected patients: attitudes and behavior among Danish dentists

The aims of the study were to study Danish dentists' attitudes and behavior with regard to providing dental care to HIV-infected persons and to look for explanatory variables for the dentists' attitudes and behavior. Two hundred and twenty-eight Danish dentists responded to a questionnaire on dental treatment of HIV-infected patients and related problems (response rate: 91.2%). The dentists' attitudes differed a great deal from the current national policy as to where HIV-infected patients should be treated and with regard to the possibility of being tested for HIV anonymously. 64% of the dentists favored the idea of referral of HIV-infected patients to special dental clinics for routine dental treatment, and 93% disapproved of the idea that infected individuals themselves should decide whether they wish to inform their dentist or doctor of seropositivity. Older dentists were more reluctant to treat HIV-infected individuals than younger. Other differences with regard to a number of demographic variables were not found. No difference in attitude towards HIV-infected persons was found when compared to that towards HBV-infected individuals. The reluctance towards treatment of HIV-infected persons was present irrespective of any subsidy for an extra cost for treatment of HIV-infected patients.     

Knowledge of general practitioners dentists about the emergency management of dental avulsion in Curitiba, Brazil

Abstract –  The prognosis of traumatized teeth in general and of avulsed teeth in particular depends on prompt and appropriate treatment. Management of traumatic injuries may be a challenge to the non-specialized dentist, as they may occur when dentists are least prepared for it. The objective of this research was to investigate the knowledge of general practitioner dentists about the emergency management of dental avulsion in Curitiba, PR, Brazil. A group of 250 professionals were interviewed. The questions were related to knowledge of how to treat traumatic avulsion of teeth. The results suggest that the level of knowledge on the management of dental avulsion of the general practitioners dentists in Curitiba is adequate.     

The utilization of dental care services according to health insurance coverage in Catalonia (Spain)

Abstract –  The aim of this study was to assess the relationship of dental care service use with health insurance and its evolution. The Catalan Health Interview Survey is a cross-sectional study conducted in 1994 ( n  = 15 000) and 2001–2 ( n  = 8400) by interviews at home to a representative sample of Catalonia (Spain). All the estimates were obtained by applying weights to restore the representativeness of the Catalonia general population. In the bivariate analysis, age, gender, social class and health insurance coverage were statistically associated with a dental visit in the previous year ( P  < 0.001). Analysis with logistic regression showed that health insurance status has a statistically significant association with utilization ( P  < 0.001), which was independent of the other socio-economic factors (age, gender, country of birth, and social class). However, the falling trend of differences by health insurance coverage is of note (adjusted OR = 2.2 and 1.5 at 1994 and 2002, respectively); as well as the positive evolution of the overall rate of dental service care use in the previous year, from 26.7% in 1994 to 34.3% in 2002. Future studies will be needed to monitor this tendency.     

Income, dental insurance coverage, and financial barriers to dental care among Canadian adults

Objectives: To explore the issue of affordability in dental care by assessing associations between income, dental insurance, and financial barriers to dental care in Canadian adults. Methods: Data were collection from a national sample of adults 18 years and over using a telephone interview survey based on random digit dialing. Questions were asked about household income and dental insurance coverage along with three questions concerning cost barriers to accessing dental care. These were: “In the past three years . . . has the cost of dental care been a financial burden to you? . . . have you delayed or avoided going to a dentist because of the cost? . . . have you been unable to have all of the treatment recommended by your dentist because of the cost?” Results: The survey was completed by 2,027 people, over half of which (56.0%) were covered by private dental insurance and 4.9 percent by public dental programs. The remainder, 39.1 percent, paid for dental care out‐of‐pocket. Only 19.3 percent of the lowest income group had private coverage compared with 80.5 percent of the highest income group (P < 0.001). Half (48.2%) responded positively to at least one of the three questions concerning cost barriers, and 14.8 percent responded positively to all three. Low income subjects (P < 0.001) and those without dental insurance (P < 0.001) were most likely to report financial barriers to care. While private dental insurance reduced financial barriers to dental care, it did not entirely eliminate it, particularly for those with low incomes. Those reporting such barriers visited the dentist less frequently and had poorer oral health outcomes after controlling for the effects of income and insurance coverage. Conclusions: Canadian adults report financial barriers to dental care, especially those of low income. These barriers appear to have negative effects with respect to dental visiting and oral health outcomes. For policy, appropriateness will be key, as clarity needs to be established in terms of what constitutes actual need, and thus which dental services can then be considered a public health response to affordability.