National Health Care: Whither Goeth Dentistry?*

National health insurance is reemerging as an important issue on the national health policy scene. The continuing escalation of health care costs in the US and increasing numbers of individuals without access to health services are stimulating a variety of proposals to redesign the structure and financing of the American health care system. Some change in the current system toward a more national approach to health care is inevitable in the years ahead. While dental care is subject to pressures similar to other health care services, little attention is being accorded dental services in the various national health care proposals that are being advanced. This may be due largely to organized dentistry's reluctance to define a role for itself. If dentistry is to be included in such a plan, it is essential that concerted efforts start soon and that the various public and private sectors of dentistry work collaboratively to develop the dental component to such a plan. The future oral health of the public and the future health of dentistry as a profession depend on it.     

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.     

A Symposium on the Future of Dentistry Report: Implications for the Public Sector: Impact on Dental Hygiene

This paper reviews the six recommendations as approved by the House of Delegates of the American Dental Association in 1983. Each recommendation is reviewed in relation to public health and preventive dentistry as well as the established goal of dental hygiene: "To improve the public's total health by increasing the awareness of and access to quality oral health care and to position the dental hygienist as the preventive oral health professional." To reach this goal it is recommended that dental hygienists seek out opportunities in the public sector where there is more job satisfaction, their professional roles have higher acceptance with both coworkers and patients, and there is a high level of interaction with other health-care professionals.     

Adult Dental Visits in California: Successes and Challenges

OBJECTIVES: This study sought to estimate and characterize the proportion of California adults who visited a dentist in the preceding year and to identify reasons for not going. METHODS: In 1995, 4,029 adults were interviewed by telephone as part of the California Behavioral Risk Factor Surveillance System. Items included recentness of a dental visit, dental insurance status, and number of teeth lost due to disease. Persons who had not seen a dentist within the preceding year were asked the main reason they had not gone. RESULTS: In 1995, 65.9% of adults reported visiting a dentist in the preceding twelve months. Use of dental services was greater among persons aged 35 years or older (70.4%) than among those aged 18-34 years (58.4%) and among those with dental insurance (74.9%) than those without (54.4%). Dental visits were less likely among adults living at or below 200 percent of the federal poverty level, those with less than a high school education, and the edentulous. Reasons most commonly cited for not seeing a dentist were no perceived reason to go (37.2%), cost (30.7%), and fear (9.2%). CONCLUSION: Substantial variation in use of dental services exists among California's adults. Achieving equity in access and opportunity for disease prevention in this state may require expanded dental insurance coverage and serious efforts in oral health promotion.     

The Choice of Health Insurance Plans by University Employees

This study presents the results of a survey of university employees to determine the factors that were important in the choice between two health insurance plans (CHIP vs traditional). The major differences between the plans were their coverage of hospital services, physician office visits, and routine dental services. Separate analyses were conducted for employees of departments associated with the health professions and employees of other departments. The majority of employees selected the CHIP plan, which included coverage of routine dental services. Employees who chose the traditional plan were more likely to have other medical or dental insurance coverage than those who chose CHIP. Multiple regression analyses and discriminant function analyses indicated that the ranking of the importance of coverage of routine dental services and physician office visits were the most important factors in the choice of health insurance plan. These findings indicate that employees may be willing to trade the coverage of other health benefits to secure coverage of routine dental services and physician office visits.     

Developing and deploying a new member of the dental team: a pediatric oral health therapist

There are inadequate numbers of dentists able and willing to treat America's children, specifically children from low income and minority populations. This has led to the well-publicized disparities in oral health among children. In the early part of the 20th century New Zealand faced a significant problem with oral disease among its children and introduced a School Dental Service, staffed by allied dental professionals with two years' training in caring for the teeth of children, "school dental nurses." A significant number of countries have adopted the model. This article reviews the history of attempts to develop such an approach in the United States. It advocates for the development and deployment of pediatric oral health therapists as a means of addressing the disparities problem that exists in America with such individuals being trained in children's dentistry in a two-year academic program. The article asserts that adding a pediatric oral health therapist to the dental team is one way in which the profession of dentistry can fulfill its moral obligation to care for the oral health of America's children and ensure that all children are treated justly. Recently, the American Association of Public Health Dentistry promulgated a strategic plan that endorsed such an approach.     

Determinants of oral health care utilization among diverse groups of immigrants in New York City

BackgroundFew studies have examined utilization of oral health care services among immigrants. The authors examined the determinants of utilization of oral health care among a diverse group of immigrants in New York City.MethodsThe authors examined and interviewed 1,417 foreign-born people, aged 18 to 65 years, who were residents of New York City. They conducted examinations by using criteria established by the National Institute of Dental and Craniofacial Research, Bethesda, Md. The authors used unconditional logistic regression to estimate odds ratios (ORs) and 95 percent confidence intervals for having visited a dentist within the previous year for each of the independent variables.ResultsMore than 70 percent of the participants lacked dental insurance and only about 31 percent reported that they had visited a dentist within the previous year. Flossing (OR = 1.18), dental insurance (OR = 1.58), having a regular source of dental care (OR = 4.76) and more filled teeth (1.33) were independent predictors of utilization of services.ConclusionsHaving a regular source of dental care and having dental insurance are important predictors of immigrants' utilization of oral health care services in New York City.Clinical ImplicationsThe study results suggest the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of vulnerable populations.     

Income, dental insurance coverage, and financial barriers to dental care among Canadian adults

Objectives: To explore the issue of affordability in dental care by assessing associations between income, dental insurance, and financial barriers to dental care in Canadian adults. Methods: Data were collection from a national sample of adults 18 years and over using a telephone interview survey based on random digit dialing. Questions were asked about household income and dental insurance coverage along with three questions concerning cost barriers to accessing dental care. These were: “In the past three years . . . has the cost of dental care been a financial burden to you? . . . have you delayed or avoided going to a dentist because of the cost? . . . have you been unable to have all of the treatment recommended by your dentist because of the cost?” Results: The survey was completed by 2,027 people, over half of which (56.0%) were covered by private dental insurance and 4.9 percent by public dental programs. The remainder, 39.1 percent, paid for dental care out‐of‐pocket. Only 19.3 percent of the lowest income group had private coverage compared with 80.5 percent of the highest income group (P < 0.001). Half (48.2%) responded positively to at least one of the three questions concerning cost barriers, and 14.8 percent responded positively to all three. Low income subjects (P < 0.001) and those without dental insurance (P < 0.001) were most likely to report financial barriers to care. While private dental insurance reduced financial barriers to dental care, it did not entirely eliminate it, particularly for those with low incomes. Those reporting such barriers visited the dentist less frequently and had poorer oral health outcomes after controlling for the effects of income and insurance coverage. Conclusions: Canadian adults report financial barriers to dental care, especially those of low income. These barriers appear to have negative effects with respect to dental visiting and oral health outcomes. For policy, appropriateness will be key, as clarity needs to be established in terms of what constitutes actual need, and thus which dental services can then be considered a public health response to affordability.     

中国口腔医疗保险发展之分析

本文通过查阅大量文献,分析口腔疾病的特点、影响口腔服务利用的因素以及国内外口腔保险的现状,着重讨论了口腔医疗保险对改善口腔医疗服务利用率和促进人群口腔健康的积极作用,利用PEST分析法分析了在中国建立和完善口腔医疗保险的必要性和可行性,提出急需解决的核心问题和发展策略.只有发展口腔保险事业,提高人们对口腔健康的关注度以...     

Dental care coverage and retirement

Objectives: To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS).
Methods: We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables.
Results: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage.
Conclusions: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.     

Dental status and oral health quality of life in economically disadvantaged French adults

Expansion of French health insurance coverage has increased funding for dental care for economically disadvantaged adults. This study aimed to measure clinical and self-perceived oral health, behaviors, and use of dental services by adults who were eligible for such coverage. The regional agency that gives administrative services for the health insurance funds provided a sample of 900 adults aged 35–44 years, insured through this program. We reached 805 of these adults by mail; of these 18% were surveyed and clinically examined. Self-perceived oral health was measured by the Global Oral Health Assessment Index (GOHAI) and participants' attitudes to dental health, by questionnaire. Decayed and Missing teeth constituted 40% of the DMFT. Participants reported poor oral health (63%), and 79% perceived a need for care, although they used dental services infrequently and had poor knowledge of available services. Cost of care and number of carious teeth were important predictors of the GOHAI.     

Dental insurance,attitudes to dental care,and dental visiting

Objective: Dental insurance status is strongly associated with service use. In models of dental visiting, insurance is typically included as an enabling factor. However, in Australia, people self‐select into health insurance (privately purchased) and levels of cover for dental services are modest. Rather than enabling access, insurance status may be a “marker” for unmeasured predisposing attitudes. This study aims to explore associations between dental insurance status and visiting while adjusting for dental care attitudes. Methods: Participants (South Australians aged 45‐54 years) of a 2‐year prospective cohort study (2005‐2007) investigating dental service use were surveyed on their attitudes to dental care and insurance status. Six attitudinal factors were assessed using a 23‐item Likert scale. Bivariate associations between insurance, attitudes, visiting, and other known covariates (age, sex, and household income) were explored. A series of regression models assessed whether prevalence ratios of visiting were attenuated after controlling for attitudinal factors. Results: Response rate was 85.0 percent. Analysis was limited to dentate adults with known dental insurance status (n = 529). The majority had dental insurance (75.2%) and made regular visits (63.7%). Insurance status, visiting, and attitudinal factors were significantly associated. Controlling for covariates, insured adults, compared with the uninsured, were 57 percent more likely to make regular visits. After adjusting for attitudinal factors, the significant association between insurance and visiting persisted. Conclusion: Dental care attitudes did not confound the association between dental insurance and visiting, indicating that dental insurance status was not a “marker” for predisposing attitudes.     

The face of a child: children's oral health and dental education

Dental care is the most common unmet health care need of children. Those at increased risk for problems with oral health and access to care are from poor or minority families, lack health insurance, or have special health care needs. These factors place more than 52 percent of children at risk for untreated oral disease. Measures of access and parental report indicate unmet oral health needs, but do not provide guidance as to the nature of children's oral health needs. Children's oral health needs can be predicted from their developmental changes and position in the life span. their dependency and environmental context, and current demographic changes. Specific gaps in education include training of general dentists to care for infants and young children and those with special health care needs, as well as training of pediatric providers and other professionals caring for children in oral health promotion and disease prevention. Educational focus on the technical aspects of dentistry leaves little time for important interdisciplinary health and/or social issues. It will not be possible to address these training gaps without further integration of dentistry with medicine and other health professions. Children's oral health care is the shared moral responsibility of dental and other professionals working with children, parents, and society. Academic dental centers hold in trust the training of oral health professionals for society and have a special responsibility to train future professionals to meet children's needs. Leadership in this area is urgently needed.     

The impact of HIV on oral health and subsequent use of dental services

OBJECTIVE: This study examined differences in health and access to dental services among a nationally representative sample of patients with HIV using Andersen's Behavioral Model of Health Services Use. METHODS: This investigation is a longitudinal study that used structural equation modeling to analyze data from the HIV Cost and Services Utilization Study, a probability sample of 2,864 adults under treatment for HIV infection. Key predisposing variables included sex, drug use, race/ethnicity, education, and age. Enabling factors included income, insurance, and regular source of care. Need factors included mental, physical, and oral health. Dependent variables included whether a respondent utilized dental services and number of visits. RESULTS: More education, dental insurance, usual source of dental care, and poor oral health predicted a higher probability of having a dental visit. African Americans, Hispanics, those exposed to HIV through drug use or heterosexual contact, and those in poor physical health were less likely to have a dental visit. Of those who visited dental professionals, older persons, those with dental insurance, and those in worse oral health had more visits. African Americans and persons in poor mental health had fewer visits. CONCLUSIONS: Persons with more HIV-related symptoms and a diagnosis of AIDS have a greater need for dental care than those with fewer symptoms and without AIDS, but more pressing needs for physical and mental health services limit their access to dental services. Providers should better attend to the oral health needs of persons with HIV who are in poor physical and mental health.     

Poor oral health as an obstacle to employment for Medicaid beneficiaries with disabilities

Objectives: To inform policy with better information about the oral health‐care needs of a Medicaid population that engages in employment, that is, people ages 16 to 64 with Social Security‐determined disabilities enrolled in a Medicaid Buy‐In program. Methods: Statistically test for significant differences among responses to a Medicaid Buy‐In program satisfaction survey that included oral health questions from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the Oral Health Impact Profile (OHIP) to results for the state's general population and the US general population. Results: All measures of dental care access and oral health were significantly worse for the study population as compared with a state general population or a US general population. Differences were particularly pronounced for the OHIP measure for difficulty doing one's job due to dental problems, which was almost five times higher for the study population. Conclusions: More comprehensive dental benefits for the study population could result in increased oral and overall health, and eventual cost savings to Medicaid as more people work, have improved health, and pay premiums for coverage.     

The virtual dental home: a critique

The Virtual Dental Home is a concept of the Pacific Center for Special Care of the Arthur A. Dugoni School of Dentistry in San Francisco. It is designed to improve access to dental care for underserved populations, specifically children and institutionalized adults. This article describes the development and implementation of the Virtual Dental Home, subsequently critiquing the concept. The criteria for a dental home are not met by the program. It is the equivalent of a traditional public oral health prevention and screening program, with the additional dimension of allowing dental hygienists and assistants to place interim glass ionomer restorations in dental cavities. The critique questions the need to insert a “cloud” dentist into the process. The routine utilization of radiographs is also challenged. The VDH not only lacks the attributes of a dental home, it has not been shown to be as efficient and effective as traditional programs staffed by dental hygienists and dental therapists. The article concludes by describing how programs utilizing dental therapists could address the deficiencies of the Virtual Dental Home, effectively improving access to oral health care for underserved populations.     

成都市外国人口腔卫生服务利用的影响因素研究

目的 调查中国成都市外国人的口腔卫生服务利用情况及其影响因素,为口腔卫生从业者对口腔卫生服务的国际化发展进行探索,为卫生政策制定者制定移民口腔健康政策提供建议。方法 参照世界卫生组织制定的《成人口腔健康问卷》,结合安德森卫生服务利用模型设计问卷。问卷内容包括口腔健康情况、口腔保健意识、口腔健康保障和基本信息4个部分。采用方便抽样方法选择调查对象。调查结果使用SPSS 20.0统计软件分析,采用Binary Logistic回归和分层分析方法进行统计学分析。结果 共有来自75个国家的654名调查对象完成调查,结果显示有102（15.6%）名外国人在成都曾经遇到过口腔问题却没有就诊。Binary Logistic回归分析显示,女性、长时间在成都居住、过去1年内出现过口腔健康问题、有使用牙线习惯、和家人一起居住在成都者遇到口腔问题或定期口腔体检时,更倾向于到本地口腔科就诊。通过ROC曲线分析,居住在成都10.5个月是外国人选择在成都就诊的临界值。结论 卫生政策制定者可以根据不同居住时间的外国人制定不同的口腔急诊或平诊指南,创造出更方便外国人在成都因口腔问题就诊的环境,以促进外国人在成都的口腔卫生服务利用。     

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     

Technology is a Critical Game Changer to the Practice of Dental Hygiene

Dental hygienists will need to embrace 21st century technology to adapt to workplace settings.Background and PurposeTo stay relevant in the workforce, dental hygienists need mastery of new skills and technologies. The purpose of this paper is to elucidate the vast array of technological advances impacting dental practice and the consequent implications for oral health care providers.Critical AnalysisNew technologies have provided unparalleled opportunities for degree and career advancement for dental hygienists. Advances in science and technology are providing patients with better quality and more convenient oral health care. Dental hygienists need technological skills that enable them to fully utilize technology as a strategy for consultation with dentists and other health care professionals and for other purposes. Continuing education and life-long learning factor into preparing dental hygienists for 21st century technologies.ConclusionWith technological advances, less adaptive professionals could potentially see a decrease in demand for their services. Possessing a high level of knowledge of dentistry and dental hygiene does not ensure a position in the workforce. Knowledge of technologies and associated skills are required for quality patient care and career and personal growth.     

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.