Development of dental status and treatment behavior among Norwegian adults 1973–85

Utilization rates, types of dental services received and reports on number of teeth present were studied through seven sets of cross-sectional data collected in 1973, '77, '79, '81, '83 and '85. Personal interviews performed by trained interviewers were held with nationwide probability samples, each of 1500 persons covering the Norwegian population aged 15 and above. During the 12-yr period, the percentage of the samples reporting to have 20 or more teeth increased from 63 in 1973 to 74 in 1985, while the percentage of edentulous subjects dropped from 16 to 12. The time interval since the last dental visit decreased continuously: in 1973, 58% of the sample reported to have paid a dental visit during the last year, in 1983, 70%. Correspondingly, a higher proportion of the samples stated they were regular treatment attenders (52% in 1973 and 67% in 1985), while the proportion of "irregulars" dropped. Although the regularity of the visits probably was somewhat overreported, the favorable trend was substantiated by the information on services received: extractions, denture services and fillings diminished, while preventive and "other" services gained importance. Possible explanations and implications for dental practice and education are discussed.     

The use of dental services among Norwegian adults in 1973

ABSTRACT The dental treatment pattern and its determinants were surveyed in 1973 by interviews with a sample comprising 1,632 persons drawn to cover the total Norwegian population aged 15 and above. In all, 58 % of the interviewees stated having visited a dentist during the year prior to the interview. In contrast, 16 % had not consulted a dentist for at least 5 years. Fifty-five percent of the sample reported having received fillings at the last dental visit and 15 % reported having received some periodontal and/or preventive treatment. Regular (at least annual) treatment attendance, was claimed by 52 % of the sample. However, some respondents had seemingly embellished their treatment behavior, and a relatively valid estimate for the current proportion of regular treatment attenders was considered to be 40 % of the adult population in Norway. Sex and geographic region were found to be the most influential predictors of the recent treatment pattern, whereas school dental treatment had a major influence in youth. Dental conditions including the wearing of dentures was the reason most often given for not seeing a dentist on a regular basis.     

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.     

Dental attendance patterns in renal transplant recipients

OBJECTIVES: Renal transplant recipients (RTR) represent a large and growing population of individuals on potent immunosuppressant therapy who are at significantly greater risk of developing lip and oral mucosal disease, including lip cancer. The aims of this study were to determine the proportion of RTR receiving regular dental treatment, the dental services they used, and the relationship between the prevalence of lip and intraoral lesions and dental attendance.
DESIGN: The lip and oral mucosa of 159 RTR and 160 controls were examined. Subjects were asked questions about frequency of dental attendance and which service they used.
RESULTS: 57.9% RTR attended a dentist regularly compared with 51.3% controls. Among the RTR who attended a dentist regularly, 54.3% visited their general dental practitioner, and 45.6% attended a dental hospital for treatment. This was significantly different from controls where 92.7% of regular attenders used their general dental practitioner (P<0.001). Although the prevalence of oral lesions in RTR (54.7%) was more than twice as many as controls (19.4%). no significant difference was observed between RTR regular dental attenders and non-attenders.
CONCLUSIONS: This study indicates a clear need for oral health care and screening to be focused on RTR.     

The use of dental services in a population in Northern Norway.

The utilization of dental services was studied by means of records from dentist's files, a method which permits gathering of detailed information with high reliability and validity. 53% of the adult population of 358 persons living in a coastal community in Northern Norway had visited a dentist during a period of two years. In the group of 13% who were considered to be regular treatment attenders, number of teeth, sex and socio-economical status were the most influential predictors of utilization. Among the 182 persons with 10 or more remaining teeth, 59% had made preventive and restorative dental visits, and in this group there was a dominating proportion of women, young people and people with high income and/or social class. In contrast, only six persons out of 61 with one to nine remaining teeth had made such visits. People in social class 3 were overrepresented among the 26% of the population who visited a dentist because of extractions or complete denture services. The treatment profile according to age showed that younger people used most of their treatment time on consultations, preventive measures and conservative treatments, while fixed and removable prosthetics constituted a major part of the treatment time among elderly people.     

A register-based study of variations in services received among dental care attenders

Objectives. To investigate whether receipt of dental services, among attenders, reflects variations in dental health or whether and to what degree it is associated with socioeconomic status, with irregular or regular dental attendance and with the availability of dentists in residential areas. Materials and methods. This retrospective register-based study followed two Danish cohorts, aged 25 and 40, with a dental examination in 2009 (n = 32,351). The dental service data were registered during 2005–2009. The number of dental examinations, individual preventive services (IPS), tooth extractions, root fillings and composite fillings were analyzed in relation to socioeconomic status, irregular/regular dental attendance, inhabitant/dentist ratio and to DMFT at age 15 (DMFT15) and change in DMFT (ΔDMFT) from age 15 to age 25 and age 40, respectively. Poisson regression and negative binomial regression analyses were used. Results. The variations in number of services received in the study population were small (SD = 0.2–2.7). However, with a few exceptions, high levels of DMFT15 and ΔDMFT were associated with receipt of more dental services. Socioeconomically-privileged individuals received more dental examinations but fewer tooth extractions, root fillings and composite fillings compared to disadvantaged persons, when controlled for dental health levels. Irregular attenders received fewer IPS and composite fillings but had more extractions compared to regular attenders. Conclusions. Variations in dental care services were found to reflect variations in dental health, but the variations were also related to individual socioeconomic status, residential area and dental attendance patterns.     

A 3-year comparison of dental anxiety treatment outcomes: hypnosis,group therapy and individual desensitization vs. no specialist treatment

Outcomes of hypnotherapy (HT), group therapy (GT) and individual systematic desensitization (SD) on extreme dental anxiety in adults aged 19-65 yr were compared by regular attendance behaviors, changes in dental anxiety and changes in beliefs about dentists and treatment after 3 yr. Treatment groups were comparable with a static reference control group of 65 anxious patients (Dental Anxiety Scale > or = 15) who were followed for a mean of nearly 6 yr. After 3 yr, 54.5% of HT patients, 69.6% of GT patients and 65.5% of SD patients were maintaining regular dental care habits. This was better than the 46.1% of the reference group, who reported going regularly to the dentist again within the cohort follow-up period, and 38.9% of a control subgroup with observation for 3 yr. Women were better regular attenders than men at 3 yr. Specialist-treated regular attenders were significantly less anxious and had more positive beliefs than regular attenders from reference groups. There were few differences between HT, GT and SD after 3 yr. It was concluded that many patients can, on their own, successfully start and maintain regular dental treatment habits with dentists despite years of avoidance associated with phobic or extreme anxiety. However, it also appears that these patients had less success in reducing dental anxiety and improving beliefs about dentists long-term than did patients who were treated at the specialist clinic with psychological strategies.     

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.     

Mediators between education and dental pain: a cross‐sectional study to assess the role of dental services utilization

This study tested whether the pattern of dental services utilization and the reason for the last dental visit mediate the association between educational attainment and dental pain. This is a cross‐sectional analysis (n = 1099) based on data from a prospective cohort study in adults, southern Brazil. The mediating effects were assessed by including interaction terms in logistic regression models and by the KHB method, which estimated the direct, mediated, and total effects of education on dental pain. The prevalence of dental pain was 17.5%. Individuals with less than 12 yr of study who visited the dentist to solve dental problems had a 20% higher odds of reporting dental pain than those with 12 or more years of study, who sought the dentist for preventive reasons. Dental services should also focus on preventive measures, especially if less‐educated individuals visit the dentist only to treat problems; this may help reduce the frequency of negative oral health outcomes, including dental pain.     

Public knowledge of dental registration and management of common dental problems

The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.     

Association between dental fear and dental attendance among adults in Finland

OBJECTIVE: Our aim was to evaluate the association between dental attendance and dental fear while considering the simultaneous effects of perceived oral health and treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education. MATERIAL AND METHODS: The two-stage stratified cluster sample (n=8028) represented Finnish adults aged 30 years and older. The response rate to this nationwide sample was 88%. Dental fear was measured with the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analyses were used to determine the association between dental fear and dental attendance, including the following independent variables: perceived oral health, perceived treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education. RESULTS: Among all ages, except 30 to 34-year-olds, irregular attenders were more likely to be very afraid of visiting a dentist than regular attenders were. The association was stronger the older the age group. Only age modified the association between dental fear and attendance. Irregular dental attendance can be attributed to high dental fear (etiologic fraction among exposed) in 41% of cases. CONCLUSION: Reducing dental fear would increase the number of regular attenders, especially among older age groups. Individuals for whom oral health services have been provided regularly since childhood seem to continue to use these services regularly despite high dental fear.     

Factors influencing the local planning of dental services

Findings from a survey of 796 high school children in four districts constituting a health administrative area were examined to ascertain the factors influencing their dental disease experience, treatment received and attendance pattern. In three of the four districts, over 60% of the children were regular attenders, enjoying the benefit of less active caries than irregular attenders. However, in the remaining district, much of which consisted of depressed, inner city areas undergoing re-development, only one third were regular attenders. Several local factors, such as availability and accessibility of services, probably influenced the numbers seeking regular care, but one of the most important appeared to be the level of provision in the salaried Community Dental Service. The implications of the findings for planning improvements in local services are discussed.     

Effects of a national dental health campaign in Finland

In 1981 a national health campaign was launched to increase demand for dental services in Finland. The nationwide campaign was preceded by a separate campaign directed at getting the dentists to accept the responsibility for maintaining a regular treatment pattern for their patients. In the second part the public was informed of the means to keep their teeth throughout life via mass-media communication. The effects of this campaign was evaluated by the data from an interview study of 694 15- to 50-year-old Finns made in 1983 and by comparing these results with data from a nationwide study of 648 of the same age group carried out in 1980. In 1980, 54% of the interviewees had visited a dentist within the last 12 months. The corresponding percentage in 1983 was 65%. The commonest reason for the latest dental visit in both surveys was routine examination. The number of interviewees recalled by the dentist was 4% in 1980 and 8% in 1983. Oral hygiene was most frequently stated as the most important preventive dental measure. The interviewees had no doubts that teeth could be kept throughout life. Although the effect of the campaign can be considered positive, in terms of giving stimulus to visit the dentist, the insufficiency of the mass media communication in changing health behavior was also demonstrated.     

Utilization of dental care in a Finnish industrial population

Ninety-three percent of the 300 employees of a paper mill in central-eastern Finland answered a questionnaire in the context of a clinical dental survey. One third had visited the dentist annually, 22% once in 2 years and the rest irregularly. Dental visit frequency of females was somewhat higher than that of males. People in younger age groups and higher income groups used more dental services, whereas those who had dentures used clearly less dental services than others. Subjective assessment of treatment need was the main reason for dental visits, more than half of the subjects had attended the dentist the last time because of self-assessed need. Thirty-eight percent went to the dentist because of toothache and only 9% for regular check-up. Although more than one third had gone to the dentist because of toothache only one third of those who had toothache during the preceding year had visited the dentist during that period. People without toothache, in fact, used more dental services than those who had had it.     

Dental needs of the elderly in residential care in Newcastle-upon-Tyne and the role of formal carers

Interviews were carried out on 61 formal carers from 41 residential homes and 379 elderly residents from 35 homes. Formal carers were questioned about their own dental health and arrangements made to maintain the dental health of the residents. Only 46% of carers attended a dentist regularly although the majority knew that teeth and dentures should be examined regularly. Carers arranged most of the dental treatment received by residents. The percentage of residents from each home receiving treatment ranged from 0% to 52%. Residents judged by formal carers to be capable of participation were interviewed and a 40% stratified random sub-sample was examined. 96% of residents stated that they would only attend a dentist if they were experiencing problems. However, among residents reporting problems (25% of the sample), only a third wished to see a dentist. This proportion rose to half when treatment was offered. The reported barriers to seeking dental treatment included the resident's belief that he or she was coping satisfactorily, transport difficulties and ill health. Denture and oral hygiene were poor and dentures cleaned by staff were no cleaner than those cleaned by residents. A random sample of residents judged by formal carers to be confused were also examined. The condition of their teeth and dentures was similar to that of non-confused residents.     

Evaluation of a dental benefit plan for children conducted in Auvergne, France, since 1992

Abstract– Usually, the French dental insurance system covers the cost of restorative treatment but does not reimburse the cost of preventive therapies. A French sick-fund covering self-employed persons tested a new dental benefit plan for children intended to provide an incentive to develop office-based preventive activities. The programme, which started in 1992, concerns all 4-year-old children of self-employed workers in a single French region (Auvergne). Participants undergo an annual examination by the dentist of their choice until their 15th birthday. If the child is seen every year, all services related to dental caries (preventive and restorative) are provided free of charge. An ongoing evaluation of the programme was necessary to determine its influence on the development of office-based preventive activities and the dental health of the participants. A cohort of children enrolled in the programme in 1992 was followed over 4 years to examine the patterns of service use. In addition, a cross-sectional study comparing the caries experience of all 8-year-old children participating continuously in the programme (test sample) with that of a sample of control children (n=90) was conducted in 1996. Data from the longitudinal follow-up indicate that 43.37% of the 551 children to whom the programme was offered in 1992 underwent an annual examination in the first year. Of the children enrolled in 1992, 55.2% were still participating in the programme in 1996. Results showed that independent practitioners continued to focus on restorative treatment rather than preventive therapy. Results from the cross-sectional study are in accordance with this trend. The number of caries-free children was identical in test and control samples and the mean dft, DMFT, DT and dt did not vary between the two groups (Student's t-test, P > 0.05). However the mean number of filled teeth was significantly higher in the test children than in the controls (P < 0.01). For children with caries, the mean dft was 23.5% greater in the test group than in the control group (P < 0.05). In Auvergne, a large number of families were not ready to participate in a plan that required them to take their child to the dentist every year. There was not a perceived need for regular preventive dental care, an attitude probably reinforced by the interventionist approach undertaken by the dentists over the survey period. Moreover, the plan did not provide an incentive for dentists to develop office-based preventive activities.     

Testing the effect of including oral health in general health checks for elderly patients in medical practice--a randomized controlled trial

AIM: To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. OBJECTIVES: To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. Setting: Three general medical practices in east Cheshire, UK. DESIGN: A randomized controlled trial. METHOD: Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. RESULTS: Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. CONCLUSIONS: The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met.     

Adult Dental Visits in California: Successes and Challenges

OBJECTIVES: This study sought to estimate and characterize the proportion of California adults who visited a dentist in the preceding year and to identify reasons for not going. METHODS: In 1995, 4,029 adults were interviewed by telephone as part of the California Behavioral Risk Factor Surveillance System. Items included recentness of a dental visit, dental insurance status, and number of teeth lost due to disease. Persons who had not seen a dentist within the preceding year were asked the main reason they had not gone. RESULTS: In 1995, 65.9% of adults reported visiting a dentist in the preceding twelve months. Use of dental services was greater among persons aged 35 years or older (70.4%) than among those aged 18-34 years (58.4%) and among those with dental insurance (74.9%) than those without (54.4%). Dental visits were less likely among adults living at or below 200 percent of the federal poverty level, those with less than a high school education, and the edentulous. Reasons most commonly cited for not seeing a dentist were no perceived reason to go (37.2%), cost (30.7%), and fear (9.2%). CONCLUSION: Substantial variation in use of dental services exists among California's adults. Achieving equity in access and opportunity for disease prevention in this state may require expanded dental insurance coverage and serious efforts in oral health promotion.     

Dental caries in a group of 20-year-olds after previous participation in public child dental health services in Copenhagen, Denmark

The present study was undertaken to investigate the prevalence of dental caries in a group of 20-year-olds who had previously participated in Public Child Dental Health Services. Dental caries was related to social status and preventive vists to the private dentist after termination of school. The study population comprised 389 persons aged 20, out of which 313 (80.5%) were examined clinically and radiographically by one dentist according to standardized criteria. Mean DMFT was 10.4 and mean DMFS 16.7. Differences in relation to sex were not significant. The distribution of subjects according to DMFS was uneven. The 20% with the highest DMFS accounted for about 45% of the total amounts of DS. A consistent pattern with higher mean DMFS in the low social groups was found. Attendance to Regular Youth Dental Service was higher the longer the subjects had been students and higher mean DMFS was found in nonregular attenders. The presence of a high caries risk group is discussed in relation to the dental care system received by the study population.     

Dental service trends for older US adults, 1998-2006

This study of the Medicare Current Beneficiary Survey (MCBS) updates trends in utilization of dental services between 1998 and 2006 for community-dwelling U.S. adults of age 65 years and older. Bivariate comparisons were made between dependent variables (annual dental visits and types of dental procedures) and independent variables (age, gender, race, income, education, population density, marital status, U.S. Census Bureau regions, and self-reported health). The estimated percentage of community-dwelling Medicare beneficiaries with a dental visit for the years studied increased from 45.0% in 1998 to 46.3% in 2006. The age group of respondents who were 85 years and older had the greatest percentage increase in dental visits. Those reporting visits with preventive procedures increased from 87.8% to 91.2% whereas those reporting visits with nonpreventive procedures declined from 63.9% to 58.4%. The prevalence of dental visits continues to trend upward for this population of older adults. Increasing delivery of preventive services will likely impact the future mix of dental services as U.S. adults live longer.