Related Articles

Background

The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aims of this study were to develop a Spanish version (OHIP-Sp) of the Oral Health Impact Profile and to evaluate its convergent and discriminative validity, and its internal consistency.

Methods

The original 49-items OHIP was translated to Spanish, revised for understanding and semantics by two independent dentists, and then translated back to English by an independent bilingual dentist. The data originated in a cross sectional study conducted among high school students from the Province of Santiago, Chile. The study group was sampled using a multistage random cluster procedure yielding 9,203 students aged 12–21 years. All selected students were invited to participate and all filled a questionnaire with information on socio-demographic factors; oral health related behaviors; and self-reported oral health status (good, fair or poor). From this group, 9,163 students also accepted to fill a detailed questionnaire on socio-economic indicators and to receive a clinical examination comprising direct recordings of clinical attachment levels (CAL) in molars and incisors, tooth loss, and the presence of necrotizing ulcerative gingival lesions.

Results

The participation rate and the questionnaire completeness were high with OHIP-Sp total scores being computed for 9,133 subjects. Self-perceived oral health status was associated with the total OHIP-Sp score and all its domains (Spearman rank correlation). The OHIP-Sp total score was also directly associated with the 4 dental outcomes investigated (Mann-Whitney test) and the largest impact was found for the outcomes, 'tooth loss' with a mean OHIP-Sp score = 13.5 and 'CAL >= 3 mm' with a mean OHIP-Sp score = 13.0.

Conclusion

The OHIP-Sp revealed suitable convergent and discriminative validity and appropriate internal consistency (Cronbach's α). Further studies on OHIP-Sp warrant the inclusion of populations with a higher disease burden; and the use of test-retest reliability exercises to evaluate the stability of the test.

Objectives:

To evaluate self-reported oral health attitudes and behavior among a group of dental students in Bangalore, India and to compare the oral health attitudes of students of different years of dental school.

Methods:

A self-administered questionnaire based on a modified version of the Hiroshima University Dental Behavior Inventory (HU-DBI) was administered to 250 dental students.

Results:

Significant differences (P<.05) were observed among students of different years in the degree of worrying about the color of the teeth, not having been to the dentist before and brushing each tooth carefully. Strongly significant differences (P<.001) were observed among students of different years in brushing the teeth twice daily, being satisfied with the appearance of the teeth, cleaning the teeth well without toothpaste, visiting dentist only when having a toothache, taking too much time to brush their teeth, worrying about having bad breath and using mouth rinse on a regular basis.

Conclusions:

Among dental students, the overall knowledge of oral health was good, even though there were deficits in knowledge in a few areas. The oral health attitudes and behavior of dental students improved with increasing levels of education.

Purpose

This study investigated dental care service utilization among adults with spinal cord injury (SCI) and identified barriers and other factors affecting utilization among this population.

Methods

Respondents (n = 192) with SCI participated in an oral health survey assessing dental care service utilization and were compared with respondents from the 2004 Behavioral Risk Factors Surveillance System (BRFSS).

Results

There was no significant difference in the proportion of SCI respondents who visited the dentist for any reason in the past year compared to the general population (65.5% vs. 68.8%, P = 0.350). However, SCI respondents were less likely to go to the dentist for a dental cleaning in the past year compared to the general population (54.6% vs. 69.4%, P < 0.001). The three most commonly reported barriers to accessing dental care were cost (40.1 %), physical barriers (22.9%), and dental fear (15.1%). Multivariable modeling showed physical barriers and fear of dental visits were the two significant factors deterring respondents from dental visits in the past year.

Conclusions

Physical barriers preventing access to dental facilities and dental fear are prevalent and significantly impede the delivery of dental health care to adults with SCI. Dentists should undertake necessary physical remodeling in their facilities to accommodate wheelchair users and implement appropriate strategies for the management of dental fear among patients with SCI.

According to theory, health beliefs are related to health behaviors. We investigated whether individuals who hold favorable oral-health-related beliefs over time have better adult oral health than those who do not. Beliefs about the efficacy of water fluoridation, keeping the mouth clean, avoiding sweet foods, visiting the dentist, using dental floss, and using fluoridated toothpaste were assessed in a birth cohort at ages 15, 18, and 26 years. At each age, the majority of participants endorsed the importance of each practice. However, there was also evidence of instability across time. Individuals who held stable favorable dental beliefs from adolescence through adulthood had fewer teeth missing due to caries, less periodontal disease, better oral hygiene, better self-rated oral health, and more restorations. Dental beliefs can change between adolescence and young adulthood, and these changes are related to oral health. In particular, unfavorable dental health beliefs are related to poorer oral health.

Background

The purpose of this study was to assess the knowledge, practices, and opinions of dentists and dental hygienists in New York State regarding oral cancer prevention and early detection.

Method

We sent questionnaires to a stratified random sample of dentists and dental hygienists selected from a list of licensed oral health care providers in New York State. We analyzed responses to the questionnaires, and we derived descriptive statistics.

Results

The effective response rate was 55% and 65% among dentists and dental hygienists, respectively. About 85% of dentists and 78% of dental hygienists reported providing annual oral cancer examination to their patients aged 40 and above. Although a majority assessed tobacco use, fewer practitioners assessed alcohol use. Both dentists and dental hygienists lacked knowledge in some aspects of risk factors, signs, and symptoms of oral cancer. However, dentists had significantly higher knowledge scores than dental hygienists.

Conclusion

Dentists and dental hygienists in New York State are knowledgeable about oral cancer, but there are gaps in the knowledge of certain risk factors and in the oral cancer examination technique.

Objectives

To find out the relationship between dental insurance and demand for dental care, the present study evaluated impact of insurance scheme on adults’ dental check-ups in a developing oral health care system.

Methods

The target population included adults in the city of Tehran where the only telecommunication company provides 90% of the 1.9 million households with a fixed telephone. Of the 1531 subjects who answered the phone call, 224 were outside the target age (under 18), 67 said that they never had visited a dentist, and 221 refused to respond, leaving 1019 subjects in the final sample. Each interview lasted 15 minutes and was carried out using a structured questionnaire with fixed and open-ended questions.

Results

71% of the subjects reported having dental insurance and 16% having visited a dentist for a check-up; 55%, more women than men, reported having had a dental visit within the past 12 months.

Conclusions

The present results revealed the positive relationship between insurance and demand for dental care. Those having dental insurance were more likely to go to check-ups despite their generally low rate found in this country with a developing oral health care system. In such countries, health insurance schemes should therefore include obligatory regular dental check-ups to emphasize prevention-oriented dental care.

SYNOPSIS

Objectives

The aim of this study was to provide state-level surveillance data to assess the oral health of people with disabilities.

Methods

Data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS)—a state-based, random-digit-dialed telephone survey of the U.S. civilian noninstitutionalized population 18 years of age and older—were used to estimate disability prevalence and state-level differences in oral health among people with and those without disabilities.

Results

Nationally, people with disabilities were less likely than people without disabilities to visit a dentist or dental clinic in the past year. The percentage of people with disabilities who reported they had visited a dentist in the past year was lowest in Mississippi (48.9%) and highest in Connecticut (74.5%). Among people without disabilities reporting they had visited a dentist or dental clinic in the past year, the percentage was lowest in Mississippi (60.7%) and highest in Minnesota (80.7%). Edentulism was higher among people with disabilities compared with those without disabilities. Among people with disabilities, edentulism was lowest in the District of Columbia (4.1%) and highest in Kentucky (18.7%). Among people without disabilities, edentulism was lowest in California (2.7%) and highest in Kentucky (11.3%).

Conclusions

Despite numerous studies and reports documenting the unmet oral health needs of people with disabilities, there has been no systematic national surveillance of oral health among people with disabilities in the United States. This article provides much-needed state-by-state and national epidemiologic data regarding the oral health of people with disabilities.

Purpose

The purpose of the study was to understand US dentists’ attitudes, knowledge, and practices regarding dental care for pregnant women and to determine the impact of recent papers on oral health and pregnancy and guidelines disseminated widely.

Methods

In 2006–2007, the investigators conducted a mailed survey of all 1,604 general dentists in Oregon; 55.2% responded). Structural equation modeling was used to estimate associations between dentists’ attitudes toward providing care to pregnant women, dentists’ knowledge about the safety of dental procedures, and dentists’ current practice patterns.

Results

Dentist’s perceived barriers have the strongest direct effect on current practice and might be the most important factor deterring dentists from providing care to pregnant patients. Five attitudes (perceived barriers) were associated with providing less dental services: time, economic, skills, dental staff resistance, and peer pressure. The final model shows a good fit with a chi-square of 38.286 (p = .12, n=772, df = 52) and a Bentler-Bonett Normed Fit index of .98, CFI = .993. The Root Mean Square Error of Approximation is .02.

Conclusions

Findings suggest attitudes are significant determinants of accurate knowledge and current practice. Multi-dimensional approaches are needed to increase access to dental care and protect the oral health of women during pregnancy. Despite current clinical recommendations to deliver all necessary care to pregnant patients during 1st, 2nd, and 3rd trimesters, dentists’ knowledge of the appropriateness of procedures continues to lag the state of the art in dental science.

Objectives:

Dental care forms an important part of the multidisciplinary management of oral cancer patients. The aim of this study was to examine actual and self-perceived knowledge and clinical expertise regarding dental management of oral cancer patients receiving radiation therapy among Western Australian general dentists.

Materials and Methods:

An invitation to participate in a web-based questionnaire was emailed to 1095 dentists registered with the Australian Dental Association (ADA), WA branch. To assess dentists’ knowledge and expertise, actual and perceived knowledge was investigated. Information regarding type of practice, practice location, year of graduation and number of oral cancer patients treated in the preceding 12 months was also obtained.

Results:

One hundred and ninety one dentists responded to the survey. General dentists who took part in the study appeared to possess some knowledge regarding dental management of oral cancer patients treated with radiation therapy. The majority of responders however identified deficiencies in their knowledge and willingness to participate in continuing education programs.

Conclusion:

In view of the rising incidence of oral cancer in Western Australia, efforts should be made to provide more clinically relevant training to dentists in this area.

OBJECTIVE: Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will require a better understanding of the patterns of health care associated with orofacial pain. This study examined factors associated with pain-related acute oral health care. METHODS: The authors used data on 698 participants in the Florida Dental Care Study, a study of oral health among dentate adults aged 45 years and older at baseline. RESULTS: Fifteen percent of the respondents reported having had at least one dental visit as the result of orofacial pain. The majority of the respondents reportedly delayed contacting a dentist for at least one day; however, there was no difference between respondents reporting pain as the initiating symptom and those with other problems. Once respondents decided that dental services were needed, those with a painful symptom were nearly twice as likely as those without pain to want to be seen immediately. Rural adults were more likely than urban adults to report having received urgent dental care for a painful symptom. When orofacial pain occurred, those who identified as non-Hispanic African American were more likely than those who identified as non-Hispanic white to delay care rather than to seek treatment immediately, and women were more likely then men. Having a pain-related oral problem was associated with significantly less satisfaction with the services provided; non-Hispanic African American respondents were less likely than non-Hispanic white respondents to report being very satisfied, and rural residents were less likely than urban residents. Furthermore, men were more likely than women to suffer with orofacial pain without receiving either scheduled dental care or an urgent visit. CONCLUSIONS: Barriers to care are complex and likely to be interactive, but must be understood before the goals of Healthy People 2010 can be accomplished.

Background

To address dental workforce shortages in underserved areas in the United States, some States have enacted legislation to make it easier for foreign dental school graduates to become licensed dentists. However, the extent to which foreign dental school graduates will solve the problem of dental workforce shortages is poorly understood. Furthermore, the potential impact that foreign-trained dentists have on improving access to dental care for vulnerable patients living in dental Health Professional Shortage Areas (HPSAs) and those enrolled in public insurance programs, such as Medicaid, is unknown. The objective of this paper is to provide a preliminary understanding of the practice behaviors of foreign-trained dentists. The authors used Washington State as a case study to identify the potential impact foreign dental school graduates have on improving access to dental care for vulnerable populations. The following hypotheses were tested: a) among all newly licensed dentists, foreign-trained dentists are more likely to participate in the Medicaid program than U.S.-trained dentists; and b) among newly licensed dentists who participated in the Medicaid program, foreign-trained dentists are more likely to practice in dental HPSAs than U.S.-trained dentists.

Methods

The authors used dental license and Medicaid license data to compare the proportions of newly licensed, foreign- and U.S.-trained dentists who participated in the Medicaid program and the proportions that practiced in a dental HPSA.

Results

Using bivariate analyses, the authors found that a significantly lower proportion of foreign-trained dentists participated in the Medicaid program than U.S.-trained dentists (12.9% and 22.8%, respectively; P = 0.011). Among newly licensed dentists who participated in the Medicaid program, there was no significant difference in the proportions of foreign- and U.S.-trained dentists who practiced in a dental HPSA (P = 0.683).

Conclusions

Legislation that makes it easier for foreign-trained dentists to obtain licensure is unlikely to address dental workforce shortages or improve access to dental care for vulnerable populations in the United States. Licensing foreign dental school graduates in the United States also has ethical implications for the dental workforces in other countries.

Background

Dental neglect has been found to be related to poor oral health, a tendency not to have had routine check-ups, and a longer period of time since the last dental appointment in samples of children and adults. The Dental Neglect Scale (DNS) has been found to be a valid measure of dental neglect in samples of children and adults, and may be valid for adolescents as well. We administered the DNS to a sample of adolescents and report on the relationships between the DNS and oral health status, whether or not the adolescent has been to the dentist recently for routine check-ups, and whether or not the adolescent currently goes to a dentist. We also report the internal and test-retest reliabilities of the DNS in this sample, as well as the results of an exploratory factor analysis.

Methods

One hundred seventeen adolescents from seven youth groups in the Seattle-Tacoma metropolitan area (Washington State, U.S.) completed the DNS and indicated whether they currently go to a dentist, while parents indicated whether the adolescent had a check-up in the previous three years. Adolescents also received a dental screening. Sixty six adolescents completed the questionnaire twice. T-tests were used to compare DNS scores of adolescents who have visible caries or not, adolescents who have had a check-up in the past three years or not, and adolescents who currently go to a dentist or not. Internal reliability was measured by Cronbach's alpha, and test-rest reliability was measured by intra-class correlation. Factor analysis (Varimax rotation) was used to examine the factor structure.

Results

In each comparison, significantly higher DNS scores were observed in adolescents with visible caries, who have not had a check-up in the past three years, or who do not go to a dentist (all p values < 0.05). The test-retest reliability of the DNS was high (ICC = 0.81), and its internal reliability was acceptable (Cronbach's alpha = 0.60). Factor analysis yielded two factors, characterized by home care and visiting a dentist.

Conclusion

The DNS appears to operate similarly in this sample of adolescents as it has in other samples of children and adults.

Adolescent dental patients pose a unique challenge to providers, particularly when intravenous sedation is introduced to the treatment plan. Surveys show many adolescents are afraid of the dentist. Five to six per cent overall are fearful of dental injections and may avoid care or have irregular attendance. At the same time, adolescents may assert their independence by refusing to cooperate with providers’ and parents’ requests even while accepting that the goal of better health is reasonable. Successful treatment of – and rapport with – the adolescent dental patient, however, can ensure that adolescents’ oral needs are met. Successful providers recognise that adolescents alternate between childlike and mature coping strategies during the course of dental treatment. Identifying an adolescent’s current coping style can help the dental team select appropriate strategies to help treatment proceed more smoothly for the adolescent and clinical team. Working with adolescents’ individual coping styles, rather than expecting consistently adult behaviour, will ideally help decrease frustration and improve treatment outcome.

Objective

The aim of this study is to explore behavioral factors associated with toothache among African American adolescents living in rural South Carolina.

Methods

Using a self-administered questionnaire, data were collected on toothache experience in the past 12 months, oral hygiene behavior, dental care utilization, and cariogenic snack and non-diet soft drink consumption in a convenience sample of 156 African American adolescents aged 10-18 years old living in rural South Carolina. Univariable and multivariable logistic regression analyses were used to assess the associations between reported toothache experience and socio-demographic variables, oral health behavior, and snack consumption.

Results

Thirty-four percent of adolescents reported having toothache in the past 12 months. In univariable modeling, age, dental visit in the last two years, quantity and frequency of cariogenic snack consumption, and quantity of non-diet soft drink consumption were each significantly associated with experiencing toothache in the past 12 months (all p-values < 0.05). Multivariable logistic regression analysis indicated that younger age, frequent consumption of cariogenic snacks, and number of cans of non-diet soft drink consumed during the weekend significantly increased the odds of experiencing toothache in the past 12 months (all p-values ≤ 0.01).

Conclusion

Findings indicate age, frequent consumption of cariogenic snacks and number of cans of non-diet soft drinks are related to toothache in this group. Public policy implications related to selling cariogenic snacks and soft drink that targeting children and adolescents especially those from low income families are discussed.

World Health Organization defines palliative care as the active total care of patients whose disease is not responding to curative treatment. Palliative care for the terminally ill is based on a multidimensional approach to provide whole-person comfort care while maintaining optimal function; dental care plays an important role in this multidisciplinary approach. The aim of the present study is to review significance of dentist's role to determine whether mouth care was effectively assessed and implemented in the palliative care setting. The oral problems experienced by the hospice head and neck patient clearly affect the quality of his or her remaining life. Dentist plays an essential role in palliative care by the maintenance of oral hygiene; dental examination may identify and cure opportunistic infections and dental disease like caries, periodontal disease, oral mucosal problems or prosthetic requirement. Oral care may reduce not only the microbial load of the mouth but the risk for pain and oral infection as well. This multidisciplinary approach to palliative care, including a dentist, may reduce the oral debilities that influence the patient's ability to speak, eat or swallow. This review highlighted that without effective assessment of the mouth, the appropriate implementation of care will not be delivered. Palliative dental care has been fundamental in management of patients with active, progressive, far-advanced disease in which the oral cavity has been compromised either by the disease directly or by its treatment; the focus of care is quality of life.

Common fears were studied by household telephone interviews and mail survey in Seattle, Washington, to determine their relationship to dental fear and to utilization of the dentist. Dental fear was either the first or second most common fear, with a prevalence estimated between 183 and 226 persons per 1000 population. Dental fear was associated with fears of heights, flying, and enclosures. Respondents with multiple common fears other than fear of dentistry were more likely to delay or cancel dental appointments, report a longer period since their last visit to the dentist, and report poorer oral health and less satisfaction with oral appearance. Over 22 percent of the dentally fearful group reported two or more accompanying common fears.

Background

Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.

Objectives

To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.

Methods

The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.

Results

Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.

Conclusions

Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

The SMILE project represented a partnership among the University of Texas Health Science Center at San Antonio Libraries, the Gateway Clinic in Laredo, and the San Antonio Metropolitan Health District. The project focused on improving dental practitioners' access to reliable information resources and integrating the best evidence into public health dental practice. Through its training program, SMILE cultivated a set of “power information users” among the dentists, dental hygienists, and community health workers (promotores) who provide public health preventive care and oral health education. The dental public health practitioners gained information literacy skills and increased their knowledge about reliable sites such as blogs, PubMed®, and MedlinePlus®. This project fostered opportunities for expanded partnerships with public health personnel.

Objective

To examine past year dental visits among underserved, Hispanic farmworker families using the Andersen Behavioral Model of Health Services Utilization (1968), which posits that predisposing, enabling, and need factors influence care-seeking behavior.

Methods

Oral health survey and clinical data were collected in 2006-7 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 socio-demographic 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.

Background

Twice as many U.S. children are overweight or at risk of being overweight as compared to 20 years ago. Dental professionals have an opportunity to participate in obesity prevention with their patients. The authors present a dental office-based healthy weight intervention protocol designed for all children and adolescents.

Conclusions

Routine dental visits offer an excellent opportunity for healthy weight interventions for children. The Healthy Weight Intervention described in this paper can be feasible and acceptable in a pediatric dental setting. It was considered useful by caregivers, providers, and well accepted by children.

Clinical Implications

Healthy eating and lifestyle behaviors can have a positive impact on systemic health as well as oral health. Better food choices can reduce dental caries; while prevention of obesity-related systemic diseases, particularly diabetes, can help to maintain good oral health.

Background

Risk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers. This study identifies pediatrician-assessed risk factors for early childhood caries (ECC) and their association with the need for a dentist’s evaluation.

Methods

A priority oral health risk assessment and referral tool (PORRT) for children < 36 months was developed collaboratively by physicians and dentists and used by 10 pediatricians during well-child visits. PORRT documented behavioral, clinical, and child health risks for ECC. Pediatricians also assessed overall ECC risk on an 11-point scale and determined the need for a dental evaluation. Logistic regression models calculated the odds for evaluation need for each risk factor and according to a 3-level risk classification.

Results

In total 1,288 PORRT forms were completed; 6.8% of children were identified as needing a dentist evaluation. Behavioral risk factors were prevalent but not strong predictors of the need for an evaluation. The child’s overall caries risk was the strongest predictor of the need for an evaluation. Cavitated (OR = 17.5; 95% CI = 8.08, 37.97) and non-cavitated (OR = 6.9; 95% CI = 4.47, 10.82) lesions were the strongest predictors when the caries risk scale was excluded from the analysis. Few patients (6.3%) were classified as high risk, but their probability of needing an evaluation was only 0.36.

Conclusions

Low referral rates for children with disease and prior to disease onset but at elevated risk, indicate interventions are needed to help improve the dental referral rates of physicians.

It is important that healthcare professionals caring for the elderly in hospitals have a core knowledge of the orodental care requirements of their patients. The aim of this study was to determine the knowledge and views of nurses working on acute and rehabilitation care of the elderly wards about orodental care. One hundred nurses and healthcare assistants took part in this questionnaire study of which 58 were qualified nurses and 70 had been employed on care of the elderly wards for two or more years. Although the majority of the respondents were registered with a dentist and attended regularly, 40 did have `some anxiety' about visiting their dentist. Approximately half of the study population regularly gave advice to their patients about dental care but their knowledge of and reasons for providing oral care and advice was often incorrect. The group's understanding of the availability of dental treatment provided by the National Health Service was also often inaccurate. It was concluded that a better core knowledge of the orodental care of older patients is required by all healthcare professionals who care for this group. It is also important that individuals in whom anxiety is associated with their own dental experience do not neglect to give orodental health advice to their patients.


Keywords: oral care; elderly; nurses' knowledge

Objectives

Interest is growing on conceptualizing dental disease aetiology under the life-course approach. The aim of this study was to assess the association of dental caries experience with the major components of life-course approach, health- and behavioral capital, among Turkish and Finnish pre-adolescents, with different family-related characteristics, as this association has not been explored yet.

Methods

A cross-sectional study of Finnish (n=338) and Turkish (n=611) pre-adolescents was undertaken with questionnaires and oral health data.

Results

Turkish pre-adolescents, more dentally diseased (84%) than the Finnish (33%) (P<.01), had lower means of health (body height-weight) and behavioural (self-esteem, tooth-brushing self-efficacy) capital, (P<.01). Finnish pre-adolescents were less likely to live in two-parent families (P=.001) and spent less time with their mothers (P<.05). Turkish pre-adolescents with high levels of self-esteem were more likely to spend time with their mothers and less likely to live in families with three or more children (28%) than were their counterparts with low levels of self-esteem (41%). Such associations were not evident among Finnish pre-adolescents (P>.05). Health capital, in terms of body height, and family-related characteristics in differing patterns, contributed to DMFT, in common, among Turkish and Finnish pre-adolescents. Self-esteem, behavioural capital was explanatory variable for DMFT only for the Turks.

Conclusions

Dental health of pre-adolescents was associated with health- and behavioural capital in different pathways under the influence of family-related characteristics. The cooperation of paediatricians and dentists is vital in assessment of general and dental health in a holistic context throughout the life-course, to enhance the well-being of pre-adolescents.

To provide hospital dental programs with useful information about the expansion of dental services and the identification of pertinent financial information, a production function and cost function analysis was performed. Results showed that hospital ownership (public or private) and size of the dental clinics were associated with the cost of providing dental services and the volume of services provided. Among 23 hospitals studied, private hospitals had a much lower cost per visit, had more paid attending dentist staff, paid their resident dentists less, and had significantly more billings paid by Medicaid and by patients than public hospitals. When stratified by ownership and size, these basic differences were accentuated for the small clinics. Except for primarily the Medicaid and self-pay billings, the characteristics of large public and private hospital dental clinics were extremely similar. Multiple regression analysis found that a decrease in cost per visit was associated with more visits to dentists and more to hygienists. Production of dental services could be increased by increasing the number of attending dentists, hygienists, and residents. Preliminary econometric analysis reveals that the optimal mix of attending dentists to resident dentists should be approximately 1.8 full-time equivalent (FTE) resident for every 1 attending FTE dentist to produce the most dental services at the lowest cost.

Background

Dentists are in a unique position to advise smokers to quit by providing effective counseling on the various aspects of tobacco-induced diseases. The present study assessed the feasibility and acceptability of integrating dentists in a medical smoking cessation intervention.

Methods

Smokers willing to quit underwent an 8-week smoking cessation intervention combining individual-based counseling and nicotine replacement therapy and/or bupropion, provided by a general internist. In addition, a dentist performed a dental exam, followed by an oral hygiene treatment and gave information about chronic effects of smoking on oral health. Outcomes were acceptability, global satisfaction of the dentist's intervention, and smoking abstinence at 6-month.

Results

39 adult smokers were included, and 27 (69%) completed the study. Global acceptability of the dental intervention was very high (94% yes, 6% mostly yes). Annoyances at the dental exam were described as acceptable by participants (61% yes, 23% mostly yes, 6%, mostly no, 10% no). Participants provided very positive qualitative comments about the dentist counseling, the oral exam, and the resulting motivational effect, emphasizing the feeling of oral cleanliness and health that encouraged smoking abstinence. At the end of the intervention (week 8), 17 (44%) participants reported smoking abstinence. After 6 months, 6 (15%, 95% CI 3.5 to 27.2) reported a confirmed continuous smoking abstinence.

Discussion

We explored a new multi-disciplinary approach to smoking cessation, which included medical and dental interventions. Despite the small sample size and non-controlled study design, the observed rate was similar to that found in standard medical care. In terms of acceptability and feasibility, our results support further investigations in this field.

Trial Registration number

ISRCTN67470159