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1.  Do the Indonesians Receive the Dental Care Treatment They Need? A Secondary Analysis on Self-Perceived Dental Care Need 
ISRN Dentistry  2012;2012:769809.
Increasing access for citizens to health services, including dental care, is one of the primary targets of the Indonesian Ministry of Health. To assess progress toward this goal, we sought to describe the magnitude of unmet needs for dental care among Indonesians. Secondary data of nationally representative surveys conducted from 2003 to 2007 were analysed to describe the associations between unmet needs for dental care in different demographic groups. In average, 2.28% of the Indonesian population reported perceiving need for dental care and 0.74% reported utilizing dental care. The average of unmet need was 72.04%. Logistic regression analysis indicated that respondents who lived in rural areas, who were uninsured, had higher odds ratios in reporting unmet dental care needs. Perceived need for and utilization of dental care among Indonesians was found to be low. Moreover, the unmet need for dental care is relatively high.
doi:10.5402/2012/769809
PMCID: PMC3408658  PMID: 22888443
2.  Evaluating components of dental care utilization among adults with diabetes and matched controls via hurdle models 
BMC Oral Health  2012;12:20.
Background
About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental care utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes.
Methods
Data included secondary enrollment and demographic data from Washington Dental Service (WDS) and Group Health Cooperative (GH), clinical data from GH, and dental-utilization data from WDS claims during 2002–2006. Dental and medical records from WDS and GH were linked for enrolees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups.
Results
We found that adults with diabetes had lower odds of visiting a dentist (OR = 0.74, p < 0.001). Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxes (OR = 0.77), fillings (OR = 0.80) and crowns (OR = 0.84) (p < 0.005 for all) and higher odds of receiving periodontal maintenance (OR = 1.24), non-surgical periodontal procedures (OR = 1.30), extractions (OR = 1.38) and removable prosthetics (OR = 1.36) (p < 0.001 for all).
Conclusions
Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes.
doi:10.1186/1472-6831-12-20
PMCID: PMC3528407  PMID: 22776352
3.  Noise Exposure Assessment in a Dental School 
Safety and Health at Work  2011;2(4):348-354.
Objectives
This cross-sectional study was performed in the Dental School of Prince of Songkla University to ascertain noise exposure of dentists, dental assistants, and laboratory technicians. A noise spectral analysis was taken to illustrate the spectra of dental devices.
Methods
A noise evaluation was performed to measure the noise level at dental clinics and one dental laboratory from May to December 2010. Noise spectral data of dental devices were taken during dental practices at the dental services clinic and at the dental laboratory. A noise dosimeter was set following the Occupational Safety and Health Administration criteria and then attached to the subjects' collar to record personal noise dose exposure during working periods.
Results
The peaks of the noise spectrum of dental instruments were at 1,000, 4,000, and 8,000 Hz which depended on the type of instrument. The differences in working areas and job positions had an influence on the level of noise exposure (p < 0.01). Noise measurement in the personal hearing zone found that the laboratory technicians were exposed to the highest impulsive noise levels (137.1 dBC). The dentists and dental assistants who worked at a pedodontic clinic had the highest percent noise dose (4.60 ± 3.59%). In the working areas, the 8-hour time-weighted average of noise levels ranged between 49.7-58.1 dBA while the noisiest working area was the dental laboratory.
Conclusion
Dental personnel are exposed to noise intensities lower than occupational exposure limits. Therefore, these dental personnel may not experience a noise-induced hearing loss.
doi:10.5491/SHAW.2011.2.4.348
PMCID: PMC3430914  PMID: 22953219
Noise-induced hearing loss; Noise; Dental practice; Dental school; Dental instruments
4.  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 (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.
doi:10.1111/j.1752-7325.2010.00184.x
PMCID: PMC3462228  PMID: 20545826
dental health services; Hispanic; agricultural workers
5.  Factors influencing the use of public dental services: An application of the Theory of Planned Behaviour 
Background
There is limited evidence of the influence of psychosocial factors and health beliefs on public dental patient's patterns of service use in Australia. The research aims were to examine associations between dental attitudes and beliefs of public dental service users and dental visiting intention and behaviour using the Theory of Planned Behaviour.
Methods
517 randomly selected adult public dental patients completed a questionnaire assessing dental attitudes and beliefs which was matched with electronic records for past and future dental service use. A questionnaire measured intentions, attitudes, subjective norms and perceptions of behavioural control and self-efficacy in relation to visiting public dentists. A measure of dental attendance at public dental clinics was obtained retrospectively (over 3 1/2 years) and prospectively (over a one year period following the return of the questionnaire) by accessing electronic patient clinical records.
Results
Participants had positive attitudes, subjective norms and self-efficacy beliefs towards dental visiting but perceived a lack of control over visiting the dentist. Attitudes, subjective norms, self-efficacy and perceived control were significant predictors of intention (P < 0.05). Intentions, self-efficacy and past dental attendance were significant predictors of actual dental attendance (P < 0.05).
Conclusion
Public dental patients held favourable attitudes and beliefs but perceived a lack of control towards dental visiting. Reducing structural barriers may therefore improve access to public dental services.
doi:10.1186/1472-6963-8-93
PMCID: PMC2390532  PMID: 18445298
6.  Patterns of preventive dental behavior. 
Public Health Reports  1986;101(2):175-184.
Preventive dental behavior was examined using data from the National Health and Nutrition Examination Survey of 1971-75 conducted by the National Center for Health Statistics. Most research to date has dealt with the use of all types of dental services, with relatively few studies focusing on utilization of dental services for preventive purposes or on preventive dental behavior. Economic theory on the demand for health services and the Andersen model of health services utilization were applied to examine predisposing, enabling, and need characteristics which may influence use of preventive dental health services and preventive dental behavior. The associations between each of three measures of preventive dental behavior and the three sets of characteristics from Andersen's model were analyzed using multiple regression analysis. The enabling factors (income and a regular source of care) were the most important determinants of use of preventive dental services. Need characteristics, measured by self-evaluated condition of teeth, were also significant determinants of use, while the predisposing variables were the least important of the three types. In contrast, for the home care measure, frequency of brushing, the predisposing variables were the most important, with gender and education ranking highest. Consideration of these results may be useful to health educators and to those who formulate policies affecting the distribution of preventive dental services and dental insurance coverage.
PMCID: PMC1477802  PMID: 3083472
7.  Does Dental Insurance Make a Difference in Type of Service Received by Iranian Dentate Adults? 
European Journal of Dentistry  2011;5(1):68-76.
Objectives:
To assess the relationship between insurance status and type of service received among dentate adults in a developing oral health care system.
Methods:
A cross-sectional survey based on phone interviews in Tehran, Iran. Four trained interviewers collected data using a structured questionnaire. Of 1,531 subjects answering the phone call, 224 were <18 years; of the remaining 1,307, 221 (17%) refused to participate, and 85 (6%) were excluded as edentate or reporting no dental visit, leaving 1,001 eligible subjects in the sample. The questionnaire covered insurance status, socio-demographics, frequency of tooth brushing, dental attendance as reasons for, and time since last dental visit, and dental service received then. Data analysis included the chi-square test and logistic regression.
Results:
Of the subjects, 71% had a dental insurance. Those with no insurance were more likely to report tooth extractions (OR=1.5) than those with an insurance coverage; for all other treatments no differences according to the insurance status appeared. Among the insured subjects, extractions were more likely for those reporting a problem-based dental visit (OR=6.0) or having a low level of education (OR=2.3).
Conclusions:
In Iran, with its developing oral health care system, dental insurance had only a minor impact on dental services reported.
PMCID: PMC3037191  PMID: 21311609
Adults’ dental care; Dental services; Dental insurance
8.  Experiences of dental care: what do patients value? 
Background
Dentistry in Australia combines business and health care service, that is, the majority of patients pay money for tangible dental procedures such as fluoride applications, dental radiographs, dental fillings, crowns, and dentures among others. There is evidence that patients question dentists’ behaviours and attitudes during a dental visit when those highly technical procedures are performed. However, little is known about how patients’ experience dental care as a whole. This paper illustrates the findings from a qualitative study recently undertaken in general dental practice in Australia. It focuses on patients’ experiences of dental care, particularly on the relationship between patients and dentists during the provision of preventive care and advice in general dental practices.
Methods
Seventeen patients were interviewed. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation.
Results
Patients described their experiences when visiting dental practices with and without a structured preventive approach in place, together with the historical, biological, financial, psychosocial and habitual dimensions of their experience. Potential barriers that could hinder preventive activities as well as facilitators for prevention were also described. The offer of preventive dental care and advice was an amazing revelation for this group of patients as they realized that dentists could practice dentistry without having to “drill and fill” their teeth. All patients, regardless of the practice they came from or their level of clinical risk of developing dental caries, valued having a caring dentist who respected them and listened to their concerns without “blaming” them for their oral health status. These patients complied with and supported the preventive care options because they were being “treated as a person not as a patient” by their dentists. Patients valued dentists who made them aware of existing preventive options, educated them about how to maintain a healthy mouth and teeth, and supported and reassured them frequently during visits.
Conclusions
Patients valued having a supportive and caring dentist and a dedicated dental team. The experience of having a dedicated, supportive and caring dentist helped patients to take control of their own oral health. These dentists and dental teams produced profound changes in not just the oral health care routines of patients, but in the way patients thought about their own oral health and the role of dental professionals.
doi:10.1186/1472-6963-12-177
PMCID: PMC3407476  PMID: 22726888
Qualitative research; Dentist-patient relationship; Prevention
9.  Income-related Inequalities in Dental Service Utilization by Europeans Aged 50+ 
Journal of Dental Research  2011;90(6):717-723.
The purpose of this study was to describe income-related inequalities in dental service utilization by the elderly populations residing in different European countries. We used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Wave 2), which contains information on utilization of dental services by 33,358 individuals aged 50+ years from 14 different countries. We assessed income-related inequalities in dental attendance and preventive and/or operative dental treatment by means of Concentration Indices (CI) and Slope Indices of Inequality (SII). We could identify a disproportionate concentration of access to treatment among the rich elderly populations in all 14 countries (relative inequality according to CI), as well as significantly higher access to treatment by individuals located in the highest in relation to the lowest income group for all countries except Italy and the Czech Republic (absolute inequality according to SII). Such differential utilization appears mainly attributable to inequalities in preventive dental visits, either alone or in combination with operative treatment. Persons’ oral health status explains substantial proportions of absolute but not of relative inequalities. Overall, there is considerable income-related inequality in dental service utilization by several elderly populations residing in Europe. More research is needed to identify the exact causes of such disparities.
doi:10.1177/0022034511399907
PMCID: PMC3318029  PMID: 21508432
health services research; geriatric dentistry; dental public health
10.  Interventions for tobacco cessation in the dental setting 
Background
Tobacco use has significant adverse effects on oral health. Oral health professionals in the dental office or community setting have a unique opportunity to increase tobacco abstinence rates among tobacco users.
Objectives
This review assesses the effectiveness of interventions for tobacco cessation delivered by oral health professionals and offered to cigarette smokers and smokeless tobacco users in the dental office or community setting.
Search methods
We searched the Cochrane Tobacco Addiction Group Specialized Register (CENTRAL), MEDLINE (1966-November 2011), EMBASE (1988-November 2011), CINAHL (1982-November 2011), Healthstar (1975-November 2011), ERIC (1967-November 2011), PsycINFO (1984-November 2011), National Technical Information Service database (NTIS, 1964-November 2011), Dissertation Abstracts Online (1861-November 2011), Database of Abstract of Reviews of Effectiveness (DARE, 1995-November 2011), and Web of Science (1993-November 2011).
Selection criteria
We included randomized and pseudo-randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office or community setting with at least six months of follow-up.
Data collection and analysis
Two authors independently reviewed abstracts for potential inclusion and abstracted data from included trials. Disagreements were resolved by consensus. The primary outcome was abstinence from smoking or all tobacco use (for users of smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. The effect was summarised as an odds ratio, with correction for clustering where appropriate. Heterogeneity was assessed using the I2 statistic and where appropriate a pooled effect was estimated using an inverse variance fixed-effect model.
Main results
Fourteen clinical trials met the criteria for inclusion in this review. Included studies assessed the efficacy of interventions in the dental office or in a community school or college setting. Six studies evaluated the effectiveness of interventions among smokeless tobacco (ST) users, and eight studies evaluated interventions among cigarette smokers, six of which involved adult smokers in dental practice settings. All studies employed behavioral interventions and only one required pharmacotherapy as an interventional component. All studies included an oral examination component. Pooling all 14 studies suggested that interventions conducted by oral health professionals can increase tobacco abstinence rates (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.44 to 2.03) at six months or longer, but there was evidence of heterogeneity (I2 = 61%). Within the subgroup of interventions for smokers, heterogeneity was smaller (I2 = 51%), but was largely attributable to a large study showing no evidence of benefit. Within this subgroup there were five studies which involved adult smokers in dental practice settings. Pooling these showed clear evidence of benefit and minimal heterogeneity (OR 2.38, 95% CI 1.70 to 3.35, 5 studies, I2 = 3%) but this was a posthoc subgroup analysis. Amongst the studies in smokeless tobacco users the heterogeneity was also attributable to a large study showing no sign of benefit, possibly due to intervention spillover to control colleges; the other five studies indicated that interventions for ST users were effective (OR 1.70; 95% CI 1.36 to 2.11).
Authors’ conclusions
Available evidence suggests that behavioral interventions for tobacco cessation conducted by oral health professionals incorporating an oral examination component in the dental office or community setting may increase tobacco abstinence rates among both cigarette smokers and smokeless tobacco users. Differences between the studies limit the ability to make conclusive recommendations regarding the intervention components that should be incorporated into clinical practice, however, behavioral counselling (typically brief) in conjunction with an oral examination was a consistent intervention component that was also provided in some control groups.
doi:10.1002/14651858.CD005084.pub3
PMCID: PMC3916957  PMID: 22696348
11.  Factors affecting utilization of dental health services and satisfaction among adolescent females in Riyadh City 
The Saudi Dental Journal  2009;22(1):19-25.
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.
doi:10.1016/j.sdentj.2009.12.004
PMCID: PMC3723370  PMID: 23960475
Dental health services; Utilization factors; Patient satisfaction
12.  Utilization of services rendered in dental outreach programs in rural areas of Haryana 
Contemporary Clinical Dentistry  2012;3(Suppl 2):S164-S166.
Background:
The availability of oral health services are very scarce in rural India; therefore the unmet treatment needs of rural population are very high. Hence, a retrospective study was conducted to evaluate the types of patients, disease pattern, and services rendered in outreach programs in rural areas of Haryana.
Materials and Methods:
A The data were obtained from records of outreach programs conducted, in last 3 months, by Swami Devi Dyal Hospital and Dental College. The data from were analyzed using descriptive statistics.
Results:
A total of 1371 individuals in the age group of 4--70 years (56.8% males and 43.2% females) attended the outreach program seeking the treatment. Dental caries (43.7%), gingivitis (27.2%), and periodontitis (22.9%) were commonly observed dental diseases. The services provided were oral prophylaxis (51.2%), restoration (22.9%), referral (20%), and extractions (8.8%).
Conclusion:
The attendance and utilization of dental services in the out reach programs seem to be influenced by sociodemographic characteristics of the population.
doi:10.4103/0976-237X.101076
PMCID: PMC3514936  PMID: 23230354
Disease pattern; out reach program; utilization
13.  Perceived dental treatment need among older Tanzanian adults – a cross-sectional study 
BMC Oral Health  2007;7:9.
Background
Need perceptions for dental care play a key role as to whether people in general will seek dental care. The aim was to assess the prevalence of perceived need of problem based dental care, dental check-ups and any type of dental care. Guided by the conceptual model of Wilson and Cleary, the relationship of perceived need for dental care with socio-demographic characteristics, clinically defined dental problems and self-reported oral health outcomes was investigated. Partial prosthetic treatment need was estimated using a socio-dental approach.
Method
A cross-sectional survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. Information from interviews and clinical examination became available for 511 urban and 520 rural adults (mean age 62.9 yr).
Results
51.7% (95% CI 46.2, 57.0) urban and 62.5 % (95% CI 53.1, 70.9) rural inhabitants confirmed need for dental check-up, 42.9% (95% CI 36.9, 48.9) urban and 52.7% (95% CI 44.5, 60.6) rural subjects confirmed need for problem oriented care and 38.4% (95% CI 32.4, 44.6) urban versus 49.6% (95% CI 41.8, 57.4) rural residents reported need for any type of dental care. Binary and ordinal multiple logistic regression analyses revealed that adults who reported bad oral health and broken teeth were more likely to perceive need for dental care across the three outcome measures than their counterparts. Socio-demographic factors and clinically defined problems had less impact. Based on a normative and an integrated socio-dental approach respectively 39.5% and 4.7% were in need for partial dentures.
Conclusion
About half of the participants confirmed need for problem oriented care, dental check-ups and any type of dental care. Need perceptions were influenced by perceived oral health, clinically assessed oral problems and socio-demographic characteristics. Need estimates for partial denture was higher when based on clinical examination alone compared to an integrative socio-dental approach.
doi:10.1186/1472-6831-7-9
PMCID: PMC1939845  PMID: 17625014
14.  Dental fear among university students: implications for pharmacological research. 
Anesthesia Progress  1998;45(2):62-67.
University students are often subjects in randomized clinical trials involving anxiolytic and analgesic medications used during clinical dental and medical procedures. The purpose of this study was to describe a typical university student population available for research by using data from a mail survey. Subjects were 350 students chosen randomly from all enrolled, full-time, traditional students on the main campus at the University of Washington in Seattle, WA. The aim was to determine the extent and nature of dental anxiety in this population. In addition, the relationships between subject willingness to receive dental injections and general and mental health and medical avoidance and medical fears were examined. The Dental Anxiety Scale (DAS) was used to measure dental anxiety. Dental anxiety was prevalent in this population; 19% of students reported high rates of dental fear. Thirteen percent of students had never had a dental injection. Students with no experience with dental injections were more reluctant than those with experience to receive an injection if one were needed. DAS scores were correlated with injection reluctance. Students who were reluctant to go ahead with a dental injection also reported poorer general and mental health than those who were less reluctant. These students also reported higher medical avoidance and medical anxiety scores. University students provide a rich source of potential subjects for clinical research. The student population, like the community at large, contains people with high levels of dental and medical fear.
PMCID: PMC2148972  PMID: 10356434
15.  Utilization of dental health care services in context of the HIV epidemic- a cross-sectional study of dental patients in the Sudan 
BMC Oral Health  2009;9:30.
Background
HIV infected patients should be expected in the Sudanese dental health care services with an increasing frequency. Dental care utilization in the context of the HIV epidemic is generally poorly understood. Focusing on Sudanese dental patients with reported unknown HIV status, this study assessed the extent to which Andersen's model in terms of predisposing (socio-demographics), enabling (knowledge, attitudes and perceived risk related to HIV) and need related factors (oral health status) predict dental care utilization. It was hypothesized that enabling factors would add to the explanation of dental care utilization beyond that of predisposing and need related factors.
Methods
Dental patients were recruited from Khartoum Dental Teaching Hospital (KDTH) and University of Science and Technology (UST) during March-July 2008. A total of 1262 patients (mean age 30.7, 56.5% females and 61% from KDTH) were examined clinically (DMFT) and participated in an interview.
Results
A total of 53.9% confirmed having attended a dental clinic for treatment at least once in the past 2 years. Logistic regression analysis revealed that predisposing factors; travelling inside Sudan (OR = 0.5) were associated with lower odds and females were associated with higher odds (OR = 2.0) for dental service utilization. Enabling factors; higher knowledge of HIV transmission (OR = 0.6) and higher HIV related experience (OR = 0.7) were associated with lower odds, whereas positive attitudes towards infected people and high perceived risk of contagion (OR = 1.3) were associated with higher odds for dental care utilization. Among need related factors dental caries experience was strongly associated with dental care utilization (OR = 4.8).
Conclusion
Disparity in the history of dental care utilization goes beyond socio-demographic position and need for dental care. Public awareness of HIV infection control and confidence on the competence of dentists should be improved to minimize avoidance behaviour and help establish dental health care patterns in Sudan.
doi:10.1186/1472-6831-9-30
PMCID: PMC2784752  PMID: 19917090
16.  An evaluation of the role and clinical contribution of New Cross dental therapists1 
The first dental therapists (previously called dental auxiliaries), started their training in 1960 and, by the end of 1976, 792 women had qualified after a two-year course. In the present study the role of all dental therapists was investigated by means of a postal survey. The clinical contribution made by these ancillaries was assessed by means of a retrospective analysis of clinic day sheets recorded by 55 dental therapists employed in the community dental services. It was found that dental therapists, in terms of their working pattern and family profile, are typical of women of their age and level of qualification in Britain. The return to work by therapists, after a break from practice because of family commitments, will depend mainly on the availability of posts, particularly part-time posts. Dental therapists provide treatment predominantly for younger children. Compared with previous studies, a noticeable increase in the clinical preventive care provided by therapists was observed.
PMCID: PMC1437541  PMID: 7230201
17.  Attitudes towards, and utility of, an integrated medical-dental patient-held record in primary care. 
BACKGROUND: The need for closer coordination between primary care medical and dental services has been recognized. AIM: To assess the attitudes of general medical practitioners (GMPs), general dental practitioners (GDPs), and patients to an integrated medical-dental patient-held record (integrated medical-dental PHR); to examine patients' use of these records, and the utility of the records for doctors and dentists. METHOD: A three-phase study was carried out: (1) postal survey of GMPs and GDPs; (2) randomized trial of patients, using postal questionnaires before and one year after the issue of integrated medical-dental PHRs to cases; (3) assessment by doctors and dentists of anonymized integrated medical-dental PHRs from this trial. The study was carried out in medical and dental practices in affluent and deprived areas in Greater Glasgow Health Board. Two hundred and thirteen GMPs, 183 GDPs, and 369 patients registered with GMPs and GDPs were surveyed. Eighteen GDPs and GMPs assessed the integrated medical-dental PHRs. RESULTS: Eighty per cent of dentists had contacted a doctor and 16% of doctors had contacted a dentist in the previous three months; 87% of dentists and 68% of doctors thought an integrated medical-dental PHR would be of some use. Twenty-one per cent of dentists and 85% of doctors had practice computers. Most patients wanted to be able to see and read their own records. Twenty-four per cent of patients said there were mistakes and 30% noticed omissions in the integrated medical-dental PHR issued. Experience of having an integrated medical-dental PHR made patients more positive towards the idea of having a patient-held record and being able to check the accuracy of records. Integrated medical-dental PHRs contained important information for half the GDPs and one-third of the GMPs. CONCLUSION: Both professionals and patients have reasonably positive attitudes towards the use of patient-held records. Among patients, the experience of having the integrated medical-dental PHR led to greater enthusiasm towards the idea. Dentists in particular would benefit from the transfer of information from doctors, but better methods are needed to ensure that patients take the integrated medical-dental PHR with them. Given the current lack of ability to easily produce an integrated medical-dental PHR, further examination of the routine issue of a copy of their medical summary, by GMPs, to all patients would be worthwhile.
PMCID: PMC1313422  PMID: 10736887
18.  Survival of Black Colleges from a Dental Perspective 
If we are to achieve health for all in the US by the year 2000, as proposed by the World Health Organization (WHO), we must consider dental health needs as a component of total health. The failure to address dental health needs has reached a crisis level, particularly in the black and underserved communities throughout the nation.
The dental delivery system in the US requires a continuous upgrading of the quality of education received by the students who will be the deliverers of dental services, the dental educators, and the researchers of the future. In order to accomplish this, we must utilize fully the present academic system to assure access, quality, and availability of dental health care for all Americans now and in the future.
PMCID: PMC2552723  PMID: 7241609
19.  A survey of oral health in a Sudanese population 
BMC Oral Health  2012;12:5.
Background
We aimed to assess the oral health status and risk factors for dental caries and periodontal disease among Sudanese adults resident in Khartoum State. To date, this information was not available to health policy planners in Sudan.
Methods
A descriptive population-based survey of Sudanese adults aged ≥ 16 years was conducted. After stratified sampling, 1,888 adult patients from public dental hospitals and dental health centres scattered across Khartoum State, including different ethnic groups present in Sudan, were examined in 2009-10. Data were collected using patient interviews and clinical examinations. Dental status was recorded using the DMFT index, community periodontal index (CPI), and a validated tooth wear index.
Results
Caries prevalence was high, with 87.7% of teeth examined having untreated decay. Periodontal disease increased in extent and severity with age. For 25.8% of adults, tooth wear was mild; 8.7% had moderate and 1% severe toothwear. Multivariate analysis revealed that decay was less prevalent in older age groups but more prevalent in southern tribes and frequent problem based attenders; western tribes and people with dry mouths who presented with less than18 sound, untreated natural teeth (SUNT). Older age groups were more likely to present with tooth wear; increasing age and gender were associated with having periodontal pocketing ≥ 4 mm.
Conclusions
The prevalence of untreated caries and periodontal disease was high in this population. There appear to be some barriers to restorative dental care, with frequent use of dental extractions to treat caries and limited use of restorative dentistry. Implementation of population-based strategies tailored to the circumstances of Sudanese population is important to improve oral health status in Sudan.
doi:10.1186/1472-6831-12-5
PMCID: PMC3311612  PMID: 22364514
20.  Early Childhood Caries and the Impact of Current U.S. Medicaid Program: An Overview 
Pediatric dental caries is the most common chronic disease among children. Above 40% of the U.S. children aged 2–11 years have dental caries; more than 50% of them come from low-income families. Under dental services of the Medicaid program, children enrolled in Medicaid must receive preventive dental services. However, only 1/5 of them utilize preventive dental services. The purpose of this overview is to measure the impact of Medicaid dental benefits on reducing oral health disparities among Medicaid-eligible children. This paper explains the importance of preventive dental care, children at high risk of dental caries, Medicaid dental benefits, utilization of dental preventive services by Medicaid-eligible children, dental utilization influencing factors, and outcome evaluation of Medicaid in preventing dental caries among children. In conclusion, despite the recent increase of children enrolled in Medicaid, utilizing preventive dental care is still a real challenge that faces Medicaid.
doi:10.1155/2012/348237
PMCID: PMC3312229  PMID: 22496690
21.  Dental care demand: insurance effects and plan design. 
Health Services Research  1987;22(3):341-367.
This study concentrates on an important health policy question: the impact of dental insurance on the demand of adults for dental services. Demand equations for individuals are estimated from a systematic random sample of 4,173 families with complete information on their dental claims (insured through Pennsylvania Blue Shield) and survey data. The principal contributions of the research are twofold: (1) to provide rigorous, large-sample estimates of the demand for dental services of insured individuals--providing a complementary set of "natural" experiment results to the randomized experiment results of the RAND Health Insurance Experiment--and (2) to estimate the incremental effects on dental care demand of certain factors related to adverse selection. The study is a companion to a previously published study of children by the same authors. Generally, the analysis shows relatively small money price elasticities of dental care demand among this insured adult population (ranging from -.01 to -.266 across specific types of service). Given a finding that total expenditures for Basic services are 37 percent and 90 percent higher, respectively, for community-rated (versus experience-rated) primary subscribers and insureds, we conclude that differential adverse selection between community- and experience-rated groups accounts for significant differences in dental demand.
PMCID: PMC1065442  PMID: 3119521
22.  Assessing the Need for Anesthesia and Sedation Services in Kuwaiti Dental Practice 
Anesthesia Progress  2010;57(3):91-95.
The objective of this study was to examine the public health relevance of the prevalence of dental fear in Kuwait and the resultant barrier that it creates regarding access to dental care. The study analysis demonstrated a high prevalence of dental fear and anxiety in the Kuwaiti population and a perceived need for anesthesia services by dental care providers. The telephone survey of the general population showed nearly 35% of respondents reported being somewhat nervous, very nervous, or terrified about going to the dentist. In addition, about 36% of the population postponed their dental treatment because of fear. Respondents showed a preference to receive sedation and anesthesia services as a means of anxiety relief, and they were willing to go to the dentist more often when such services were available. People with high fear and anxiety preferred to receive some type of medication to relieve their anxiety. In conclusion, the significance and importance of the need for anesthesia services to enhance the public health of dental patients in Kuwait has been demonstrated, and improvements are needed in anesthesia and sedation training of Kuwaiti dental care providers.
PMCID: PMC3315280  PMID: 20843223
Needs assessment; Sedation; Kuwait; Dental anesthesia; Anxiety
23.  Risk indicators for severe impaired oral health among indigenous Australian young adults 
BMC Oral Health  2010;10:1.
Background
Oral health impairment comprises three conceptual domains; pain, appearance and function. This study sought to: (1) estimate the prevalence of severe oral health impairment as assessed by a summary oral health impairment measure, including aspects of dental pain, dissatisfaction with dental appearance and difficulty eating, among a birth cohort of Indigenous Australian young adults (n = 442, age range 16-20 years); (2) compare prevalence according to demographic, socio-economic, behavioural, dental service utilisation and oral health outcome risk indicators; and (3) ascertain the independent contribution of those risk indicators to severe oral health impairment in this population.
Methods
Data were from the Aboriginal Birth Cohort (ABC) study, a prospective longitudinal investigation of Aboriginal individuals born 1987-1990 at an Australian regional hospital. Data for this analysis pertained to Wave-3 of the study only. Severe oral health impairment was defined as reported experience of toothache, poor dental appearance and food avoidance in the last 12 months. Logistic regression models were used to evaluate effects of demographic, socio-economic, behavioural, dental service utilisation and clinical oral disease indicators on severe oral health impairment. Effects were quantified as odds ratios (OR).
Results
The percent of participants with severe oral health impairment was 16.3 (95% CI 12.9-19.7). In the multivariate model, severe oral health impairment was associated with untreated dental decay (OR 4.0, 95% CI 1.6-9.6). In addition to that clinical indicator, greater odds of severe oral health impairment were associated with being female (OR 2.0, 95% CI 1.2-3.6), being aged 19-20 years (OR 2.1, 95% CI 1.2-3.6), soft drink consumption every day or a few days a week (OR 2.6, 95% 1.2-5.6) and non-ownership of a toothbrush (OR 1.9, 95% CI 1.1-3.4).
Conclusions
Severe oral health impairment was prevalent among this population. The findings suggest that public health strategies that address prevention and treatment of dental disease, self-regulation of soft drink consumption and ownership of oral self-care devices are needed if severe oral health impairment among Indigenous Australian young adults is to be reduced.
doi:10.1186/1472-6831-10-1
PMCID: PMC2827466  PMID: 20102640
24.  Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach 
BMC Oral Health  2010;10:20.
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.
doi:10.1186/1472-6831-10-20
PMCID: PMC2928166  PMID: 20707920
dental pain; epidemiology; oral health; socioeconomic factors; multilevel analysis
25.  Oral health-related quality of life in a birth cohort of 32-year olds 
Objectives
To describe oral health-related quality of life (OHRQoL) among New Zealand adults and assess the relationship between clinical measures of oral health status and a well-established OHRQoL measure, controlling for sex, socioeconomic status (SES) and use of dental services.
Methods
A birth cohort of 924 dentate adults (participants in the Dunedin Multidisciplinary Health and Development Study) was systematically examined for dental caries, tooth loss, and periodontal attachment loss (CAL) at age 32 years. OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14). The questionnaire also collected data on each study member’s occupation, self-rated oral health and reasons for seeing a dental care provider. SES was determined from each individual’s occupation at age 32 years.
Results
The mean total OHIP-14 score was 8.0 (SD 8.1); 23.4% of the cohort reported one or more OHIP problems ‘fairly often’ or ‘very often’. When the prevalence of impacts ‘fairly/very often’ was modeled using logistic regression, having untreated caries, two or more sites with CAL of 4+ mm and 1 or more teeth missing by age 32 years remained significantly associated with OHRQoL, after adjusting for sex and ‘episodic’ dental care. Multivariate analysis using Poisson regression determined that being in the low SES group was also associated with the mean number of impacts (extent) and the rated severity of impacts.
Conclusions
OHIP-14 scores were significantly associated with clinical oral health status indicators, independently of sex and socioeconomic inequalities in oral health. The prevalence of impacts (23.4%) in the cohort was significantly greater than age- and sex-standardized estimates from Australia (18.2%) and the UK (15.9%).
doi:10.1111/j.1600-0528.2007.00395.x
PMCID: PMC2288569  PMID: 18650957
adult; dental caries; oral health; Oral Health Impact Profile; periodontal diseases; prevalence; quality of life; tooth loss

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