Factors associated with self-reported use of dental health services among older Greek and Italian immigrants

The authors discuss utilization of dental health services by older Greek and Italian immigrants in Melbourne. Australia. Their study involved 374 Greek and 360 Italian adults who completed a questionnaire and received an oral examination. Nearly 41% of Greek and 45% of Italian respondents had used dental services in the previous year. As barriers to care, Greek participants most often cited waiting lists and waiting time in the office. Italian participants most often identified cost, length of waiting lists and language barriers. Multivariate analyses associated recent use of dental services with number of teeth, oral health knowledge, age and occupation before retirement for both groups, as well as living arrangements among Greek participants and perceived barriers among Italian participants. Findings highlight the need for oral health promotion programs targeted toward older adults from immigrant populations and reductions of the structural barriers that prevent these adults from seeking oral health care.     

Wealth effect and dental care utilization in the United States

Objective: The purpose of this article is to examine the relationship of wealth and income and the relative impact of each on dental utilization in a population of older Americans, using data from the Health and Retirement Study (HRS). Methods: Data from the HRS were analyzed for US individuals aged 51 years and older during the 2008 wave of the HRS. The primary focus of the analysis is the relationship between wealth, income, and dental utilization. We estimate a multivariable model of dental use controlling for wealth, income, and other potentially confounding covariates. Results: We find that both wealth and income each have a strong and independent positive effect on dental care use of older Americans (P < 0.05). A test of the interaction between income and wealth in our model failed to show that the impact on dental care utilization as wealth increases depends on a person's income level or, alternatively, that the impact on dental use as income increases depends on a person's household wealth status (P > 0.05). Conclusions: Relative to those living in the wealthiest US households, the likelihood of utilizing dental care appears to decrease with a decline in wealth. The likelihood of utilizing dental care also appears to decrease with a decline in income as well.     

Dental knowledge, attitudes towards oral health care and utilization of dental services among male industrial workers with or without an employer-provided dental benefit scheme

Abstract In industrialized countries various dental benefit schemes have been implemented to improve the utilization of dental services, though few studies have demonstrated that effect. Prior to a comprehensive clinical study in southern Finland, a postal questionnaire survey of male industrial workers (age 38–65 yrs) was conducted to investigate knowledge and attitudes concerning oral health care and whether access to an employer-provided dental benefit scheme was associated with the utilization of dental services. The response rate was 81% (n=325) in the subsidized group and 69% (n=174) in the control group. In both groups, 60% of the subjects had had their last dental visit within a year but 91% of the subsidized workers compared to 79% of the controls had visited a dentist in the past two years (p<0.001). The subjects had similar attitudes towards the importance of regular dental care and its implications for dental and general health. Subsidization explained the disparity in the current dental visiting pattern between the groups better than the possibility of using working hours for dental visits. Backward stepwise logistic regression revealed that the probability of a dental visit within the past two years was positively associated with access to an employer-provided dental benefit scheme, tooth brushing to maintain dental health, and number of teeth, and negatively associated with number of carious teeth. Our results demonstrate a positive impact of subsidization on the utilization of dental services.     

Dental care visits among dentate adults with diabetes, United States, 2003

OBJECTIVES: Regular dental assessments are beneficial to adults with diabetes. This analysis evaluates nationally representative data to test the relation between diabetes status and dental care visits, and to compare diabetes care, foot care, eye care, and dental care visits among dentate adults with diabetes. METHODS: Data from the 2003 National Health Interview Survey were used to test whether diabetes status was associated with dental care visits among dentate adults aged > or =25 years, controlling for available covariates. RESULTS: There was a significant interaction between diabetes status and sex for the odds of having a dental care visit. Among dentate men, there was no significant association between diabetes status and dental care visits. Dentate women with diabetes were significantly less likely to have had a dental care visit than were dentate women without diabetes. Of the four types of health care visits compared, dentate adults with diabetes were least likely to have had a dental care visit in the preceding year. Disparities in health care visit rates across race/ethnicity, poverty status, and education categories were most pronounced for dental care. CONCLUSIONS: Having diabetes is associated with a variety of adverse health outcomes, including periodontitis. Adults with diabetes would benefit from regular health care visits to address these concerns, but this report shows that women with diabetes are underutilizing dental care services. The underutilization may be a result of the barriers to dental care that disproportionately affect women. Additional research should test the plausibility of these explanations and the influence of sex.     

Dental service trends for older US adults, 1998-2006

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

Investigation of delay in utilization ot government dental services in Malaysia

Although delays in seeking dental care among patients are frequently observed in daily practice, this problem has never been investigated in other utilization studies. This study attempts to establish the magnitude and severity of the problem of delay in a delivery system where cost is not a major barrier to utilization. 555 users of Government dental services were interviewed. Only 37% of them came promptly within 6 days of perceiving a dental need. The majority (63%) had delayed their dental visit for more than 1 week. In fact, the highest frequency of delay was for more than 1 month. Prompt attendance was found to be associated with people who regularly came for asymptomatic check-ups. In contrast, more than 50% of those who thought they needed fillings and extractions had delayed their visit for more than a month. The main causes of delays were attributed to work commitments and the lack of perceived need for urgent care. Barriers related to transport or financial problems were ranked very low. The implications of these findings are discussed.     

Determinants for dental visit behavior among Hong Kong Chinese in a longitudinal study

OBJECTIVES: The aim of this research was to study the major determinants for dental services utilization among middle-aged Hong Kong Chinese in a longitudinal study using an expanded Andersen and Newman model as the theoretical framework. METHODS: A random sample of 372 middle-aged Hong Kong Chinese were interviewed and clinically examined in an oral health survey. The findings were explained to the subjects and they were advised to seek care from their own dentist as appropriate. RESULTS: A total of 322 subjects were interviewed over the telephone after 12 months. About half had visited a dentist within the study period. Results of the bivariate analysis showed that proportionally more subjects who had dental benefit coverage, had prevention-oriented attitudes, were regular users of dental services, had received counseling from a dentist, or had more filled teeth at the baseline examination had visited a dentist within the study period. Logistic regression analysis produced a final model consisting of seven factors and three interaction terms that was able to classify 68 percent of the subjects into the correct user category. CONCLUSION: The expanded Andersen and Newman model was useful as a theoretical framework in studying the dental services utilization behaviors of the Hong Kong adults.     

Research utilization among dental hygienists in Sweden--a national survey

Over the last decade evidence-based practice has become increasingly important in health care as an approach to improve patient outcomes. It is vital that dental hygienists, like other health professionals, use research findings to inform clinical practice. The objective of the present study was to investigate the extent of research utilization among dental hygienists in Sweden and to investigate the relationship between level of education and factors related to research utilization. A random sample of 261 dental hygienists in Sweden, 113 with 1 year and 148 with 2-year education, responded to a postal questionnaire covering various aspects of research utilization, i.e. their attitudes towards research, availability and support for the implementation of research findings, use of research in daily practice, their activity in seeking new research findings and their participation in a range of research-related activities. Dental hygienists with 2-year education had a more positive attitude towards research, used research to a greater extent and were more active in seeking new research findings than dental hygienists with 1-year education. Overall, relatively few dental hygienists reported that they implemented research findings in practice; the most frequently reported activity concerned reading research articles in professional journals. The conclusions are that the length of dental hygiene education is a key factor influencing the application of research findings to practice. One-year education appears to be inadequate to achieve evidence-based practice. Moreover, not even two years of formal education guarantees necessary competence in research for evidence-based dental hygiene practice.     

Demand for and utilization of dental services among Hong Kong employees with and without dental benefit coverage

Abstract The objectives of the present study were to investigate the effects of employer-provided dental benefits on the pattern of demand for and utilization of denial services among Hong Kong employees and to analyse whether employees' awareness about an existing denial benefit programme influenced their denial service demand and utilization. Staff from 11 selected companies with and without dental benefits responded to questionnaires concerning their personal factors, demand for dental services, and utilization of denial services and about their awareness of their dental benefit coverage. Overall response rate was 67%. The socio-demographic characteristics of those respondents who were covered and those who were not were similar. Forty per cent of the covered respondents were not aware of their dental benefit coverage, so analysis was performed with three groups of respondents, covered and aware, covered and unaware, and uncovered. A larger proportion of employees in the “aware” group had visited a dentist in the previous 12 months and had visited a dentist for asymptomatic reasons. The “aware” group reported more “low expenditure” items and less “high expenditure” items. Those who were aware of their dental benefit coverage irrespective of the type of scheme reported a significantly higher demand than those who were not aware of their coverage. Demand and utilization of the covered, but unaware, group was more similar to the uncovered group than lo the “aware” group. Coverage per se had no apparent effect on the demand for dental services. Further studies will be necessary lo establish that higher dental care demand and utilization induced by third party schemes also leads to improved oral health.     

Demographic, health and lifestyle factors associated with dental service attendance by young adults

BACKGROUND: The aim of this study was to describe the demographic and health and lifestyle factors associated with dental service attendance in the previous 12 months by young Australian adults (18-24 years). METHODS: Population-based data from the 2001 Australian National Health Survey were analysed. Proportions and single associations between variables of interest and dental service attendance were calculated. A logistic regression analysis using significant single association variables was then conducted. RESULTS: Overall, 41 per cent of young adults in this study had visited a dental professional in the previous 12 months. Females, those in cities, those with private insurance, those who spoke languages other than English, those in the highest socioeconomic group and those with healthy behaviours were subgroups most likely to have visited a dental professional. With logistic regression, factors found to be associated with dental services attendance were being female, having private health insurance and low alcohol consumption. CONCLUSIONS: In this study, the proportion of young adults who had visited a dental professional in the previous 12 months was only 41 per cent. It is therefore suggested that oral health policy and promotion activities be encouraged for this group, paying attention to young adults in groups with low attendance.     

Predictors of dental care utilization among working poor Canadians

Abstract – Objective: This study used the Gelberg–Andersen Behavioral Model for Vulnerable Populations to identify predictors of dental care utilization by working poor Canadians. Methods: A cross‐sectional stratified sampling study design and telephone survey methodology was used to collect data from a nationally representative sample of 1049 working poor individuals aged 18 to 64 years. Working poor persons worked ≥20 h a week, were not full‐time students and had annual family incomes <$34 300. A pretested questionnaire included sociodemographic items, self‐reported oral health measures and two dental care utilization outcomes: time since their last dental visit and the usual reason for dental visits. Results: Hierarchical stepwise logistic analyses identified independent predictors associated with visiting the dentist >1 year ago: male gender (OR = 1.63; P = 0.005), aged 25–34 years (OR = 2.05; P = 0.02), paying for dental care with cash or credit (OR = 2.31; P < 0.001), past welfare recipients (OR = 1.65; P = 0.03), <21 teeth (OR = 4.23; P < 0.001) and having a perceived need for dental treatment (OR=2.78; P < 0.001). Sacrificing goods or services to pay for dental treatment was associated with visiting the dentist within the past year. The predictors of visiting the dentist only when in pain/trouble were lone parent status (OR = 4.04; P < 0.001), immigrant status (OR = 1.72; P = 0.006), paying for dental care with cash or credit (OR = 2.71; P < 0.001), a history of an inability to afford dental care (OR = 1.62; P = 0.01), a satisfactory/poor/very poor self‐rated oral health (OR = 2.10; P < 0.001), number of teeth <21 (OR = 2.58; P < 0.001) and having a perceived need for dental treatment (OR = 2.99; P < 0.001). Conclusions: This study identified predisposing and enabling vulnerabilities that jeopardize the dental care‐seeking practices of working poor persons. Dental care utilization was associated with relinquishing spending on other goods and services, which suggests that dental care utilization is a competing financial demand for economically constrained adults.     

Disparities in dental service utilization among Alabama Medicaid children

OBJECTIVES: Access to oral health care and utilization of available services are important factors in minimizing the oral health disparities among underserved minorities. Our objective was to evaluate the racial and other factors related to 'realized access' to oral health care among Alabama Medicaid children. METHODS: Data were obtained from 308 538 Alabama Medicaid claims submitted in 1995-96 and analyzed using regression analyses. RESULTS: A lower proportion of Blacks (24%) and other racial groups (22%) compared to Whites (31%) and a lower proportion of 15-19-year-olds (15%) compared to younger age groups (30%) obtained dental services (P < 0.05). Odds of males obtaining care were slightly lower compared to females (OR = 0.96; 95% CI = 0.94-0.99). However, there was a significant interaction of race with other factors in determining service utilization. Subjects who were continuously eligible for Medicaid throughout the fiscal year were more likely to obtain care (OR = 2.86; 95% CI = 2.78-2.93). About one-fourth of the visits had an emergency procedure included in the treatment rendered. Availability of a participating dentist within the county of residence and the lower reimbursement-to-charge ratio were among the other related factors for underutilization of services. CONCLUSIONS: There is a significant racial disparity in utilization of dental services even among the Medicaid-eligible children. However, this was not a simple function of race, but a complex interaction of race with other factors such as age, gender, and location. ACKNOWLEDGMENT: Supported by CDC grant #U48/CCU 409679.     

社区与门诊老年人牙科焦虑症及其相关因素的研究

目的:调查社区和牙科门诊老年人牙科焦虑症的发生情况及其相关的因素. 方法:使用汉化Coarh's牙科焦虑量表(Dental Anxiety Scale,DAS)评定来自社区和口腔门诊的各700名老年人的牙科焦虑症(DA)情况,通过自行设计的一般情况表,收集可能与老年人DA发生有关的变量,采用多因素Logistic回归方法分析与社区、口腔门诊老年人DA发生有关因素.结果:DA的发生率在社区老人和口腔门诊老人中分别为23.86%、34.10%.Logistic回归分析显示,社区和口腔门诊老年人牙科焦虑症的共同影响因素包括性别、自我健康评价、亲友看牙经历、生活有焦虑;影响社区老年人牙科焦虑症的因素还包括看牙医的频率和既往就诊满意度. 结论:老年人DA的发生在社区和口腔门诊中均普遍存在,但影响因素有所不同. 减少DA对老年人口腔甚至身心健康的不良影响需要多方面共同努力.