Comparing dental utilization of United States of America military recruits with their employed civilian cohorts

This study compares the dental utilization of United States of America (USA) military recruits with that of their employed civilian cohorts. Military data were collected between February and June 1994 at one recruit in-processing site per service, using self-administered questionnaires on a prestratified, systematic, random sample of 2369 Army, Air Force, Navy, and Marine recruits. Women and blacks were oversampled. Civilian data come from the most recent oral health survey of working adults in the USA. Results show that annual dental utilization rates of military recruits equal or are less than those of their employed civilian cohorts. Overall, 38% of recruits have seen a dentist in the past year, while 30% have not seen a dentist in 3 or more years. Such low consumption of dental care suggests that dental utilization habits prior to service entry do not contribute appreciably to the high dental utilization rates seen among active duty US military personnel. Received: 17 December 1996 / Accepted: 30 June 1997     

Relationship of dental status, sociodemographic status, and oral symptoms to perceived need for dental care

OBJECTIVE: Previous studies have noted a discrepancy between clinically determined oral health status (normative need), patients' perceptions, and perceived significance of dental signs and symptoms. Our objective was to quantify the relationships between normative need and self-reports to improve our understanding of the factors that contribute to perceived need for care. METHODS: Clinical examination and questionnaire data were derived from the Florida Dental Care Study, a study of oral health and dental care, in a representative sample of community-dwelling adults aged > or = 45 years. The questionnaire provided information about presence of signs and symptoms, self-ratings of oral health, perceived need for dental care, and sociodemographic status (SDS). Perceived need was measured on a 4-point nominal scale. RESULTS: Self-reported broken filling, broken denture, cavities, loose tooth, teeth that look bad, and toothache were strongly associated with self-reported perceived need for dental care. Satisfaction with dental health was also associated with perceived need, but self-rated oral health was not. Most measures of SDS were associated with perceived need. However, in a single multiple regression, with self-reported signs and symptoms accounted for, race, age group, sex, and educational attainment were not significantly associated with a currently perceived dental problem. CONCLUSIONS: Certain dental signs and symptoms were significantly associated with perceived need for dental care, as were certain aspects of SDS; even once differences in dental signs and symptoms had been taken into account. Disaggregating measurement of perceived need from a single dichotomous ('yes/no') scale to a 4-point nominal scale was elucidative.     

Perceived, desired, and normatively determined orthodontic treatment needs in male US Army recruits

Abstract This study assessed perceived, desired, and normative need for orthodontic care in a systematic random sample of 576 male enlisted Army recruits at one Army post in fall 1990. Perceived and desired need were collected using a pretested questionnaire. Normative need was assessed on all participants by one dentist using the Treatment Priority Index. Results show 16.3% of enlisted male Army recruits have severe or handicapping malocclusions. yet only one-third desire corrective treatment. Preference for orthodontic care is strongly influenced by the recruit's education level. We recommend that military health policymakers consider expanding access to adult orthodontic care for active duty military personnel to keep pace with its widening acceptance by the general public and to keep the military health benefits package competitive with those of civilian employers.     

The relationship between cigarette smoking and perceived dental treatment needs in the United States, 1988-1994

BACKGROUND: Although factors affecting perceived dental treatment needs have been investigated, the effect of smoking status on perceptions of dental needs has not been examined. METHODS: The authors examined data on 13,227 dentate people aged 20 to 79 years from the Third National Health and Nutrition Examination Survey (NHANES III). Information was collected information on sociodemographic characteristics, cigarette smoking, perceived dental treatment needs and other factors during a home interview, and clinical oral health information was collected at a mobile examination center. RESULTS: In univariate analyses, current smokers were more likely than nonsmokers to perceive dental needs in all categories, except for the need for a dental cleaning. Multivariate regression results indicate that current smokers were more likely to report a need for periodontal treatment and dental extractions compared with nonsmokers (odds ratio [OR] = 1.40; 95 percent confidence interval [CI] = 1.05-1.87 and OR = 1.61; 95 percent CI = 1.22-2.14, respectively). The authors found an interaction between smoking and race/ethnicity in models describing the need for teeth to be filled/replaced and for orthodontic/cosmetic work. CONCLUSIONS: Current smokers were more likely to have more perceived dental needs compared with nonsmokers. Practice Implications. These results may be important for the advancement of efforts directed toward tobacco-use cessation programs and to understand factors that could affect dental care utilization.     

The initial dental health status of British Army Gurkha recruits

AIM: To describe the initial dental health status of British Army Gurkhas who were recruited in 1999 and to compare the present caries data with previous unpublished data from before 1970 and 1983. DESIGN AND SETTING: A clinical examination was conducted on the 228 Gurkhas, the entire UK intake for 1999, during their second week of military training. The focus of the examinations was on caries experience. A questionnaire was employed to collect demographic data as well as information on the recruits' reported dental behaviour and beliefs. RESULTS: 1999 recruits who reported a dental problem within the past year were significantly more likely to have visited a dentist before compared to those recruits who reported no dental problems. The frequency distributions of D3MFT for the 1983 and 1999 recruits were very similar. CONCLUSIONS: Gurkha men are at relatively low risk of dental caries and predicted treatment time suggests a relatively small use of resources would be needed to make this group dentally fit. These recruits are an extremely homogeneous group who remain discernible from the general Nepalese population.     

Factors associated with perceived oral health status in older individuals

AIM: To assess factors associated with perception of oral health in older individuals. DESIGN: A cross sectional study. SETTING: A densely populated urban area in Sri Lanka. PARTICIPANTS: 585 older adults aged 60 years and above of which 475 were living at home and 110 in institutions. The present analysis is limited to 235 subjects who were subjected to a clinical oral examination. METHOD: The data were collected by means of an interviewer-administered questionnaire and a clinical oral examination. RESULTS: Overall, 48% of the dentate and 42% of the edentate perceived their oral health as poor. The final model of the hierarchical logistic regression analysis for the dentate revealed that presence of retained roots, mobile teeth, >20 missing teeth and perceived need for dental care were significantly associated with poor perceived oral health status. For the edentate, perceived need for dental care, loss of taste sensation and difficulty in eating were significantly associated with poor perceived oral health status. CONCLUSIONS: Factors associated with perceived oral health status differed between the dentate and the edentate. Clinical oral health indicators emerged as significant predictors of perceived oral health status in the dentate although the explanatory power of these indicators on perception of oral health was low.     

Dental utilization among Hispanic adults in agricultural worker families in California's Central Valley

Objective: To examine past‐year dental visits among underserved, Hispanic farmworker families using the Andersen Behavioral Model of Health Services Utilization, which posits that predisposing, enabling, and need factors influence care‐seeking behavior. Methods: Oral health survey and clinical data were collected in 2006‐2007 from families in Mendota, California (Fresno County) as part of a larger, population‐based study. Generalized estimating equation logit regression assessed effects of factors on having a dental visit among adults (N = 326). Predisposing variables included sociodemographic characteristics, days worked in agriculture, self‐rated health status, and dental beliefs. Enabling factors included resources to obtain services (dental insurance, income, acculturation level, regular dental care source). Need measures included perceived need for care and reported symptoms, along with clinically determined untreated caries and bleeding on probing. Results: Only 34% of adults had a past‐year dental visit, despite 44% reporting a regular dental care source. Most (66%) lacked dental insurance, and nearly half (46%) had untreated caries. Most (86%) perceived having current needs, and on average, reported a mean of 4.2 dental symptoms (of 12 queried). Regression analyses indicated those with more symptoms were less likely to have a past‐year dental visit. Those who would ask a dentist for advice and had a regular dental care source were more likely to have a past‐year dental visit. Conclusions: The final model included predisposing, enabling, and need factors. Despite low utilization and prevalent symptoms, having a regular source of care helps break this pattern and should be facilitated.     

A retrospective longitudinal study of caries prevalence during and 7 years after free dental care at school in Finland

ABSTRACT The objective of the study was to evaluate the benefit left from free dental care at public school after an average time interval of 7 years (mean: 7.03 years). The school dental service given to 66 Army recruits was extracted from their respective school dental care records, and then compared with the caries situation at the time of their military service. The results showed that the average number of 10.42 filled and extracted tooth surfaces at the end of school dental care had increased to a score of 36.72 DMFS 7 years later. The increase was significantly higher than expected on the basis of the average caries development between ages 7 and 15 years. Of the teeth filled during school dental care, only 26% were in no need of additional treatment, 15% had been properly retreated afterwards and the rest were either decayed (35%), retreated and redecayed (13%) or extracted (11%). Of the teeth that had been given root canal treatment at school, 27% had been extracted within the following 7 years. The caries situation was worst in the group of recruits who had had free dental care for the longest period of time. It was concluded that constant free repair of the teeth does not seem to give long term relief from the caries problem.     

Perceived Need for Dental Care Among Dentate Older Individuals in Sri Lanka

The authors assessed the perceived need for dental care among 585 older individuals, of whom 235 received a clinical oral examination. Of the 235 participants, only 171 were dentate. The present analysis is limited to this group. Of these 171 dentate adults, 43 percent perceived a need for dental care. Of this sample section, 53 percent perceived a need for dentures. Age, perceived oral health status, presence of mobile teeth, three impact items of the Oral Health Impact Profile‐14 (OHIP‐14) scale—namely “had a painful aching in the mouth, had difficulty in eating and that the diet had been unsatisfactory due problems with teeth, mouth or dentures”–and the total OHIP‐14 score showed significant associations with perceived need for dental care in bi‐vartate analysis. Poor perceived oral health status emerged as the strongest predictor of perceived need for dental care in logistic regression.     

Dental Utilization by Low-income Mothers

Objective : This study examines the influence of predisposing, enabling, and need variables on whether low-income mothers sought dental care during the past year. This report is a substudy of mothers and children on their self-reported health status, utilization, access, and satisfaction with health care in general. Methods : A convenience sample of 502 mothers and youngest child younger than 6 years old was administered a face-to-face questionnaire in four Ohio counties. Information was collected at county human services offices and WIC clinics between November 1995 and July 1996. Using whether or not the mother sought dental care as the dependent variable, logistic regression models were created for the variables within the predisposing, enabling, and need characteristics separately and together. Results : Fewer than one-half of the mothers sought dental care during the past year. Variables associated with the predisposing characteristic explained little about who sought care. Those mothers who have Medicaid coverage are 2.7 times more likely to have a dental visit than those without insurance. Moreover, those mothers who perceive any dental need are several times less likely to have received dental care than those who have no perceived need. Conclusion : Even among a somewhat homogeneous population of low-income women, source of payment for dental services and perceived need for dental care are discriminating variables in determining who seeks dental care.     

Correlates of partial tooth loss and edentulism in the Brazilian elderly

BACKGROUND: In South American older adults the association between tooth loss and demographic, predisposing and enabling factors has not been determined. The purpose of this study was to evaluate the association between partial and complete tooth loss and demographic, predisposing, enabling and need factors, and quality of life variables in the Brazilian older adults. METHODS: In this cross-sectional study, 5349 subjects aged 65-74 years were evaluated using conglomerate random sampling. Data collection included dental examinations and questionnaires evaluating demographic, predisposing, enabling and need factors, and quality of life variables. Multinomial logistic regression was carried out to evaluate correlates of tooth loss. The number of teeth was set as the outcome and categorized as: edentulous, subjects with 1-19 teeth, and subjects with 20 or more teeth. RESULTS: Predisposing factors including age, female gender and schooling were independently associated with edentulism. Female gender was associated with partial tooth loss. The only enabling factor associated with edentulism was car ownership. Need factors were associated with edentulism and partial tooth loss. Edentulous subjects perceived the need for dental treatment less frequently. Quality of life factors were associated with partial tooth loss and edentulism. Subjects with 1-19 teeth and edentulous subjects were more likely to rate their chewing ability as not good. Edentulous subjects were more likely to rate their speech ability and their dental appearance as good. CONCLUSIONS: The results indicate that tooth loss and edentulism were complex phenomena, with intricate predisposing, demographic, enabling and need factors playing a role.     

Parental perceptions of their preschool-aged children's oral health

BACKGROUND: Parents have an important role in making decisions about their children's oral health. The purpose of the authors' study was to determine parental perceptions of their children's oral health status and factors correlated with these perceptions of health. METHODS: The authors analyzed data for 3,424 children (2-5 years of age) from the Third National Health and Nutrition Examination Survey. They based the dependent variable on a question asked of primary caregivers: "How would you describe the condition of [child's name]'s natural teeth?" Explanatory variables included demographic variables, dental visits, perception of child's general health, need for dental care and presence of tooth caries. RESULTS: Eighty-nine percent of parents rated their child's oral health as excellent, very good or good, and 11 percent rated it as fair or poor (mean = 2.7 on a five-point scale, with 1 being excellent and 5 being poor). Tooth caries, perceived need for dental cleaning and treatment, lower income and poorer general health perceptions were associated with poorer parental ratings. CONCLUSIONS: Actual disease and perceived need are associated significantly with parents' perceptions of their children's oral health. PRACTICE IMPLICATIONS: Understanding parents' perceptions of their children's oral health and factors that motivate these perceptions can help dentistry overcome barriers that parents encounter in accessing dental care for their children.     

What is the function of psychosocial factors in predicting length of time since last dental visit? A secondary data analysis

Aim: To conduct a secondary analysis of the Adult Dental Health Survey, UK (ADHS.UK) data to investigate the function of psychosocial factors (costs, dental anxiety, communication) and whether their interaction mediates the relationship between perception of need and length of time since last dental visit. Materials and methods: The data used from the ADHS.UK interview questionnaires included demography, costs, perception of treatment need, communication, dental anxiety and reported dental attendance. The data were subjected to χ²‐analysis and hierarchical logistic regression analysis. Results: Time since last dental visit was significantly associated with all demographic and psychosocial variables. The hierarchical logistic regression analysis tested three models. Model 1 examined the demography and explained 2% of the variance. Model 2 showed that those in intermediate (e.g. clerical staff) and routine (e.g. agriculture workers) occupations and those who were unemployed/never worked had a greater likelihood of increased interval between dental visits, explaining an additional 2% of the variance of the time interval between dental visits. Model 3 provided an additional 10% of the variance, which included costs, perceived need, communication and dental anxiety. The interaction of the perception of need by extreme dental anxiety (OR = 0.52; 95% CI: 0.40, 0.69) improved the fit of the model [χ² (df1) = 22.85, P < 0.001]. Conclusion: This study revealed that dental anxiety, communication and treatment costs acted as barriers to accessing dental care. Dental anxiety acted as a mediator in the relationship between perception of need and increased time interval between dental visits.     

Inequalities in dental services utilization among Brazilian low-income children: the role of individual determinants

Objectives: To assess the role of the individual determinants on the inequalities of dental services utilization among low‐income children living in the working area of Brazilian's federal Primary Health Care program, which is called Family Health Program (FHP), in a big city in Southern Brazil. Methods: A cross‐sectional population‐based study was performed. The sample included 350 children, ages 0 to 14 years, whose parents answered a questionnaire about their socioeconomic conditions, perceived needs, oral hygiene habits, and access to dental services. The data analysis was performed according to a conceptual framework based on Andersen's behavioral model of health services use. Multivariate models of logistic regression analysis instructed the hypothesis on covariates for never having had a dental visit. Results: Thirty one percent of the surveyed children had never had a dental visit. In the bivariate analysis, higher proportion of children who had never had a dental visit was found among the very young, those with inadequate oral hygiene habits, those without perceived need of dental care, and those whose family homes were under absent ownership. The mechanisms of social support showed to be important enabling factors: children attending schools/kindergartens and being regularly monitored by the FHP teams had higher odds of having gone to the dentist, even after adjusting for socioeconomic, demographic, and need variables. Conclusions: The conceptual framework has confirmed the presence of social and psychosocial inequalities on the utilization pattern of dental services for low‐income children. The individual determinants seem to be important predictors of access.     

A study of military recruitment strategies for dentists: possible implications for academia

Results of the annual American Dental Education Association surveys of dental school seniors show approximately 10 percent of graduates enter federal government services while less than 1 percent enter dental academia. To examine this difference, this study sought the perceptions of senior dental students and junior military dental officers regarding their choice of a military career in order to determine how military recruitment strategies influenced their career decisions. Official documents explaining military recruitment efforts were requested from the military services and summarized. In-depth telephone interviews were conducted to gather perception data from the students and dental officers on successful strategies. By employing several strategies, the military was able to inform potential recruits about the benefits of being a dentist in the military. The opportunity to have the military finance a student's dental education was a successful military recruitment tool. Other enticing factors included guaranteed employment upon graduation, prestige associated with serving in the military, access to postgraduate training, minimal practice management responsibilities, and opportunities to continue learning and improve clinical skills without significant financial implications. It was concluded that dental education can use the same strategies to highlight the benefits of an academic career and offer many similar incentives that may encourage students to consider a career path in dental education.     

Factors affecting dental utilization of elders aged 75 years or older

Data collected from 496 elders aged 75 years or older participating in the Massachusetts Health Care Panel Study were analyzed by means of multiple regression to determine the principal predictors of perceived need for care and of dental users. The relationship between perceived need and use of services also was examined. The significant variables influencing perceived need in elders were poorer self-perceived oral health, having some teeth, and reporting a dental visit within two years. Dental users were best predicted by dentate status, a history of alcohol consumption, and perceived need for care. Although the variables of perceived need and being a user each influenced the other, both were more influenced by a common significant predictor variable, dentate status.     

Periodontal health status in a cohort of young US Navy personnel

OBJECTIVES: Neither the prevalence of periodontal disease nor long-term trends in periodontal health among US military personnel has been well studied. The authors analyzed dental records to assess the prevalence and severity of periodontal disease, characterize changes in periodontal health, and determine the associations of age, race, gender, and tobacco use with periodontal status among US Navy personnel. METHODS: Dental records from 1,107 personnel who entered military service in 1997 were gathered from eight US Navy dental treatment facilities. Demographic information, tobacco use status, and periodontal health status, as reflected by the Periodontal Screening and Recording (PSR) information recorded at each required dental examination during the 4-year observational period (1997 to 2001), were collected. To improve sensitivity in measuring the extent of periodontal disease, the standard five-point PSR scale was reexpressed as a "PSR grade." RESULTS: Over 98 percent of Navy recruits exhibited some level of periodontal disease at initial examination. Most (76 percent) exhibited gingivitis of varying severity. Over a mean observational period of 3.4 years, 91 percent of subjects received at least one oral prophylaxis, and over 60 percent received two to four prophylaxes. Subjects with severe periodontal conditions received as many as 22 appointments for prophylaxis or periodontal therapy. From initial to final examination, periodontal status improved for 29.2 percent of subjects, deteriorated for 31.3 percent, and remained unchanged for 39.5 percent. Subjects presenting initially with healthy periodontia, or gingivitis without evidence of periodontitis, tended to deteriorate or remain unchanged, while those exhibiting periodontitis tended to improve with periodontal therapy. Race (non-White) and greater age at entry were significantly associated with increased risk for poorer periodontal health at both initial and final examination. CONCLUSIONS: Although a needs-based dental care model appears effective in managing periodontal disease among those receiving active therapy, patients who receive sporadic care may deteriorate over time. To maintain periodontal health in this population, appropriate preventive and periodontal therapies should be provided soon after entry and repeated at intervals specific to individual patient need.     

Oral health-related quality of life and perceived dental needs in the United States

Objectives: The purpose of this study is to investigate the oral health‐related quality of life (OHRQOL) in the US population by sociodemographic factors, perception of dental needs, reported dental visits, and saliva indicators. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2003‐2004 were used. NHANES measured OHRQOL by a modified version of the Oral Health Impact Profile. Results: The study had 6,183 subjects who averaged an OHRQOL score of 2.8 points. About 40% had painful aching in the mouth during the last year on at least one occasion. Perceived need to relieve dental pain was the strongest risk factor for poor OHRQOL (resulting in a higher score by 5.2 points), followed by perceived need for a denture or feeling of dry mouth (each resulting in a higher score by about 2 points). Conclusions: OHRQOL is the poorest among those with perceived dental needs especially those with the perceived need to relieve dental pain.