The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome

OBJECTIVE: To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. BASIC DESIGN: Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. SETTING: Two health authorities in South Wales, UK. SUBJECTS: A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. RESULTS: For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. CONCLUSIONS: Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.     

A typology of models for expanding access to oral health care for people living with HIV/AIDS

Objectives: This article describes a typology of program models for expanding access to dental services for people living with HIV/AIDS (PLWHA). These programs serve communities with limited access and high unmet need for oral health care, such as rural areas, low‐income and racial/ethnic minorities. Methods: Interviews and site visits with dental and program directors were conducted at participating sites, including AIDS service organizations, community health centers, and university‐affiliated medical centers or hospitals. Results: Despite the differences across organizational structure, similar models and approaches were developed to engage and retain PLWHA in dental care. These approaches included: using mobile dental units; expanding the type and availability of previous dental services provided; providing training opportunities for dental residents and hygienists; establishing linkages with medical providers; providing transportation and other ancillary services; using dental case managers and peer navigators to coordinate care; and patient education. Conclusions: This typology can assist program planners, medical and dental care providers with service delivery strategies for addressing the unmet need for oral health care in their area.     

Factors associated with the use of emergency dental care facilities in a French public hospital

This study was undertaken to qualitatively analyze patients’ profiles and to identify the sociodemographic and oral health factors associated with emergency visits to the public dental service in Montpellier, France. A cross‐sectional survey was conducted in the dental care service at Montpellier Hospital. Socioeconomic and clinical variables were compared between the patients using the emergency dental care service and those utilizing the general dental services, which were by appointment. An evaluation of the results indicated that younger patients and people from lower socioeconomic groups used the emergency dental service more frequently. Unemployed people (OR = 1.60) and manual workers (OR = 1.86) were also more likely to use this service. The need for treatment of caries was significantly higher in the group that used the emergency service. It appeared that the two groups of patients had different attendance behavior and showed significantly different socioeconomic and oral health status.     

新型冠状病毒肺炎防疫期口腔患者的心理干预

突发公共卫生事件可对公众心理产生影响。新型冠状病毒疫情暴发影响了全国口腔医疗机构正常开展诊疗服务,口腔门诊延期等应对措施可对口腔疾病患者的体验、认知、治疗和康复等方面产生潜在影响。本文通过文献复习,对口腔黏膜病、颞下颌关节病、磨牙症、牙周病等与患者心理状态密切相关的口腔心身疾病进行回顾,认为这些患者可能更容易受到应激事件的影响,需要口腔专科医师提高关注度。同时分析了不同口腔疾病患者可能出现的心理应激症状,为口腔医师远程咨询和急诊接诊提出建议。疫情期间口腔医师不仅承担了口腔专业指导的专家角色,还承担了帮助患者进行心理疏导的角色。     

A preventive dental care programme at the workplace

Employees from an industrial group in Brisbane were examined at the workplace and found to have generally low levels of dental disease. At the same time, the Australian Bureau of Statistics suggests that less than 45 per cent of Australians attend a dentist annually. This low attendance for regular dental care reduces the effectiveness of any preventive dental service. A pilot scheme of preventive dental care was provided for employees at the workplace in Brisbane. The aim of the programme was to provide regular health counselling and reinforcement of oral health activities, general dental information, regular prophylaxis, scaling and cleaning, and referrals for restorative care. The preventive programme was appropriate given the disease levels. The services were effective in improving the periodontal status and restorative care which resulted from referrals. As well, the preventive dental care programme proved to be readily acceptable to both employees and management.     

Factors influencing use of dental services in rural and urban communities: considerations for practitioners in underserved areas

Individuals' utilization of dental services depends upon an array of factors, including access to care, financial restrictions, attitudes toward dental care, and dental fear. These factors, in turn, may vary across geographic locations and demographic groups. The goals of this study were to assess the use of dental services in both rural and urban areas of Kentucky and to examine challenges facing practitioners in rural areas. Individuals sampled from a rural population and patients in rural and urban dental clinics completed questionnaires about use of dental services, self-rated dental health, and dental fear. While these variables were strongly interrelated, differences emerged across locations. Patients in the urban area reported having more dental insurance but not better dental health. Patients in more rural areas reported seeking more emergency dental treatment but not more dental fear. While these factors are important considerations across locations, dental practitioners in rural areas in particular should be aware of barriers to dental care facing individuals in these areas. They have unique opportunities to provide education to their patients regarding the importance of dental care and the role of oral health in overall physical health.     

Implementation of the ART approach in South Africa: an activity report.

The Atraumatic Restorative Treatment (ART) approach has been adopted in public dental services in South Africa as an appropriate and economical means to provide basic restorative care in communities where it was not possible before. The approach also offers a less-traumatic treatment concept for fearful patients and children in the private dental practice. In 2000, the Division of Community Dentistry, University of the Witwatersrand, implemented a training, research and service programme in the ART approach. The aim of these activities was the promotion of ART at various levels within the oral health care system in the Republic of South Africa. The objectives of the programme were to initiate and provide training of oral health workers in ART, to evaluate the outcome of training and service programmes and to disseminate results. This paper describes the Division's ART activities in 2000, regarding public, private and refugee health services.     

Analysis of inquiry responses related to visits of stomatological patients depending on age, sex and educational level

The purpose of the study was demonstration of possible relationships between the frequency of visits to stomatological office and the age, the sex and the educational level of the patients. The analysis covered 776 responses to an inquiry obtained from the patients visiting the Department of Conservative Stomatology. Comparative statistical analysis showed that these parameters had no effect on the frequency of visits to stomatological surgery. With a high likelihood one can state that this frequency depends on adequately conducted health education, wide network of specialist services, and the health care of the population.     

Multivariate analyses of patient financial systems and oral health‐related quality of life

Johansson V, Axtelius B, Söderfeldt B, Sampogna F, Paulander J, Sondell K. Multivariate analyses of patient financial systems and oral health‐related quality of life. Community Dent Oral Epidemiol 2010; 38: 436–444. © 2010 John Wiley & Sons A/S Abstract – Objectives: Since 1999, the public dental health service (PDHS) in the county of Värmland, Sweden, has two co‐existing patient financial systems, i.e. ways for the patient to pay for dental care services. Alongside the traditional system of fee‐for‐service payment, i.e. paying afterwards for provided services, a new system of contract care is offered. In this system, dental care is covered by a contractual agreement, for which the patient pays an annual fee and receives care covered by the contract without additional costs. The aim of this article was to study whether patient financial system was associated with oral health‐related quality of life (OHRQoL). Methods: A questionnaire was answered by 1324 randomly selected patients, 52% from contract care and 48% from fee‐for‐service. The questionnaire contained questions about how much one was prepared to pay for dental care, how much one paid for dental care the previous year, OHIP‐14 (measured OHRQoL), dental anxiety, humanism of caregiver, SF‐36 (measured general health), multidimensional health locus of control, sense of coherence (SOC), self‐esteem and demographics. Data on patient financial system, gender and age were obtained from the sampling frame. The material was analysed with a hierarchical block method of multiple regression analysis. Results: When controlling for all other variables, patient financial system was one of the strongest associations with OHRQoL: patients in fee‐for‐service had worse OHRQoL than those in contract care. OHRQoL was also associated with general health, SOC and to some extent also with psychological and economic factors. Of the social variables, only being foreign born was significant: it was associated with worse OHRQoL. Conclusions: Patient financial system was associated with OHRQoL when controlling for confounding factors: patients in contract care had better OHRQoL than those in fee‐for‐service care.     

Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany

This article reviews access to and financing of dental care for aging populations in selected nations in Europe. Old age per se does not seem to be a major factor in determining the use of dental services. Dentition status, on the other hand, is a major determinant of dental attendance. In addition to perceived need, a variety of social and behavioral factors as well as general health factors have been identified as determinants of dental service use. Frail and functionally dependent elderly have special difficulties in accessing dental care; private dental practitioners are hesitant to provide dental care to these patients. One reason may be that the fee for treating these patients is too low, considering high dental office expenses. Another reason may be problems related to management of medically compromised patients. This raises an important question: does inadequate training in geriatric dentistry discourage dentists from seeking opportunities to treat geriatric patients? Overall, the availability of dental services, the organization of the dental health care delivery system, and price subsidy for dental treatment are important factors influencing access to dental care among older people in Europe as well as in the United States.     

Health insurance reimbursement of dental care in Hungary

The aim of this study was to assess the annual health insurance reimbursement of dental health service in Hungary. The assessment base of the study was the annual reports of National Health Insurance Fund Administration (OEP). Only the data collected from the services in contractual relationship with the OEP and delivered in 2008 were evaluated. Dental care services are organised in different levels: general dental service, specialist dental care, special dental care on university level and inpatient departments. Our study covers primary, outpatient and hospital dental care. Dental care was supplied by 3.378 general and specialist dental care services at the end of 2008. For the hospital treatment of more serious cases 17 inpatient departments are available with 154 patient beds. Within the period of examination (2008) 23.6 million interventions were carried out in 7.6 million cases. The total health insurance reimbursement of dental care (including primary, outpatient and hospital care) was 24.92 billion HUF (88.82 million Euro) in 2008. The health insurance reimbursement of dental care in Hungary is approximately 2% of the total health insurance expenditures of the National Health Insurance Fund Administration (OEP). Within the period under investigation, the health insurance reimbursement of dental care did not change significantly.     

Dental insurance,service use and health outcomes in Australia: a systematic review

Private health insurance plays a key role in financing dental care in Australia. Having private dental insurance has been associated with higher levels of access to dental care, visiting for a check‐up and receiving a favourable pattern of services. Associations with better oral health have also been reported. In the absence of any existing review, this paper aims to systematically review the relationship between dental insurance and dental service use and/or oral health outcomes in Australia. A systematic search of online databases and subsequent sifting resulted in 36 publications, 33 of which were cross sectional and three cohort analyses. Dental service outcomes were more commonly reported than oral health outcomes. There was considerable heterogeneity in the outcome measures reported, for both service use and health outcomes. Overall, the majority of the evidence was from cross sectional studies and few studies reported analyses adjusted for confounding factors. The consolidated evidence points towards a positive association between dental insurance and dental visiting. Dentally insured adults are likely to have more regular access to dental care and have a more favourable pattern of service use than the uninsured. However, evidence of associations between dental insurance and oral health are mixed.     

Ethnic disparities in the prevalence of dental caries and restorative dental treatment in Brazilian children

Aim : This study assesses disparities in the oral health status of Brazilian black and white children. Participants : 11‐and 12‐year‐old schoolchildren living in 131 cities of the State of São Paulo, Brazil. Methods : Spatial data analysis of city‐level indexes of oral health, socio‐economic status and provision of dental services. Main outcome measures : Ethnic ratios of the DMFT and the care index. Results : White children had higher indexes of caries in permanent teeth than their black counterparts, concurrent with a higher utilisation of dental attendance. The gap of caries prevalence between black and white children was reduced in cities with a better profile of socio‐economic status. Cities with higher per‐capita yearly budget, expenditure in health, and provision of public dental services presented reduced indications of ethnic inequality in dental care. Conclusion : The knowledge of conditions associated with a lower ethnic discrepancy in the risk of caries and in the incorporation of dental services can be used to design socially appropriate dental services. An improved community dental service, higher public expenditure in health and per‐capita municipal yearly budget contribute effectively to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between black and white children.     

Access to dental care among older adults in the United States

Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.     

The Edinburgh-Helsinki study: a comparison of dental care for children

A comparison was undertaken of dental care for children in Edinburgh and Helsinki. The evaluation centred upon an epidemiological investigation of the dental health of children in the 5-, 12- and 15-year age groups. This was performed by examiners using standardized procedures who were drawn from both countries. They employed an established system of data recording and processing (SPEED). Using these data, and background information from official and other sources, an assessment was made of the effectiveness, adequacy, efficiency and appropriateness of the services. Children's dental health, particularly in the youngest age group, was generally better in Helsinki than in Edinburgh as were both the population coverage and extent to which disease was controlled. However, the services in Edinburgh were marginally the more economically efficient. This arose from their being provided mainly by independent contractors working under a fee per item of service rather than by a public salaried system. In neither city was the delivery of dental services supplemented by water fluoridation nor was extensive use made of auxiliary personnel. The decrease in caries prevalence in recent years has profound implications for the dental services in both countries. It calls for continuing re-appraisal of present policies on expenditure, manpower, dental education and ways of delivering dental care.     

Trends in treatment performed in the Phelophepa Dental Clinic: 1995-2000.

Mobile clinics are a cost-effective method of meeting the dental needs of rural communities in South Africa. Phelophepa, the first primary health care train of its kind world-wide, provides eye care, education, medicine, basic health care and since June 1995 dental treatment to rural communities. All services are rendered by students under supervision of qualified staff. The aim of this study was to analyse and report the data for treatment performed in the dental clinic from June 1995 to May 2000. During its first five years of operation, dental services were provided at 183 towns in all provinces except Gauteng. Of the 42,073 patients treated during this time (an average of 229.9 per town), 67.4% were adults. 71.3% of the 103,283 procedures performed were extractions, 15.7% could be classified as preventive with the remaining 13% as restorative procedures. The average value of the service provided to each patient was R218.53. The exposure of dental, dental therapy and oral hygiene students to rural areas of South Africa serves the important purpose of sensitising students to the realities of oral diseases in these communities.     

Out-of-hours dental services: a survey of current provision in the United Kingdom

OBJECTIVE: To describe the variety of arrangements for providing out-of-hours dental care in the UK. DESIGN: A telephone interview survey of health authorities and health boards. SETTING: United Kingdom. SUBJECTS: 104 health authority contacts, usually consultants in dental public health, dental advisers or others in a position to describe the local dental service arrangements. RESULTS: At weekends, 25 authorities have no formal dental care arrangements for unregistered patients, 55 have separate arrangements for registered and unregistered patients, and 44 have 'universal access' arrangements--for anyone in an area, regardless of their registration status. On weekday nights over two-thirds (82/124) of UK health authorities have no formal arrangements for unregistered patients. Where there are separate 'safety-net' services intended for unregistered patients only they are usually (in 48 of 55 authorities) emergency treatment sessions. A fifth of authorities reported planned changes to their local out-of-hours arrangements, including the introduction of telephone triage, and moves to make care available at more times, to more people or from centralised premises. CONCLUSIONS: There is extremely wide geographical variation in the organisation of out-of-hours dental services provided in the United Kingdom. In many parts of the UK there are no formal out-of-hours care arrangements for unregistered patients, even at weekends. This unequal provision will mean inequitable access for many unregistered patients. With increasing demands from a growing unregistered population, and various government initiatives to make primary care services more integrated and accessible, the highly fragmented pattern of provision in many areas may no longer be acceptable.     

'What do our patients really want from us?': Investigating patients perceptions of the validity of the Chartermark criteria.

BACKGROUND: The 'restructuring' of the NHS over the last decade has demanded a 'market oriented' service more receptive to the needs and priorities of 'clients'receiving health care. These changes have been important to the provision of dental health care in which there has been a similar need to provide increasingly patient and market oriented services. One of the ways in which quality care has been assessed within NHS Trusts is through the national 'Chartermark' award, which identifies national centres of excellence in health care and research. AIM: The aim of this paper is to assess whether patients themselves considered the criteria identified by the Chartermark award important in the provision of good quality dental services METHOD: This is a pilot study consisting of a structured questionnaire conducted face-to-face with a 'convenience' sample of 46 patients. ANALYSIS: Data were inputted into SPSS and thematic analysis was conducted on the data. RESULTS: The Chartermark criteria relevant to patient involvement were divided into four main themes.The findings from this small pilot study suggest that in relation to dental care, although patients are interested in information on standards, performance and complaints, there is considerable disinterest in organisational and financial dimensions.     

The purchaser-provider split: implications for dental services.

In July 1991, the National Government announced proposals for a radical restructuring of the New Zealand public health system, a central feature of which is the separation of the purchasing and providing roles currently performed by area health boards. While the competitive market model suggests that the split should improve the efficiency of public health services by effectively creating a market system, this paper suggests that, in practice, there are likely to be a number of obstacles. Other potential sources of efficiency are improved accountability, improved management, and integration of primary and secondary care. For dental health services, the separation of purchaser and provider should introduce greater flexibility into State-funded dental services by opening up options for alternative providers and methods of provision. Factors such as the number and structure of provider units; the contractual arrangements between these units and the RHAs, especially in respect of payment mechanisms; and the regulatory regime which covers these contractual arrangements will all affect service delivery. If real choices between types of providers and methods of provision eventually emerge, a major challenge for RHAs will be to monitor and enforce at reasonable cost any quality measures built into contracts.