Mobile dental vans: planning considerations and productivity

OBJECTIVES: Many children, especially those from lower socio-economic families, have limited access to dental care, transportation problems and poor appointment attendance. Mobile dental clinics have been implemented in many communities to address these issues. METHODS: Structured surveys were sent to the three mobile programs in Connecticut to collect information on the age of the program, issues encountered in planning and implementation, and ongoing costs and productivity. RESULTS: Each mobile clinic had two operatories and operated 140-200 days per year. Programs provided 2921-3417 diagnostic and preventive procedures and 359-721 treatment procedures per year for an average daily production of 18-24 procedures. All programs required external funding to remain financially solvent. CONCLUSION: Implementation and management of these programs is complicated. However, they provide an innovative solution to bringing dental care to underserved children and when operated in conjunction with schools can eliminate transportation problems and missed appointments.     

Effect of a special dental program upon extreme dental anxiety

Abstract Dental anxiety of 60 extremely anxious dental patients enrolled in a special program, was measured multioperationally before and immediately after treatment, and 6 months later. The mean anxiety level was substantially lowered during the course of treatment, indicating a favourable effect of the program. After Amsterdam, The Netherlands 6 months dental anxiety was still at the lower level.     

A dental survey of Tibetan children in Dharamsala

Since their exodus in 1959 about 100,000 Tibetans have settled in disparate communities in northern India and Nepal. This study describes the dental health of 243 Tibetan children in Dharamsala, in the State of Himachal Pradesh, India. Only 20% of 6-yr-olds were caries-free in the primary dentition while 96.9, 53.3, and 22.4% of 6, 12, and 15-yr-olds were caries-free in the permanent dentition respectively. The DMFT of 12-yr-old children was 1.1, while 15-yr-old children had a DMFT of 3.1. While plaque and calculus were present in many sextants, there was little intense gingivitis and signs of advanced periodontal diseases were rarely present. Almost no dental care had been received. Appropriate dental health promotion activities are discussed.     

Clinical measurement of dental anxiety

Abstract The mean scores on five dental anxiety measurements of 60 patients suffering from extreme dental anxiety are compared with those of an equal-sized, matched group of regular dental attenders free from dental anxiety. Four of the measurements, especially Corah's DAS, appear to be suitable for distinguishing persons suffering from extreme dental anxiety. Also, persons with extreme dental anxiety appear to express their fear openly.     

Reasons preventing regular dental care

The aim was to determine what reasons restrict people's daily cleaning of their teeth and yearly attendance for a dental check-up, using as a theoretical background the ideas of Eichholz & Rogers on the rejection of innovation. The series consisted of young and middle-aged persons, 207 women and 183 men, who filled in a questionnaire on the above topics. The questions were phrased so as to cover different reasons for rejecting innovations. Factors analysis revealed the following factors: reasons preventing daily brushing, practical reasons, unpleasant experiences of dental care, laziness, and lack of appreciation. The reliability of the questionnaire was found to be good. Sex showed a significant correlation with reasons preventing daily brushing. Those for whom a long time had elapsed since the last visit to a dentist had more barriers relating to daily brushing, unpleasant experiences and laziness. The more educated the participants were, the fewer barriers they had in relation to the factors appreciation, unpleasant experiences, and daily brushing.     

Chronicling the dental therapist movement in the United States

There have been three attempts to introduce dental therapists (DTs) to the US dental workforce. This account will review early failed attempts to develop DTs, the recent successful Alaska initiative, the Minnesota legislature's authorization of DTs, state dental associations' deliberations on therapists in the workforce, and the efforts of national advocacy groups, foundations, and state legislatures to promote workforce innovation. It concludes with a discussion of the opposition to therapists from elements of organized dentistry.     

Intrinsic motivation in dental care

The aim of this work was to develop a method based on the idea of intrinsic motivation for analyzing motivation problems in dental care. A questionnaire dealing with intrinsic motivation was filled in by 207 women and 183 men. Factor analysis of the scale revealed the following dimensions of internal-external motivation: independence, responsibility, vs. non-independence, interest in preserving one's own teeth as long as possible vs. preference for tooth extraction, satisfaction from brushing teeth vs. brushing for others' sake, and critical evaluation of diet vs. improper diet with carbohydrates. The reliability of the questionnaire was good (standardized item alpha .69). The individual's own sense of independence and responsibility and the idea of preserving one's own teeth for as long as possible were found to be more important for the women than for the men. A longer education was also found to be related to preserving one's own teeth as long as possible. The time of the last dental visit was positively related to independence, responsibility and the far-reaching idea of preserving one's own teeth. It can be concluded that aspects of intrinsic motivation can give additional information when trying to understand dental health behavior.     

Public dental service utilization among adults in South Australia

Background:  Longitudinal patterns of public dental service use may reflect access issues to public dental care services. Therefore, patterns of dental service use among South Australian adult public dental patients over a 3½-year period were examined.
Methods:  Public dental patients (n = 898) initially receiving a course of emergency dental care (EDC) or general dental care (GDC) at baseline were followed for up to 3½ years. Patient clinical records were accessed electronically to obtain information on dental visits and treatment received at those visits.
Results:  Some 70.7 per cent of EDC and 51.3 per cent of GDC patients returned for dental treatment post-baseline. EDC patients returned within a significantly shorter time period post-baseline, received significantly more courses of care and were visiting more frequently than GDC patients. A greater proportion of EDC patients received oral surgery, restorative, endodontic and prosthodontic services, but fewer received periodontic services. EDC patients received significantly more oral surgery and fewer preventive services per follow-up year, on average, than GDC patients. Large proportions of EDC (52.4 per cent) and GDC (63.8 per cent) patients who returned sought emergency care post-baseline.
Conclusions:  Patients appeared to be cycling through emergency dental care because of lack of access to general care services, highlighting access problems to public dental care.     

Differences in dimensions of satisfaction with private and public dental care among children

Measures of patient satisfaction have application in understanding patient behaviour, and in evaluating dental providers, services, and facilities. Further, differences in delivery systems may be reflected in variation between the component dimensions of satisfaction. AIM: The aim of this study was to compare perceptions of satisfaction with care provided by the School Dental Service (SDS) and private dentists. DESIGN: A three-stage cross-sectional survey was conducted during 1993-94. This analysis is based on Stage 2 of the study (n=2,792 participants, response rate=78.0%). SETTING: Schools in metropolitan Adelaide, South Australia. PARTICIPANTS: Parents and schoolchildren. INTERVENTIONS/METHODS: Mailed self-complete questionnaires. MAIN OUTCOME MEASURES: The Dental Satisfaction Index (DSI) and component subscales. RESULTS: Overall satisfaction using the DSI showed no significant difference between SDS users and users of private dental care. Parents of children using the SDS had lower satisfaction scores for 'general satisfaction', 'quality', 'access', and 'continuity', but had higher satisfaction scores for the dimensions of 'cost' and 'availability' (OLS regression; P<0.01). These patterns of satisfaction with dental care by provider group persisted after controlling for time since last visit, parental education level, insurance status, occupation and language spoken (OLS regression; P<0.05). This may reflect a counter-balancing of dimensions of satisfaction across provider groups resulting in no significant difference in the DSI. CONCLUSIONS: Overall satisfaction was high and did not vary by provider group, but there was variation in the component dimensions of satisfaction.     

Preparing for the dental team: investigating the views of dental and dental care professional students.

There is growing evidence to support the contention that interprofessional education (IPE) at both pre and post-qualification levels will improve professionals' abilities to work more effectively in a team and to communicate more effectively with colleagues and patients. This body of evidence, however, is primarily concerned with nursing, medical and associated professionals and students, and there are few studies that include dental students and particularly where learning occurs with the dental care professions (DCP). The purpose of this study was to examine the attitudes of dental and DCP students to IPE and to highlight some of the barriers to developing programmes for these students. It was also intended to examine the students' awareness of dental and DCP roles and responsibilities. Two questionnaires, the Readiness for Interprofessional Learning Scale (RIPLS) and a dental roles and responsibilities questionnaire, were distributed to all 5 years of dental students (n = 189) based at Queen's University Belfast (QUB), both years of the dental hygiene students (n = 8) also based at QUB, as well as to final year dental nursing students based at Belfast Institute of Further and Higher Education (BIFHE) (n = 64). The results indicated that dental and DCP students had a positive attitude to IPE as a means to improve teamwork and communication skills but there are potential obstacles as demonstrated by the differing perceptions of each of the three groups about the roles of the other. Some aspects of practice, involving personal care and advice to patients, were regarded by all groups as a shared role but the dental hygiene students regarded themselves as having a shared role in several tasks identified by dental and dental nurse students as the sole role of the dentist. Dental hygiene students in this study did not see their role as primarily to support the dentist but more as a partner in care. Professional identity and its development are issues that must be considered by dental and DCP educators developing IPE initiatives.     

Population ageing and dental care

Population ageing is a fact in both developed and developing countries. The concern about population ageing largely arises from the combination of a greater number of older people requiring greater amounts of healthcare services and pensions, and relatively fewer people working to pay for them. Oral health and dental care are important aspects of health and health care. Lower rates of edentulism and an ageing population mean that older people will feature more prominently in dental services. Traditionally, economic studies of ageing have focused on the fiscal implications of ageing, projecting the increased burden on health and welfare services that accompanies ageing. It assumed that ageing is the major driver of recent changes and those past trends will simply be amplified by faster population ageing in the future. Less work has been done to understand other past drivers of increased healthcare spending and their implications for the future. The conclusion of these reports is usually that population ageing is unaffordable with current policy settings. They have proposed policies to deal with population ageing which focused on increasing workforce participation and worker productivity to increase the tax base and reducing entitlements. However, the affordability question is as much political as a numerical. There are no clearly articulated criteria for affordability and little opportunity for public discourse about what citizens are willing to pay in taxes to support an ageing population. While the reports do not necessarily reflect public opinion, they will certainly shape it. Predicting the future for oral health is more fraught than for general health, as oral health is in the midst of an epidemiological transition from high rates of edentulism and tooth loss to low rates. Changes in the pattern of dental expenditure in the past do not mirror the experience of rapid increases in per capita expenditure on older age groups as regards general health. Dentistry's marginal status means that less work has been done to understand the future consequences of these changes and how they will interact with population ageing. Further than this though, we need to understand why the future might look as these projections suggest, so that we may look at ways that it can be shaped.     

'Making dental care possible: a mutual affair': a grounded theory relating to adult patients with dental fear and regular dental treatment

Dental fear is a common and widespread problem, which can cause severe stress. Even so, most patients with dental fear undergo regular dental treatment in spite of their fear and many enjoy good oral health. The aim of this study was to obtain a deeper understanding of how patients with dental fear manage to undergo dental treatment. Fourteen patients with dental fear, who undergo regular dental care, were interviewed. Qualitative analysis of the transcribed interviews was performed according to the principles of grounded theory. A conceptual framework was generated, and the main concern was identified as 'making dental care possible - a mutual affair'. Four additional categories explained how patients handled their dental fear and how dental care became possible. The strategies were labelled 'taking part in a mental wrestling match', 'trust-filled interaction with dental staff', 'striving for control' and 'seeking and/or receiving social support'. The results showed that making dental care possible for patients with dental fear is a mutual challenge that requires interplay between dental staff and patients, involving verbal and non-verbal communication reflecting respect, attention, and empathy. Moreover, a balance between nearness and distance and between professional and personal treatment is required.     

Monitoring of vital signs during dental care

Advances in medicine have greatly increased the survival of patients with severe health problems and have significantly prolonged life in elderly individuals with systemic disorders. Concomitant advances in dentistry and evolving societal expectations regarding dental health and function have likewise ensured that these patients are increasingly retaining their teeth and/or seeking dental care. The administration of local anaesthetics and the performance of extensive dental procedures may cause stress and systemic disturbances in such patients. In order to avoid potentially serious reactions, dentists are obligated to monitor continuously their medically challenged patients. Monitoring provides three important benefits. First, it helps the dentist detect acute medical emergencies that may require an immediate response. Second, monitoring may reveal gradual deleterious trends that can often be easily reversed before a true emergency occurs. Third, monitoring can assist the dentist in evaluating the efficacy of any emergency treatments or preventive measures that are rendered. The purposes of this article are to: briefly review monitoring techniques and devices, discuss their suitability for use in the dental office, and provide some tips for their application during dental care. In overall decreasing order of routine importance, monitoring resources include the following: responsible personnel, non-invasive blood pressure monitor, pulse oximeter, ECG, and the pretracheal stethoscope or capnograph.     

口腔医疗服务利用水平的影响因素

口腔医疗服务利用水平的影响因素主要包括以下四方面:社会经济因素、口腔与全身健康因素、口腔健康相关意识因素和口腔健康相关行为因素.本文对以上四方面重要的影响因素进行综述,以期为提高人群口腔健康状况、促进人群积极、及时、便利地利用口腔医疗服务提供参考.     

A 2-year retrospective study of demand for dental care from Scottish school leavers

After leaving school young adults in the United Kingdom are no longer eligible to receive care from the School Dental Service. Patients who have previously been treated by the Service are obliged to seek care elsewhere. The aim of the study was to see how effectively a group of Scottish school leavers coped with the change. The study population was 912 school leavers. The method depended upon a retrospective study of clinical records relating to the year before leaving school and the following year. During the last year at school, 48% of the subjects received treatment from three sources: 30% were treated by a general practitioner, 19% by the school service and 2% by the hospital service. During the 2nd year of the study, 69% of those who had earlier been treated by a general practitioner again requested dental care compared with only 40% of those who had earlier been treated by the school service and 30% of those who had not sought dental care during their last year at school. Recommendations are made for encouraging an increased demand for care from those who have formerly been treated by the school service.     

北京市城乡居民口腔卫生服务利用与费用影响因素分析

目的：通过对北京市居民口腔卫生利用和费用的定量研究及影响因素分析，为控制口腔费用的增长和建立口腔医疗保险制度提供依据。方法：分层、整群、随机抽取城乡居民3395人进行调查，利用单变量Logistic 回归、方差分析和三部模型方法进行口腔卫生服务利用和费用的因素分析。结果：城区0－14岁儿童，享有保障制度和患病者的人群利用概率高，OR值分别为5．834、2．721、1．793，低收入者利用概率低，高收入者就诊费用高，儿童的就诊费用低较，保障制度对农村居民口腔卫生服务利用几乎没有影响。影响居民就诊的主要因素是年龄、职业，患病状况和收入的高低，一旦利用口腔卫生服务，影响就诊费用的主要是不同的病种。结论：年龄是影响居民需求的主要因素。收入对个人是否就诊的决定有显著作用，保障制度对城乡居民的服务利用呈现相反的趋势，无论城乡居民，一旦利用口腔卫生服务，口腔健康状况是影响利用频率和费用的重要因素。