Abstract
This study aimed to explore whether population characteristics were associated with the use of dental services, individual's personal oral health practices, dental caries and oral health-related impacts using the revised Andersen's behavioural model as the theoretical framework. This cross-sectional study included participants from a Norwegian general population (N=1840; 20-79years) included in the Tromstannen-Oral Health in Northern Norway (TOHNN) study. The variables included in the model were social structure (income, education, urbanization), sense of coherence (SOC), enabling resources (difficulties accessing the dentist, declined treatment, dental anxiety), treatment need, use of dental services, toothbrushing frequency, sugary soda drink consumption, decayed teeth and oral health-related impacts (OHIP-14). Structural equation modelling was used to test the direct and indirect effects within Andersen's behavioural model of access and health outcomes. Andersen's behavioural model fit the data well and explained a large part of the variance in use of dental services (58%), oral health-related impacts (48%) and, to a lesser extent, decayed teeth (12%). More social structures and a stronger SOC was associated with more enabling resources, which in turn, was associated with more use of dental services. Social structures were not directly associated with use of dental services or decayed teeth but were predictive of oral health-related impacts. A stronger SOC was associated with more frequent toothbrushing, less soda drink consumptions, fewer decayed teeth and less oral health-related impacts. Self-perceived need did not predict dental attendance but was associated with decayed teeth. A less frequent use of dental services, less frequent toothbrushing and more frequent sugary soda drink consumption were associated with more decayed teeth. Decayed teeth were not associated with oral health-related impacts. The findings suggests that, in addition to focusing on reducing socioeconomic inequalities in relation to oral health in the Norwegian population, it is also important to consider how people perceive their own resources (eg financial, psychological, social) as well as their access to dental care in order to support regular dental attendance and potentially, in turn, enhance oral health.
Highlights
Regular dental attendance has been shown to have a positive impact on oral health.[1,2] Despite this, both access to oral health care and regular dental attendance have been shown to vary considerably within and between populations.[3,4] Why people do not regularly attend dental services is complex, and there is probably an interplay between psychosocial, material, cultural and behavioural aspects as well as the perceived need for treatment
We found support for Andersen's behavioural model of access and health outcomes when applied to the oral health of a Norwegian adult general population sample
The findings regarding use of dental services were in line with our previous analysis testing Andersen's behavioural model with periodontitis as the clinically evaluated outcome.[27]
Summary
Regular dental attendance has been shown to have a positive impact on oral health.[1,2] Despite this, both access to oral health care and regular dental attendance have been shown to vary considerably within and between populations.[3,4] Why people do not regularly attend dental services is complex, and there is probably an interplay between psychosocial, material, cultural and behavioural aspects as well as the perceived need for treatment. In addition to SES indicators, psychological factors such as dental anxiety and sense of coherence are possible mediators of dental caries.[7,17] Sense of coherence (SOC) is a salutogenic construct relating to the way an individual makes sense of the world (comprehensibility), has the required resources to respond to life events (manageability) and feels that these responses are meaningful and make sense (meaningfulness).[18] A stronger SOC has been associated with greater dental attendance, more frequent toothbrushing and fewer oral health-related impacts.[19,20,21,22] The research to date would suggest that salutogenic factors—such as SOC—could play an important role in improving dental access and oral health-related behaviours and outcomes in adults
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