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.     

Dental Care Satisfaction: the Reliability and Validity of the DSQ in a Low-income Population

Objectives: Studies examining satisfaction with dental health care among the poor are quite rare. This study was done to confirm the internal structure and reliability of the Dental Satisfaction Questionnaire (DSQ), a measure of dental care satisfaction, among a low-income population, and provide normative data regarding dental satisfaction among low-income people. Methods : Subjects were 895 mothers of school-aged children who were administered the DSQ as part of a larger study of dental utilization and dental fears in Seattle. Results : Factor analysis largely confirmed the factor structure of the DSQ. Results also suggested subjects in this sample were less satisfied with pain management than nonpoor people. Self-reported dental health and dental appearance were associated with satisfaction with pain management, quality of care, access to care, and overall satisfaction. Race/ethnicity, education level, marital status, nation of origin, and type of insurance predicted differences in satisfaction with pain management and access. Conclusions : Barriers to dental care and quality of care among low-income populations are discussed. Uses and research with the DSQ are suggested.     

Factors related to satisfaction with dental care among 23-year olds in Norway

OBJECTIVES: The aims of the present study were to explore (i) the prevalence and distribution of satisfaction with dental care among 23-year olds in Norway; and (ii) possible factors associated with the same variable. METHODS: A random sample of adolescents (n=968) surveyed at age 18 were resurveyed by post at the age of 23. The questionnaire included the psychometric instruments Dental Satisfaction Questionnaire (DSQ), Dental Fear Survey (DFS), Dental Beliefs Survey (DBS), and the (WHO) Five Scale Psychological General Well-Being Schedule. RESULTS: The response rate was 69%. Of this group, 15% of the subjects were very satisfied, and another 15% were very dissatisfied with dental care. The following variables explained 58% of the variance of satisfaction with dental care at age 23: positive beliefs of the dentist (DBS), low dental anxiety, perception of having a dentist to go to, last treatment session not painful/unpleasant, and gender (male). Being very satisfied with dental care was associated with high DMFT at age 16 and few previous experiences of pain. Being very dissatisfied at age 23 was associated with low general well-being, previous experiences of pain and dislike of the dentist (both reported at age 18). Last dental treatment session was reported as very painful or unpleasant by 6.7% of the group. CONCLUSIONS: Beliefs of the dentist and pain control seems to be important aspects in young adults' evaluation of dental care.     

Patient satisfaction with the comprehensive care model of dental care delivery.

In the summer of 1997, the College of Dentistry, The Ohio State University, changed its predoctoral clinics from the traditional model to the comprehensive care (CC) model. Although the CC model is considered the better model for delivery of care, from the patient perspective it has not been previously evaluated. The purpose of this study was to compare the two dental care delivery systems--the traditional model and the CC model--using patient satisfaction. The Dental Satisfaction Questionnaire (DSQ) developed by the Rand Corporation was used to assess patient satisfaction. The questionnaire consists of nineteen items, measuring overall satisfaction and subscales of access, pain management, and quality. The questionnaire was self-administered to active and recall patients in the summers of 1997 and 1998 to evaluate satisfaction with care in the traditional and CC models respectively. The completed DSQ was returned by 119 respondents in 1997 and 116 respondents in 1998. There were no significant differences in age. gender, and self-rated general and oral health of patients using the two delivery systems. No statistically significant differences were seen in the overall Dental Satisfaction Index and the sub-scales of access, pain management, and quality of care. Statistically significant differences were observed on only two of the nineteen individual items. We conclude that there was no difference in satisfaction levels of our patients between the two dental care delivery models.     

The dental safety net in Connecticut

BACKGROUND: Many poor, medically disabled and geographically isolated populations have difficulty accessing private-sector dental care and are considered underserved. To address this problem, public- and voluntary-sector organizations have established clinics and provide care to the underserved. Collectively, these clinics are known as "the dental safety net." The authors describe the dental safety net in Connecticut and examine the capacity and efficiency of this system to provide care to the noninstitutionalized underserved population of the state. METHODS: The authors describe Connecticut's dental safety net in terms of dentists, allied health staff members, operatories, patient visits and patients treated per dentist per year. The authors compare the productivity of safety-net dentists with that of private practitioners. They also estimate the capacity of the safety net to treat people enrolled in Medicaid and the State Children's Health Insurance Program. RESULTS: The safety net is made up of dental clinics in community health centers, hospitals, the dental school and public schools. One hundred eleven dentists, 38 hygienists and 95 dental assistants staff the clinics. Safety-net dentists have fewer patient visits and patients than do private practitioners. The Connecticut safety-net system has the capacity to treat about 28.2 percent of publicly insured patients. CONCLUSIONS: The dental safety net is an important community resource, and greater use of allied dental personnel could substantially improve the capacity of the system to care for the poor and other underserved populations.     

Characteristics of Patients Seeking Care from Independent Dental Hygienist Practices

Objectives : This study determined demographic characteristics, satisfaction with care, and likelihood of follow-up dentist visits for patients seen in office-based, independent, dental hygienist practices. Methods : New patients were surveyed after their initial visits to independent hygienist practices to assess their demographic characteristics and satisfaction with care at both the beginning of practice operations and 18 months after the start of these practices. Follow-up surveys were sent to patients 12 and 24 months after their initial visits to the independently practicing dental hygienists to determine if patients had visited a dentist. Results : Most respondents were white, female, had attended some college, and reported high family incomes. Ninety-eight percent of respondents were satisfied with their dental hygiene care. Follow-up questionnaires revealed that over 80 percent of respondents visited the dentist within 12 months of receiving dental hygiene care in independent settings. This level of follow-up care with dentists was found both for respondents who reported having a regular dentist at their initial visits with the hygienists and for those who reported not having a regular dentist. Conclusion : Independent practice by dental hygienists provided access to dental hygiene care and encouraged visits to the dentist.     

Dental attendance in preschool children – a prospective study

International Journal of Paediatric Dentistry 2013; 23: 84–93 Background. At present, our understanding of the use of dental care services is incomplete, certainly where preschool children are concerned. Objectives. To investigate what proportion of 3‐ and 5‐year‐olds living in Flanders (Belgium) have already visited the dentist, to describe parents’ experience about their child’s dental visit, and to explore factors that may have an impact on children’s early dental visit. Design. Data were collected from 1057 children; validated questionnaires were completed, and children were examined by trained dentist at ages 3 and 5. Logistic regression analyses were performed to explain dental attendance. Results. At the age of 3, 62% and by 5 years, 21% had never visited the dentist. The first dental visit was considered a pleasant experience for the majority of children. Multivariable regression analyses revealed that children who were not first born, whose mothers had a higher educational level and whose parents had recently visited the dentist, had significantly higher odds for having visited the dentist at young age. Conclusions. Parents of young children need to be informed about and motivated for an early dental visit. Promotion campaigns should focus on firstborn children, children from less educated parents, and parents who do not regularly see a dentist.     

Factors associated with early-stage diagnosis of oral and pharyngeal cancer

Abstract – Objectives: The objective of this study was to examine the characteristics and treatment‐seeking behaviors of patients diagnosed with oral and pharyngeal cancer (OPC) and to determine whether seeing an oral healthcare provider in the preceding year was associated with an earlier stage of diagnosis. Methods: Trained interviewers administered a pretested survey instrument to a sample of 131 patients newly diagnosed with OPC at two cancer centers in Florida. Analyses were conducted to compare characteristics of patients by cancer summary stage (early or advanced) on receipt of OPC examination, patterns of dental care, and number of initial signs and symptoms. In addition, analyses were also conducted for characteristics of patients’ dental care utilization (regular primary care dentist, time of most recent dental visit, and regular dental care) by receipt of OPC examination. Results: Overall, 25.3% of participants reported receiving an OPC examination at their last dental visit and participants who received an OPC examination were significantly more likely (79%) to be diagnosed at early stages than those who did not receive an oral cancer examination (48%). Patients with a regular primary care dentist were more likely to be diagnosed at early stages (65%) than those without a regular primary care dentist (41%). Factors significantly associated with receiving an OPC examination included having a regular primary care dentist (P < 0.001), having a dental visit in the preceding 12 months (P < 0.001), and receiving regular care (P < 0.001). The number of signs or symptoms reported by the patient was significantly associated with the stage at diagnosis (P = 0.002) and the most common initial symptom reported by patients was soreness in the mouth. Conclusions: These results emphasize the importance of periodic and thorough OPC examinations.     

Patients' survey on regular check-up system in dental clinics

This survey classified the issues involved in promoting the regular check-up system in dental clinics. The survey was conducted in two parts: interviews with 39 dental clinics and a questionnaire survey of 5,129 patients (response rate: 56.8%). The results are summarized as follows: 1. Among the dental clinics that participated in this survey, the proportion of regular patients, the number of dental hygienists working at clinics, and the number of patients per day were higher than those of the national average. 2. The demographic patterns of regularly attending patients were "female, aged under 14 years and students or public servants". 3. Satisfaction with the technical competence of hygienists has the strongest correlation with regularity of visiting. The degree of correlation was about twice that of the correlation with technical competence of the dentist. 4. Patients' priorities for improving dental services to enhance satisfaction were treatment charges, appointment system, and attitude of staff and doctors toward welcoming the patients.     

Factors affecting utilization of dental health services and satisfaction among adolescent females in Riyadh City

Objectives

This study was conducted to determine factors affecting utilization of dental health services among intermediate female school students in Riyadh. In addition to assessing their satisfaction with the dental care received during the last dental visit.

Subjects and methods

Self-administered questionnaires were distributed among students attending eight public and four private schools. These schools were selected randomly to represent the four different administrative zones in Riyadh.

Results

Of 600 questionnaires distributed, 531 were complete and suitable for analysis. Nearly three quarters of the students visited the dentist more than once during the last 2 years. A bout 75% had their treatment in private dental clinics and 63% made their visits for routine treatment. The quality of dental care was found to be the most encouraging factor for utilization of dental services, whereas, far geographic location of the dental clinics was the most discouraging factor. For those who received treatment in the government clinics, the most discouraging factor was post operative complications (P < 0.0001), while the most encouraging factor was the availability of friendly staff (P < 0.0001). The high cost of dental care was the most discouraging factor for utilizing the dental services for those who visited private clinics (P < 0.0001), while the high quality of dental care was the most encouraging factor (P < 0.009). Students who made their visits because of pain highly considered modern clinics and those recommended by friends as highly encouraging factors (P < 0.002), while they considered the high cost of dental care as discouraging factor for using dental services (P < 0.038). Students who visited the dentist for routine treatment gave the quality of dental care as encouraging for the use of dental clinics (P < 0.0001). Satisfaction with dental care was found to be significantly associated with high quality of dental care, convenient appointment, friendly staff, modern dental clinics and clinics recommended by friends.

Conclusion

Quality of dental care, reasonable fees for dental services and close location of dental clinics to students’ homes are encouraging factors for utilization of dental services.     

Children's use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children's quality of life

OBJECTIVES?: The purpose of the study was to investigate the influence of a child's clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the child's oral health-related quality of life (OHRQoL) on a child's use of dental care services. METHODS?: A cross-sectional study of 608 mother-child dyads was conducted during the Children's Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their children's OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P?≤?0.05). RESULTS?: The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency. CONCLUSIONS?: Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their child's oral health motivated visits to the dentist.     

Utilisation of dental services in Turkey: a cross-sectional survey

AIM: To assess the factors affecting the utilisation of dental service in Turkey. METHOD: A cross-sectional study using a sample of 866 adults randomly selected from nine provinces, collecting data on socio-demographic characteristics, frequency of dental visits and attitudes toward dental services in face-to-face interviews. RESULTS: 40.4% of adults had visited a dentist within the previous year. Logistic regression analysis showed that gender and educational level were significant factors affecting the utilisation of dental services, with women using dental services significantly more than men and those having higher education compared to those having low education. Satisfaction from the services of the private dental offices and private hospitals was higher than from state hospitals. Age, reasons for dental visit and the place of the last visit were found to be the most significant predictors of satisfaction. CONCLUSION: Utilisation of dental services is low amongst Turkish adults. Women and individuals with higher levels of education use dental services more than others. The majority of the people prefer private dental offices, where the patient satisfaction is high.     

Dental utilization among Hispanic adults in agricultural worker families in California's Central Valley

Objective: To examine past‐year dental visits among underserved, Hispanic farmworker families using the Andersen Behavioral Model of Health Services Utilization, which posits that predisposing, enabling, and need factors influence care‐seeking behavior. Methods: Oral health survey and clinical data were collected in 2006‐2007 from families in Mendota, California (Fresno County) as part of a larger, population‐based study. Generalized estimating equation logit regression assessed effects of factors on having a dental visit among adults (N = 326). Predisposing variables included sociodemographic characteristics, days worked in agriculture, self‐rated health status, and dental beliefs. Enabling factors included resources to obtain services (dental insurance, income, acculturation level, regular dental care source). Need measures included perceived need for care and reported symptoms, along with clinically determined untreated caries and bleeding on probing. Results: Only 34% of adults had a past‐year dental visit, despite 44% reporting a regular dental care source. Most (66%) lacked dental insurance, and nearly half (46%) had untreated caries. Most (86%) perceived having current needs, and on average, reported a mean of 4.2 dental symptoms (of 12 queried). Regression analyses indicated those with more symptoms were less likely to have a past‐year dental visit. Those who would ask a dentist for advice and had a regular dental care source were more likely to have a past‐year dental visit. Conclusions: The final model included predisposing, enabling, and need factors. Despite low utilization and prevalent symptoms, having a regular source of care helps break this pattern and should be facilitated.     

Dental fear and satisfaction with dental services in Switzerland

Objectives: Dental satisfaction is associated with continuity of dental care, compliance with dentist advice, and positive health outcomes. It is expected that people with higher dental fear might have less dental satisfaction because of more negative dental experiences. The objective of this study was to examine satisfaction and reasons for satisfaction with dental practitioners in Switzerland and variations by dental fear. Methods: A national sample of 1,129 Swiss residents aged 15‐74 (mean = 43.2 years) completed a personal interview at their home with questions assessing dental fear, dental service use, general satisfaction with their dentist, and reasons for satisfaction or dissatisfaction. Results: Overall, 47.9 percent of participants responded that they were satisfied with their dentist and 47.6 percent that they were very satisfied. Satisfaction differed significantly by gender, language spoken, region of residence, and educational attainment. Greater dental fear was significantly associated with greater dissatisfaction with the dentist. The percentage of people who were very satisfied with the dentist ranged from 56.0 percent among people with no fear to 30.5 percent for participants with “quite a lot” of fear but was higher (44.4 percent) for people who stated that they were “very much” afraid of the dentist. The most common reasons attributed for satisfaction with dentists were interpersonal characteristics of the dentist and staff. People with “quite a lot” of fear were found to endorse these sentiments least. Conclusions: Although higher dental fear was associated with more dissatisfaction with the dentist, the level of satisfaction among fearful individuals in Switzerland is still high.     

Factors influencing whether low-income mothers have a usual source of dental care

Mothers are both the source of dental caries and the managers of children's use of dental care. This is particularly important for the low-income population. The objective of this research was to explore predictors of having a usual source of dental care among low-income women. Eight-hundred-ten mothers (82 percent white, mean age twenty-seven years), drawn from among participants in an ABCD program in one Washington State County completed a study questionnaire. The study examined predisposing, enabling and illness level variables in relation to whether the mother reported a usual source of dental care for herself. Fifty-two percent of the subjects gave positive answers to the dependent variable Do you now have a dentist you can go to if you have a problem? The analysis suggests that mothers that report good oral health and believe in care for their children are five times as likely to have a usual source of care for themselves than mothers who report both poor oral health and more negative attitudes about dental care for children. The results suggest that interventions aimed at child health that ignore the welfare of the mother are likely to be less successful than those that also address the mothers' needs.     

Correlation between patient satisfaction and dental clinic credibility in regular dental check-ups in Japan

The aim of this study was to investigate the relationship between dental clinic credibility and patient satisfaction with regular dental check-ups, to compare the level of satisfaction of patients who had regular check-ups with those who did not, and to identify factors associated with regular dental checkups. Thirty-nine private dental clinics in 17 prefectures throughout Japan participated in this study. A total of 9024 questionnaires were distributed to the patients at these clinics, and patients returned the questionnaires using a pre-paid envelope (response rate 56.8%). The questionnaires consisted of items related to patient demographics and 11 items concerning the level of patient satisfaction with the dental clinic. Using multiple logistic regression analysis, the strongest correlation was found between dental clinic credibility in regular checkups and the technical competence of the dentist. The responses to those items concerning making an appointment, and the cleanliness and neatness of the waiting room were different between patients who had regular check-ups and those who did not. To investigate the factors that encourage regular dental check-ups, correlation of factors with regular check up experience were analyzed. Multivariate-adjusted odds ratios indicated a strong association between regular dental check ups and both the technical competence of the dental hygienist and the cost of treatment.     

Characteristics of publicly insured children with high dental expenses

BACKGROUND: Dental coverage is provided for all children with Medicaid in Washington State. The goal of this study was to illuminate the characteristics of a sample of Medicaid-enrolled children with high dental expenses. METHODS: Dental care utilization data for a 33-month period were obtained from Washington State's Medicaid database. For children, 0 to 6 years, these data were linked with a parent survey addressing oral health behaviors, knowledge, family history of caries, snacking patterns, and access to dental care. Children with dental expenses of $1,000 or more were classified as the "high-expense" group. Risk factors for the high-expense group were evaluated using multiple logistic regression. RESULTS: 345 children had at least one dental procedure including preventive and diagnostic care. Among these, 30 children (9 percent) incurred 64 percent of total dental expenses for the entire group. Parent perception of lack of dental coverage was associated with incurring high dental expenses. Children of Asian or Pacific Islander heritage were at disproportionately high risk compared to White children. Age of child and family history of caries were also associated with increased risk for high expenses. CONCLUSIONS: Not all low-income children on Medicaid are at high risk for caries. A combination of factors, including family history of caries and parent's perception of lack of dental insurance coverage, can potentially increase a child's likelihood for high-expense dental treatment. This study highlighted a small group of children with disproportionately high dental expenses. For some, earlier knowledge of coverage may have resulted in more timely access to preventive and diagnostic care, reducing the subsequent need for expensive restorative treatment.     

Factors related to severe untreated tooth decay in rural adolescents: a case-control study for public health planning

Objectives. In this case‐control study of rural adolescents we identified factors to discriminate those who have high levels of tooth decay and receive treatment from those with similar levels who receive no treatment. Methods. The sample was drawn from all 12–20‐year‐olds (n = 439) in a rural high school in Washington State, U.S. The criterion for being included was 5 or more decayed, missing or filled teeth. The questionnaire included structure, history, cognition and expectation variables based on a model by Grembowski, Andersen and Chen. Results. No structural variable was related to the dependent variable. Two of 10 history variables were related: perceived poor own dental health and perceived poor mother's dental health. Four of eight cognition variables were also predictive: negative beliefs about the dentist, not planning to go to a dentist even if having severe problems, not being in any club or playing on a sports team and not having a best friend. No relationship was found for the expectation variable ‘usual source of care’. Conclusions. These data are consistent with the hypothesis that untreated tooth decay is associated with avoidance of care and point to the importance of history and cognition variables in planning efforts to improve oral health of rural adolescents.     

Determinants of dental care visits among low-income African-American children

BACKGROUND: The objective of the authors' analysis was to investigate the determinants of dental care visits among young, low-income African-American children. METHODS: Trained researchers interviewed a representative sample of low-income black families (caregivers and children aged 0 through 5 years) in Detroit to assess their dental visit history, dental insurance status and oral health behaviors. Dental examinations were conducted using the International Caries Diagnosis Assessment System (ICDAS). Of the 1,021 families who completed an interview and examination, a subset of the 552 children aged 3 to 5 years (and their primary caregivers) was the focus of this analysis. RESULTS: Children with private dental insurance had four times higher odds of having visited a dentist compared with those who had no dental insurance, and the odds for children receiving Medicaid were about 1.5 times higher. A child's age and a caregiver's educational attainment were positive and significant determinants of child dental visits. Caregivers who visited a dentist for preventive reasons were five times more likely to have taken their children to visit the dentist. Visiting a dentist was associated with an increased mean number of filled or missing tooth surfaces, but it was not significantly associated with the mean number of untreated decayed teeth. CONCLUSION: Children's dental insurance status was a significant determinant of their having visited a dentist. Even after the authors accounted for insurance status and other risk indicators, they found that children of caregivers who reported visiting a dentist for preventive care had a higher number of dental care visits. Determinants of caregivers' preventive dental visits must be identified and encouraged to improve the percentage of low-income children who visit dentists.