Long‐term patterns of dental attendance and caries experience among British adults: a retrospective analysis

There is inconclusive evidence on the value of regular dental attendance. This study explored the relationship between long‐term patterns of dental attendance and caries experience. We used retrospective data from 3,235 adults, ≥16 yrs of age, who participated in the Adult Dental Health Survey in the UK. Participants were classified into four groups (always, current, former, and never regular‐attenders) based on their responses to three questions on lifetime dental‐attendance patterns. The association between dental‐attendance patterns and caries experience, as measured using the decayed, missing, or filled teeth (DMFT) index, was tested in negative binomial regression models, adjusting for demographic (sex, age, and country of residence) and socio‐economic (educational attainment, household income, and social class) factors. A consistent pattern of association between long‐term dental attendance and caries experience was found in adjusted models. Former and never regular‐attenders had a significantly higher DMFT score and numbers of decayed and missing teeth, but fewer filled teeth, than always regular‐attenders. No differences in DMFT or its components were found between current and always regular‐attenders. The findings of this study show that adults with different lifetime trajectories of dental attendance had different dental statuses.     

Oral health‐related quality of life among rural‐dwelling Indigenous Australians

Background: There is limited information on the impact of poor oral health on Indigenous Australian quality of life. This study aimed to determine the prevalence, extent and severity of, and to calculate risk indicators for, poor oral health‐related quality of life among a convenience sample of rural‐dwelling Indigenous Australians. Methods: Participants (n = 468) completed a questionnaire that included socio‐demographic, lifestyle, dental service utilization, dental self‐care and oral health‐related quality of life (OHIP‐14) factors. Results: The prevalence of having experienced one or more of OHIP‐14 items ‘fairly often’ or ‘very often’ was 34.8%. The extent of OHIP‐14 scores was 1.88, while the severity was 15.0. Risk indicators for having experienced one or more of OHIP‐14 items ‘fairly often’ or ‘very often’ included problem‐based dental attendance, avoiding dental care because of cost, difficulty paying a $100 dental bill and non‐ownership of a toothbrush. An additional risk indicator for OHIP‐14 extent was healthcare card ownership, while additional indicators for OHIP‐14 severity were healthcare card ownership and having had 5+ teeth extracted. Conclusions: Risk indicators for poor oral health‐related quality of life among this marginalized population included socio‐economic factors, dentate status factors, dental service utilization patterns, financial factors and dental self‐care factors.     

Possible predictors of discontinuation of specialized dental treatment among children and adolescents with dental behaviour management problems

Gustafsson A, Broberg AG, Bodin L, Berggren U, Arnrup K. Possible predictors of discontinuation of specialized dental treatment among children and adolescents with dental behaviour management problems. Eur J Oral Sci 2010; 118: 270–277. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci This study aimed to identify potential predictors of non‐attendance among children and adolescents with dental behaviour management problems (DBMP). A group of 179 patients, 7.5–19 yr of age, was grouped into 56 ‘non‐attenders’ (discontinued treatment, missed appointments, or ≥ 20% cancellations) and 123 ‘attenders’. In addition to data from an introductory interview and dental recordings, baseline data from psychometric measures of fear and other personal and parental characteristics were included in logistic regression analyses and tree‐based modelling. The non‐attenders had higher scores on impulsivity and sociability and lower socio‐economic status (SES) than the attenders, and they lived more often in single‐parent families. Logistic regression analyses and tree‐based modelling point to SES and parental anxiety as important predictors for non‐attendance within this group of children and adolescents. To predict, and possibly to prevent, non‐attendance among children and adolescents referred for specialized dental care because of DBMP, we must consider their lives and family situations as well as their personal characteristics and oral health status. Further research should focus on whether the observed associations between non‐attendance and factors such as personal characteristics, family and psychosocial factors, and previous dental experiences, also hold for those who remain in regular dental care.     

Dental hygienist attendance and its covariates in an ageing Swedish cohort

Delegation of tasks between professional groups is important to make health‐care services accessible and effective for ageing people. Focussing on a Swedish 1942 birth cohort and guided by Andersen's Behavioral Model, this study assessed dental hygienist attendance from age 50 to age 70 and identified covariates at the population‐averaged and person‐specific levels. In 1992, a census of 50‐yr‐old subjects was invited to participate in a questionnaire survey. Of the 6,346 respondents, 3,585 completed follow‐ups in 1997, 2002, 2007, and 2012. Multiple logistic regression analysis was conducted using a marginal model and a random intercept model. Cochran's Q test revealed that significantly more respondents confirmed dental hygienist attendance in 2012 than in 1992 (57.2% in 2012 vs. 26.0% in 1992). Population‐averaged ORs for dental hygienist attendance across time were 3.5 at age 70 yr compared with age 50 yr (baseline); 2.0 if being a regular rather than an irregular dental attendee; and 0.7 if being of non‐native origin compared with native origin. The corresponding person‐specific ORs were 8.9, 3.2, and 0.5. Consistent with Andersen's Behavioral Model, predisposing, enabling, and need‐related factors were associated with dental hygienist attendance at population‐averaged and person‐specific levels. This has implications for promoting dental hygienist attendance among ageing people.     

Dissatisfaction with dental care among mothers of Medicaid-enrolled children

Objectives: This paper is part of a larger study examining the impact of mothers’ having a regular source of dental care (RSDC) on utilization of dental care and oral health of their preschool children. We describe levels of satisfaction with care among mothers whose preschool children were enrolled in Medicaid in Washington State. We report mothers’ satisfaction related to having a RSDC by type of dental setting/office. Methods: Disproportionate stratified sampling by racial/ethnic group selected 11 305 children aged 3–6 in Medicaid in Washington State. Mothers (n = 4373) completed a mixed‐mode survey. Satisfaction with dental care was measured using the Dental Satisfaction Questionnaire (DSQ). Results: Overall mean DSQ was 57.1 ± 9.9 (range 18–89). A higher score indicates greater satisfaction. There was not evidence of a difference in dissatisfaction by race/ethnicity but Blacks and Hispanics were less satisfied with pain management than Whites. The majority of respondents agreed with the statement that ‘Dentists sometimes act rude to their patients.’ Satisfaction is higher for mothers who have a regular private dentist they see consistently versus having a regular dentist through a public or non‐profit clinic. Conclusions: The satisfaction with dental care for this population is low, and considerably lower than found in other studies for primary medical care. Steps need to be taken to increase dental satisfaction and access to private dental clinics, and to increase perceived quality and pain management of dental care in both private clinics and public/non‐profits serving low‐income populations.     

Dentists reflect on their problem‐based education and professional satisfaction

Aim: To determine the way in which Malmö University dental graduates perceive their problem‐based dental education and evaluate their professional satisfaction. Method: The first five cohorts (graduating in years 1995–1999) of the problem‐based curriculum were invited to participate. Of 166 graduates, 77% responded to a questionnaire comprising 20 questions on aspects of their dental education, professional situations and interest in postgraduate education. They were asked to rank their perception of their dental education and satisfaction with their professional situation on a visual analogue scale (VAS) with endpoints ranging from ‘Not at all’ (1) to ‘Very well’ (10). For other statements, the markings were made on a Likert scale from 1 (not important/not satisfied) to 5 (very important/very satisfied). There were also open‐ended questions. Results: Most respondents perceived their education to prepare them well for a career in dentistry (median score VAS 8), and 90% rated above six on a VAS for their professional satisfaction as dentists. Importance and satisfaction were highly correlated with principles of the curriculum: holistic view, oral health, lifelong learning, integration between theory and clinic, and clinical competence. Forty‐five per cent of the graduates noted the problem‐based learning approach as the most valuable asset of their education, and 19% cited training in oral surgery as a deficit. Of the respondents, 77% expressed interest in specialist training and 55% in research education. Conclusion: Problem‐based education was perceived to prepare graduates well for their profession, and their professional satisfaction was high.     

Dental fear and subjective oral impacts among adults in Finland

We aimed to study the association between subjective oral impacts and dental fear adjusted for age, gender, level of education, and dental attendance, and to evaluate whether this association was modified by the number of remaining teeth. Nationally representative data on Finnish adults, 30+ yr of age (n = 5,987), were gathered through interviews, clinical examination, and questionnaires. Dental fear was measured using the question: ‘How afraid are you of visiting a dentist?’ and subjective oral impacts were measured using the 14‐item Oral Health Impact Profile (OHIP‐14) questionnaire. The outcome variables were the percentage of people reporting one or more OHIP‐14 items fairly often or very often, and the ‘extent’ and ‘severity’. Those with high dental fear reported higher levels of prevalence, ‘extent’, and ‘severity’ of subjective oral impacts than did those with low dental fear or no fear. The association between dental fear and subjective oral impacts was not significantly modified by the number of remaining teeth. The greatest differences between those with high dental fear and low dental fear were found in psychological, social, and handicap dimensions, but not in functional or physical dimensions of the OHIP‐14. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress and by improving regular dental attendance and oral health.     

Differentiating regular from irregular dental attenders of either sex by linear discriminant analysis

Abstract The present article describes an attempt to improve the prediction of dental attendance, results by using an additional number of variables and performing discriminant analyses, clone separately for men and women, It appears that regular and irregular dental attenders might be discriminated on the basis of mathematically combined variables and interactions. The (number of) variables selected by the analysis to differentiate regular from irregular male attenders differ(s) from those selected for female attenders. About 80% of all respondents can be classified correctly, but this is largely due to the assignment of actual regulars to classified regulars. The use of differing sets of prior probabilities affects the classification results, namely, either the classification of the regulars or that of the irregulars improves. In the discussion attention is given to the seemingly contradictory results of the Mann- Whitney tests per variable on the one hand and the discriminant analyses on the other. In this connection, the finding that ‘education’ plays a different role for men than for women is discussed. The validity of the variable ‘last visit’ is dubious. It is concluded that when differentiating regulars from irregulars, a division of the respondents according to sex makes sense because of the (number of) variables associated with then- regular dental attendance. Furthermore, it seems warranted to say that the Classification of the irregulars fails because he reversed scores on the variables with which the regulars are classified don't contain all information needed for the prediction of irregular dental attendance. Lastly, notwithstanding the use of more variables in the present study, the results are not better than those in the previous one, in which just three factors were used.     

Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA

Background: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries. Method: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004–2006 data from the Health and Retirement Study (HRS) in the USA for respondents ≥ 51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use. Results: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance. Conclusions: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.Key words: Dental attendance, dental insurance coverage, older populations, USA, Europe     

Self‐perceived preparedness for dental practice amongst graduates of The University of Hong Kong’s integrated PBL dental curriculum

Objectives: To determine how prepared for dental practice graduates from the integrated problem‐based learning (PBL) dental undergraduate curriculum at The University of Hong Kong (HKU) perceive themselves to be and to identify factors associated with self‐perceived preparedness. Materials and methods: A postal questionnaire was sent to five cohorts of dentists who had graduated from HKU’s integrated PBL curriculum between 2004 and 2008. Using a 4‐point Likert scale, the questionnaire assessed the self‐perceived level of preparedness in 59 competencies grouped in nine domains. Responses were dichotomised into ‘poorly prepared’ and ‘well prepared’. Results: The response rate was 66% (159/241). The mean proportion (± standard deviation) of respondents indicating well‐preparedness was 72.0 ± 15.1% overall, and for each domain was as follows: general patient management, 93.1 ± 12.1%; practice management, 81.0 ± 22.2%; periodontology and dental public health, 73.5 ± 19.3%; conservative dentistry, 92.5 ± 13.1%; oral rehabilitation, 62.8 ± 24.0%; orthodontics, 23.0 ± 32.9%; managing children and special‐needs patients, 64.8 ± 28.9%; oral and maxillofacial surgery, 52.2 ± 25.2%; and drug and emergency management, 84.7 ± 22.6%. The odds of self‐perceived well‐preparedness were increased for cohorts graduating in 2004 and 2005 and graduates working in a non‐solo dental practice. Conclusions: Dental graduates of HKU’s integrated PBL curriculum felt well prepared for the most fundamental aspects of dental practice. However, apparent deficiencies of training in orthodontics and oral and maxillofacial surgery will need to be addressed by continuing education, postgraduate training and planning for the new 6‐year undergraduate curriculum in 2012.     

Dentists' restorative decision‐making and implications for an ‘amalgamless’ profession. Part 2: a qualitative study

In some countries the use of amalgam has been restricted, and the dental profession may be forced into using alternatives to amalgam by a combination of public opinion and legislation, including the proposal that the material be ‘phased‐down’. The limited research that exists as to restorative decision‐making is quantitative in nature and focuses on ‘when’ a restoration is placed. There is little qualitative research exploring ‘why’ a material is chosen. Purposive sampling of a representative group of dentists registered in Australia was carried out in two phases; initially six interviews followed by a focus group of six different participants who were audio‐recorded. Qualitative data were analysed using computer aided qualitative data analysis software. The findings suggest that dentists' restorative decision‐making is a complex interplay of factors. These may be categorized as ‘clinical’, ‘knowledge’, ‘patient’, ‘practice type’, ‘biological’ and ‘environmental’. Use of amalgam is influenced by each of these to varying degrees. Quantitative analysis of the influences on restorative decision‐making is recommended. While the potential future ‘phase‐down’ of amalgam as a restorative material was of concern, there was a general sense of resignation or apathy to the matter. The implications for public health authorities, dental organizations and educators are noted.     

Oral health status and reasons for not attending dental care among 12- to 16-year-old children with Down syndrome in special needs centres in Jordan

To cite this article:
Int J Dent Hygiene 10 , 2012; 259–264
DOI: 10.1111/j.1601‐5037.2012.00545.x Al Habashneh R, Al‐Jundi S, Khader Y, Nofel N. Oral health status and reasons for not attending dental care among 12‐ to 16‐year‐old children with Down syndrome in special needs centres in Jordan. Abstract: Objectives: The objective of this study was to assess oral health status, treatment needs, soft and hard tissue findings, as well as reasons for not attending dental care among children with Down syndrome (DS) registered in special needs centres in Jordan. Methods: The sample consisted of a total of 206 participants with a mean age of 13.66 ± 1.47 comprising 103 with DS and 103 age‐ and gender‐matched non‐DS/public school children. Clinical levels of oral hygiene were assessed using Simplified Oral hygiene index, and caries detection was carried out according to WHO caries recording criteria. Results: Children who had DS had a significantly higher percentage of surfaces with severe gingival index (39.9 ± 9.1 versus 15.9 ± 8.0, P < 0.001) and a higher mean of probing pocket depth than children without DS (2.27 ± 0.2 versus 1.81 ± 0.32, P < 0.000). Significantly more peg‐shaped maxillary lateral incisors and retained primary teeth (P < 0.001) were observed in subjects with DS, compared with non‐DS children. Average decayed, missing and filled teeth (DMFT) was significantly lower in male children with DS compared with male non‐DS children only (P = 0.034). The most common reason cited for not taking children to the dentist for DS group was ‘Not aware of the dental problems of their children’ and for non‐DS groups ‘No awareness of the importance of dental visit’ (61.2% and 53%, respectively). Conclusions: While having similar caries level, Jordanian teenagers with DS had more dental anomalies, poorer periodontal health and less dental attendance than age‐ and gender‐matched non‐DS/public school children.     

Implementation of evidence‐based dentistry into practice: analysis of awareness,perceptions and attitudes of dentists in the World Dental Federation–European Regional Organization zone

Based on evidence‐based dentistry (EBD) being a relatively new concept in dentistry, the attitudes, perceptions and level of awareness of dentists regarding EBD, and perceived barriers to its implementation into daily practice, were comparatively analysed in six countries of the FDI (World Dental Federation‐Federation Dentaire Internationale)‐European Regional Organization (ERO) zone (France, Georgia, Poland, Portugal, Slovakia and Turkey). For this purpose, a questionnaire, ‘The Relationship Between Dental Practitioners and Universities’, was developed by the FDI‐ERO Working Group and applied by National Dental Associations (NDAs). A total of 850 valid responses were received, and cumulative data, comparisons between countries and potential impact of demographic variables were analysed. Regarding EBD, similar percentages of respondents reported that they ‘know what it is’ (32.8%) and ‘they practice’ (32.1%). Most respondents believed that ‘EBD is beneficial’ (89.1%); however, they had different thoughts regarding ‘who actually benefited from EBD’. Of the participants, 60% believed that ‘dentists experience difficulties in implementing EBD’. Although lack of time, lack of education and limited availability of evidence‐based clinical guidelines were among the major barriers, there were differences among countries (P < 0.05). Significant differences were also observed between countries regarding certain questions such as ‘where EBD needed to be taught’ (P < 0.05), as both undergraduate and continuing education were suggested to be suitable. Age, practice mode and years of practice significantly affected many of the responses (P < 0.05). There was a general, positive attitude toward EBD; however, there was also a clear demand for more information and support to enhance dentists’ knowledge and use of EBD in everyday practice and a specific role for the NDAs.     

Linking mother access to dental care and child oral health

Abstract – Objectives: The authors examined whether low‐income mothers, who have a regular source of dental care (RSDC), rate the dental health of their young children higher than mothers without an RSDC. Methods: From a population of 108 151 children enrolled in Medicaid aged 3 to 6 years and their low‐income mothers in Washington state, a disproportionate stratified random sample of 11 305 children aged 3 to 6 years was selected from enrollment records in four racial/ethnic groups: 3791 Black; 2806 Hispanic; 1902 White; and 2806 other racial/ethnic groups. A mixed‐mode survey was conducted to measure mother RSDC and mother ratings of child’s dental health and pain. The unadjusted response rate was 44%, yielding the following eligible mothers: 816 Black, 1309 Hispanic, 1379 White, 237 Asian, and 133 American‐Indian. Separate regression models for Black, Hispanic, and White mothers estimated associations between the mothers having an RSDC and ratings of child dental health. Results: Across racial/ethnic groups, mothers with an RSDC consistently rated their children’s dental health 0.15 higher on a 1‐to‐5 scale (where ‘1’ means ‘poor’ and ‘5’ means ‘excellent’) than mothers without an RSDC, controlling for child and mother characteristics and the mothers’ propensity to have an RSDC. This difference can be interpreted as a net movement of one level up the scale by 15% of the population. Conclusions: Across racial/ethnic groups, low‐income mothers who have a regular source of dental care rate the dental health of their young children higher than mothers without an RSDC.     

Gagging Problem Assessment: a re‐evaluation

The Gagging Problem Assessment (GPA) is an instrument to evaluate dental gagging. Although the GPA seemed to be reliable and valid in a pilot study, a replication study with more subjects was needed. Based on the pilot study, the number of items was reduced, resulting in the revised version of the GPA (GPA‐R). The aims of this study were to replicate the reliability of the GPA‐R and to investigate the correlation between dental gagging and general anxiety. Dental gagging patients (n = 59) were compared with a control group (n = 17) at t0 and 3 weeks later. The ‘gagging group’ also filled in the SCL‐90 anxiety scale. Gagging‐specific homogenous domains and internal consistency were determined. Stability and distinguishing capacity of the GPA‐R were assessed. SCL‐90‐Anxiety scores were compared with standard values in a non‐clinical population. The GPA‐R patient part was able to reliably discriminate between the absence or the presence of dental gagging. However, the reliability of the GPA‐R‐dentist part was insufficient. The GPA‐R seems to be sensitive to subtle differences in acts of the dentists. To overcome these problems, more detailed and explicit instructions on how to use the GPA‐R should be formulated and more specific gagging stimuli should be included. The ‘gagging group’ reported ‘fear of choking’ significantly more often than the control group (P = 0·008). This finding might be important for the treatment of dental gagging. Considering the outcome of our study, development of a new diagnostic gagging tool needs another approach that focuses on gagging severity.     

Factors related to the willingness of Palestinian dentists to treat patients with blood‐borne diseases

This study aimed to explore, using groups of simulated patients, the willingness of Palestinian dentists to treat patients with blood‐borne diseases. Simulated patients conducted a telephone survey of a random sample of dentists registered with the Palestinian Dental Association. A random system was used to assign dentists to one of two groups, in which simulated patients randomly identified themselves with either human immunodeficiency virus (HIV) or hepatitis B virus (HBV) and asked for a dental appointment. Three‐hundred and four dentists (76%) responded to our telephone survey. Sixty‐six per cent accepted requests for appointments and 34% declined the appointment requests. Sixty‐eight per cent of the dentists declined appointment requests from patients with HIV and 32% declined appointments from patients with HBV. Dentist's gender, ‘blood‐borne disease type’, ‘place of private practice’, ‘country of graduation’ and ‘years since graduation’ were all significant predictors in the final logistic model. More than one‐third of our respondents declined appointment requests from patients with blood‐borne disease, two‐thirds of which were for patients who identified themselves as having HIV. Education and training programmes are needed to improve attitudes of dentists – especially female dentists, older dentists and dentists practising in northern governorates – towards patients with blood‐borne diseases.     

Dental service utilization among junior secondary school students in Ibadan,Nigeria

The study was carried out to determine factors affecting oral health care service utilization among a representative sample of junior secondary school children in Ibadan, Nigeria. The study was a cross sectional one in which self administered questionnaire was filled by each student. Data were collected on their socio-demographic characteristics, previous visit(s) to the dental clinic and reasons for the visit(s), reasons for non dental visits for those who have never visited the dentist, the students’ beliefs in regular dental visits and reasons for these beliefs. Only 457 students completed their questionnaires reasonably well and their responses were analysed. Their mean age was 13.04±1.10 years. Over 80% of the children claimed they have never visited the dentist and lack of perceived need accounted for 82.8% of the various reasons given for the non visit. Sixty eight point nine percent of the children believed in regular dental visits while 27.8% of them did not believe in regular dental visits. Equity in access and opportunity for disease prevention among young adolescents may be achieved by school oral health program whereby regular oral health talks/education is instituted.