Dental Access Research Articles

Association of low socioeconomic status and limited dental health-care access on poor oral health outcomes among United States adults

Objective: The objective was to examine the association of having poor oral health-care access and low socioeconomic status on poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis in United States (US) adults. Methods: A cross-sectional analysis of 4745 US adults 30 years and older from the National Health and Nutrition Examination Survey (NHANES) 2015–2016 was done. Poor oral health outcomes were determined by the response of the respondents to the questionnaire. Logistic and regression analyses were used to determine the association of having poor oral health-care access and low socioeconomic status on poor oral health outcomes. To take into account the complex survey sampling methods, all the analyses were weighted. Results: This research study found an increased association between limited dental health-care access and poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis among US adults aged 30 years and older. The low socioeconomic status and severe periodontitis results of the unadjusted model of the regression analysis suggest that people who belong to the low socioeconomic group were less likely to have severe periodontitis than people who belong to the high socioeconomic group. In all the other regression models, low socioeconomic status did not have a significant association with poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis. Conclusion: On analyzing the NHANES 2015–2016 data, an increased association between limited dental health-care access and poor oral health outcomes such as gingivitis/periodontitis and severe periodontitis was found in US adults aged 30 years and older. A decreased association was found for low socioeconomic status and severe periodontitis from the unadjusted model of the regression analysis. More research is needed to solve the issue of having poor oral health outcomes such as gingivitis and periodontitis due to not having enough access to dental health care among low-income US adults.

Illuminating Mexican Migrant Adolescents' Dental Access and Utilization Experiences.

To illuminate Mexican migrant adolescents' dental access and utilization experiences. Qualitative focus groups were conducted in English between July 2015 and March 2016 as part of a community-based participatory research project. Adolescents (n=61) aged 12-19 years, from Mexican migrant worker families, who sought healthcare services at a federally-qualified migrant health clinic in San Diego County, California. Seven focus groups, with different sessions for 12-14, 15-16, and 17-19 year olds. Group size ranged from 4-14. Groups were audio-recorded, transcribed verbatim, then analyzed using content and general thematic analyses by two researchers using Dedoose qualitative analysis software. Analysis was guided by the Behavioral Model for Vulnerable Populations. Multiple themes emerged: dental fear, difficulty with scheduling dental appointments, competing with family demands, family income and dental tourism, home remedies, lack of direct adolescent-provider communication, and negative dental visit experiences. Adolescents expressed high levels of dental fear and expressed negative dental visit experiences. Cost was a top barrier to care, despite most having dental insurance. Some described seeking dental services and braces in Mexico due to cost. Adolescents wanted providers to discuss their oral health and treatment needs with them directly as patients, rather than with their parents. Adolescents identified structural and communication barriers that impede access to dental care. Improved patient-provider communication may help build rapport, mitigate dental fear, and facilitate adolescents' understanding of needed dental treatment and their oral health status. Dental providers may benefit from training to enhance culturally competent communication with Mexican migrant adolescents, and should discuss treatment plans with adolescent patients directly.

Longitudinal Analysis of CAD/CAM Restoration Incorporation Rates into Navy Dentistry.

Computer-aided design/computer-aided manufacturing (CAD/CAM) has gained increasing popularity since the first commercially viable dental system was introduced in the mid-1980s. Digitally milled dental restorations can be fabricated chairside in the course of one dental appointment, reducing time, cost, and manpower when compared with traditional laboratory-fabricated analog restorations. Clinical performance, physical properties, and esthetics of digital restorations have been shown to be comparable to traditional analog restorations. The Navy has incorporated CAD/CAM systems into dental clinics on multiple platforms to include ships. The efficiency of this technology has the potential to positively impact dental health and mission readiness. The objective of the present study was to evaluate placement rates of CAD/CAM restorations by Navy dental providers. Placement rates of CAD/CAM restorations from October 2011 to June 2017 (Department of Defense created codes specific to CAD/CAM restorations in 2011) and of laboratory-fabricated analog restorations from January 2008 to June 2017 were queried from the Dental Common Access System (DENCAS) and Corporate Dental Access system (CDA) and evaluated. Scatterplots for each dental restoration category were generated using monthly production data and overlaid with simple linear regression lines and 95% confidence intervals. Regression analysis was performed to determine whether changes in the monthly percentages of placements before and after CAD/CAM were increasing or decreasing and to determine whether the monthly percent change from before CAD/CAM implementation and after CAD/CAM implementation was significantly different from one another. A total of 20,512 CAD/CAM restorations were placed by Navy providers over the 68-month period. A year-over-year increase in digitally fabricated restorations was observed. As a percentage of total indirect restorations, CAD/CAM units surged from 13.8% in 2012 to 38.1% in 2017. All ceramic restorations fabricated by the classical analog method also increased significantly through the period. Traditional analog porcelain fused to metal (PFM) restorations and large amalgam restorations, which frequently serve a similar clinical purpose as indirect or direct full or partial tooth coverage restorations, both decreased significantly after CAD/CAM productivity tracking was initiated. Implementation of CAD/CAM digital restorations has led to a significant decline in specific traditional analog procedures since productivity tracking of CAD/CAM was initiated in 2011. Navy dentistry has embraced CAD/CAM as an efficient means to prepare sailors and marines for deployments, improve operational dental readiness, and potentially decrease dental emergencies by reducing the need for provisional restorations. The trend toward increased utilization of digital dentistry is expected to continue for the following reasons: (1) incorporation of CAD/CAM technology into dental school curricula, (2) advancement of CAD/CAM systems equipped with fast-evolving user interfaces, (3) increased accessibility to CAD/CAM technology in Navy clinics, and (4) training of a greater proportion of dentists in digital CAD/CAM technology. Future studies should investigate the survival rate of CAD/CAM restorations placed within military settings, cost, and manpower of maintaining CAD/CAM units, and impact on military dental laboratories associated with increased CAD/CAM usage.

Higher antibiotic prescribing propensity of dentists in deprived areas and those with greater access to care in the North East and Cumbria, UK.

Background Primary dental practitioners prescribe approximately 10% of all prescriptions. In 2016 NHS England launched a national programme to combat antibiotic over-usage; the main contributing factor to antimicrobial resistance. Aim To identify prescribing habits in the North East and Cumbria, UK, in October 2016 using NHS Community Pharmacy Data. Method The Business Services Authority were commissioned to undertake an audit during this timeframe. Data collected included the antibiotic name, dose, frequency, duration, practice contract number and location. Results The rate of prescriptions issued per 1,000 population reported ranged from 7.02 in Middlesbrough to 0.77 in Eden (Cumbria), with deprived areas showing higher prescribing rates. Prescriptions issued per 1,000 Units of Dental Activity (UDAs) commissioned per practice ranged from 0.02 to 16.6 per thousand. Prescription rates were highly correlated with higher dental access rates. Eleven different antibiotics were prescribed. Discussion The variability of rates of antibiotic prescribing in areas of similar deprivation indicated practitioner bias/preferences influenced rates significantly. Education on antibiotic prescribing guidelines would be of benefit. Conclusion We recommend all dentists regularly undertake self-audit to assess their own prescribing habits and a peer review assessment and/or mentored support groups be established to support colleagues that demonstrate outlying prescribing patterns.

The risks of delayed oral cancer detection in primary care

Oral malignancy necessitates early detection for a better prognosis. Clinical presentation may vary, from a small mucosal lesion with benign clinical features to a large ulcerated mass with considerable local destruction. The case of a 46-year-old patient presenting to a dental access centre with upper quadrant jaw pain, parasthaesia and unexplained tooth mobility is discussed. Delay in recognizing key features suggestive of sinister pathology led to a seven-week delay in referral of an aggressive, rare, odontogenic malignancy; ameloblastic carcinoma. The patient underwent extensive surgery with adjunctive radiotherapy. CPD/Clinical Relevance: Odontogenic malignancy can cause rapid and extensive local invasion with a high potential for local or regional spread. Maxillary tumours often present with late, non-specific symptoms, thus must be detected early.

Can the Fear of the Chair be Worsened by Dental Appointments?

Introduction: Limitations in dental access and challenges associated with service delivery often necessitates the usage of an appointment system in patient care. This research aimed to determine the association between levels of dental anxiety in dental patients and dental treatment appointment at the Lagos State University Teaching Hospital (LASUTH). Materials and Methods: A descriptive study at a tertiary hospital in Lagos State. A systematic sampling method was used to enlist 149 study patients in four clinical dental departments in LASUTH, whereas sociodemographic, clinical history, and anxiety-related data were collected using a structured interviewer-administered questionnaire. Visual analog scale (VAS) was used to assess inconvenience, whereas the Modified Dental Anxiety Scale (MDAS) was used for anxiety assessment. Data entry and analysis was performed using Statistical Package for Social Sciences version 20, P value of <0.05 was considered significant. Results: The mean age of the respondents was 25.3 ± 6.8; 53% had never had a dental visit and majority felt inconvenient by the length of dental appointment (62.7%; mean VAS = 5.95 ± 2.72); higher levels of inconvenience was significantly associated with levels of anxiety (MDAS—13.96 ± 4.8; P = 0.010). At baseline, age group ≤20 years (MDAS—15.21 ± 4.0; P = 0.026), female gender (MDAS—14.44 ± 4.8; P = 0.042), and primary level of education (MDAS—0.029; P = 15.25 ± 4.7) were significantly associated with high levels of anxiety. At baseline, 14.8% had high dental anxiety (MDAS scores of ≥19), and this increased to 18.1% on the treatment appointment day. Conclusion: Dental appointments appear to be associated with impact on anxiety levels. MDAS can be used as a screening tool to identify anxious patients to determine which treatment approach to adopt and possibly give shorter appointments.

A Pilot Quality Improvement Collaborative to Improve Safety Net Dental Access for Pregnant Women and Young Children.

Objectives To determine acceptability and feasibility of a quality improvement (QI) collaborative in safety net dental practices, and evaluate its effects on financial stability, access, efficiency, and care for pregnant women and young children. Methods Five safety net dental practices participated in a 15-month learning collaborative utilizing business assessments, QI training, early childhood oral health training, and prenatal oral health training. Practices collected monthly data on: net revenue, no-show rates, total encounters, and number of encounters for young children and pregnant women. We analyzed quantitative data using paired t-tests before and after the collaborative and collected supplemental qualitative feedback from clinic staff through focus groups and directed email. Results All mean measures improved, including: higher monthly revenue ($28,380-$33,102, p = 0.37), decreased no-show rate (17.7-14.3%, p = 0.11), higher monthly dental health encounters (283-328, p = 0.08), and higher monthly encounters for young children (8.8-10.5, p = 0.65), and pregnant women (2.8-9.7, p = 0.29). Results varied by practice, with some demonstrating largest increases in encounters for young children and others pregnant women. Focus group participants reported that the collaborative improved access for pregnant women and young children, and that QI methods were often new and difficult. Conclusion for practice Participation by safety net dental practices in a QI collaborative is feasible and acceptable. Individual sites saw greater improvements in different outcomes areas, based on their own structures and needs. Future efforts should focus on specific needs of each dental practice and should offer additional QI training.

2015–2016, Georgia Department of Public Health Districts, Evaluating Oral Health Services in Ryan White Part B Clinics

Abstract Background Poor dental health adversely affects overall health, and people living with HIV/AIDS (PLWHA) have a higher prevalence of dental disease than the general population. This study evaluated dental care access and utilization among PLWHA who receive services at Ryan White Part B (RWPB) Clinics in Georgia using three different measurement instruments. Methods Of the 19 Georgia Department of Health (GA-DPH) districts, HIV coordinators from all 16 districts that receive RWPB funding completed a web-based dental care needs assessment survey in October 2016, evaluating July 2015 to June 2016 (FY16). We compared findings to metrics obtained from two other sources: CAREWare, a national HIV electronic health system; and manual chart audits, performed using a weighted analysis of 32–42 clients per district. We analyzed the survey data and compared the three instruments descriptively. Results Of the 9,461 total active clients with HIV in the 16 DPH districts evaluated in the survey, 20% had at least one dental visit during FY16. All 16 districts had established relationships with dental providers. The average waiting period to see a dentist was &amp;lt;4 weeks in 13 (81%) of districts. Coordinators most frequently identified lack of transportation, health literacy, and high cost as important barriers to care. Though the overall average of clients with at least one dental visit during FY16 was similar between the survey, CAREWare, and audit data (20%, 16%, and 19%, respectively), the three instruments demonstrated notable variability within sites. Proportion of clients with dental visits across Georgia showed regional variation, with fewer visits reported centrally and more dental visits reported in the northeastern and southeastern areas. Conclusion Even though all DPH districts had access to dental providers with short waiting periods, PLWHA served by RWPB received limited dental services and faced many barriers to care during FY16. Three measurement tools demonstrated poor consistency between and across districts, highlighting the challenges in reporting and evaluating data in this population. By developing targeted quality improvement initiatives, GA-DPH will use these finding to improve annual dental visit rates, reduce barriers to care, and more accurately measure specific health outcomes for PLWHA. Disclosures All authors: No reported disclosures.

Sign language in dental education-A new nexus.

The introduction of the landmark mandatory teaching of sign language to undergraduate dental students at the University of the West Indies (UWI), Mona Campus in Kingston, Jamaica, to bridge the communication gap between dentists and their patients is reviewed. A review of over 90 Doctor of Dental Surgery and Doctor of Dental Medicine curricula in North America, the United Kingdom, parts of Europe and Australia showed no inclusion of sign language in those curricula as a mandatory component. In Jamaica, the government's training school for dental auxiliaries served as the forerunner to the UWI's introduction of formal training of sign language in 2012. Outside of the UWI, a couple of dental schools have sign language courses, but none have a mandatory programme as the one at the UWI. Dentists the world over have had to rely on interpreters to sign with their deaf patients. The deaf in Jamaica have not appreciated the fact that dentists cannot sign and they have felt insulted and only go to the dentist in emergency situations. The mandatory inclusion of sign language in the Undergraduate Dental Programme curriculum at The University of the West Indies, Mona Campus, sought to establish a direct communication channel to formally bridge this gap. The programme of two sign language courses and a direct clinical competency requirement was developed during the second year of the first cohort of the newly introduced undergraduate dental programme through a collaborating partnership between two faculties on the Mona Campus. The programme was introduced in 2012 in the third year of the 5-year undergraduate dental programme. To date, two cohorts have completed the programme, and the preliminary findings from an ongoing clinical study have shown a positive impact on dental care access and dental treatment for deaf patients at the UWI Mona Dental Polyclinic. The development of a direct communication channel between dental students and the deaf that has led to increased dental access and treatment for the deaf can be extended to dentists and to other dental students globally. The vision is that similar courses will be introduced in other health training programmes at the UWI, and conceivably, in other institutions. The small sample size allows for informative, but not definitive, conclusions to be drawn. The mandatory inclusion of sign language and Deaf culture in the dental curricula has not just removed a communication barrier, but has assisted in the empathetic and ethical development of the dental student.

Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India

Introduction: Dental care utilization is limited, and teeth are often left untreated or extracted in India. Several barriers exist for the utilization of dental services. The present study was undertaken to assess the oral healthcare needs, utilization pattern of oral healthcare services, and barriers to utilization of oral healthcare services among the outpatients of Peripheral Medical Centre, Poonjeri, Mamallapuram, India. Materials and Methods: Simple random sampling was conducted among outpatients and their attenders reporting to the health centre; demographic profile of the patients were recorded followed by interviewer-administered questionnaire for recording the self-perceived dental needs and barriers in utilizing dental care services followed by Type II clinical examination to assess normative dental treatment needs. Results: N =282 study participants participated in the present study; majority of the study participants were from upper lower class and lower middle class. Among the study subjects n = 124 (44%) have not accessed any dentist, n = 112 (39.7%) had visited dentist for toothache. Common reason cited as Self – perceived barriers for dental care are n = 184 (65.2%) – 'Unaware of the dental problems' and n = 118 (41.8%) 'Fear of dental treatment'. Logistic regression showed that significant difference was seen in gender, socioeconomic status, and barriers to dental care (P < 0.05) in influencing the utilization pattern of dental care. Conclusion: Perceived and normative dental needs were high among the study population due to problem-oriented care, and it is influenced by various barriers such as unawareness of dental problems, fear, cost, accessibility, and time.

Oral Health Intervention for Low-Income African American Men in Atlanta, Georgia.

To describe the Minority Men's Oral Health Dental Access Program (MOHDAP) intervention and report participants' outcomes and satisfaction. MOHDAP was designed to increase the oral health knowledge of low-income, African American men in Atlanta, GA, in 2013. A community-based participatory approach and needs assessment guided the intervention development, which consisted of 3 educational modules delivered over a 2-day period. All participants (n = 45; mean age = 50 years) were African American men. We assessed changes in oral health knowledge and attitudes at baseline and postintervention via survey. After the intervention, the percentage of correct responses to questions about gingivitis increased by 24.2% (P = .01), about use of a hard (instead of a soft) toothbrush increased by 42.2% (P < .01), and knowledge of ways to prevent gum diseases increased by 16.0% (P = .03). The percentage agreeing with erroneous statements decreased 11.3% (P = .02) regarding oral health-related fatalism and oral health self-care and 17.4% (P = .05) regarding saving front versus back teeth. Community-based oral health educational interventions designed for African American men may reduce oral health disparities among this population.

Socioeconomic Gradients in Dental Care Accessibility in Germany

The aim of this study was to determine whether dental care accessibility in Germany from 2002 to 2009 was linked to socioeconomic status (SES) or household net income (HHN). Analysis was based upon a nation-wide cross-sectional survey of German adults from 18 to 79 years (mean 49.1 years; 55% females) which was conducted by the "Bertelsmann Gesundheitsmonitor" from 2002-2009. Patients in Germany visit the dentist 2.4 times per year independently of the SES. Patients with higher income paid per income group 34 € (95%- KI: 6 €-63 €) more for their denture. People from the middle class had 1.28 (95% CI: 1.02-1.22), and people from the upper class had 1.86 (95%-CI: 1.58-2.18) as much dental coinsurance coverage as people from the lower class. The ability to pay for denture and obtain dental insurance coverage rose with higher SES or HHN. The rise of additional payments for dental services leads to discrepancies in dental health care.

Periodontal treatment in patients with learning disabilities part 1: prevention

People with learning disabilities are reported to have a significantly increased incidence and severity of periodontal disease when compared to their non-disabled counterparts. The reasons for this are numerous and may include perpetuating medical conditions, personal and social circumstances, as well as poor dental access and education. Uncontrolled or advanced periodontal disease may not only cause tooth loss and its ensuing consequences but may also affect medical health, initiating or causing deterioration of systemic disease. Despite being a significant public health issue, very few data exist in current literature about the periodontal needs and treatment of patients with learning disabilities. This may largely be because research in this group is difficult and the spectrum of learning disabilities is vast. This paper aims to report on the available data in order to produce suggestions for care. This paper forms a two part series, the first of which explores preventive strategies that may be used by general dental practitioners, as well as specialists within the field, to reduce the burden of periodontal disease within this specific patient group. CPD/Clinical Relevance: Large health inequalities exist across the population, with those with learning disabilities exhibiting much higher levels of periodontal disease and unmet dental need. Helping to reduce these inequalities is the responsibility of all dental professionals.

Oral health assessment from the perspective of the municipal manager

ABSTRACT Objective: The aim of this study was to conduct a situational diagnosis related to the organization of oral health services in 40 municipalities of São Paulo State, Brazil. Methods: This is a cross-sectional, quantitative and qualitative, descriptive study performed through document analysis and application of a semi-structured questionnaire to oral health coordinators, in 2014. The following items were defined: dental infrastructure, access and regulation, work organization and assessment strategies. Although the Basic Health Unit is the main gateway to the system, dental care was also conducted in schools; the main service access of the population was the spontaneous demand and there have been production data inconsistencies in the information systems. Results: It was observed that, 60% answered that the health planning process included oral health; 47.5% performed risk assessment; 47.5% did not perform evaluation and monitoring of results. Conclusion: It is concluded that municipalities present different moments in the structuring of the service and that managers should improve the access organization, the work process and service evaluation in order to consolidate the universality and comprehensiveness of health care.

Impact of a Community Dental Access Program on Emergency Dental Admissions in Rural Maryland.

To characterize the expansion of a community dental access program (CDP) in rural Maryland providing urgent dental care to low-income individuals, as well as the CDP's impact on dental-related visits to a regional emergency department (ED). We used de-identified CDP and ED claims data to construct a data set of weekly counts of CDP visits and dental-related ED visits among Maryland adults. A time series model examined the association over time between visits to the CDP and ED visits for fiscal years (FYs) 2011 through 2015. The CDP served approximately 1600 unique clients across 2700 visits during FYs 2011 through 2015. The model suggested that if the CDP had not provided services during that time period, about 670 more dental-related visits to the ED would have occurred, resulting in $215 000 more in charges. Effective ED dental diversion programs can result in substantial cost savings to taxpayers, and more appropriate and cost-effective care for the patient. Community dental access programs may be a viable way to patch the dental safety net in rural communities while holistic solutions are developed.

Dental service disparities in Canada: A Saskatoon, Saskatchewan case study

Key Messages This intra‐urban analysis of spatial accessibility to dental services highlights poorly served municipalities. The dental access score is found to be associated with the following socio‐economic variables: lone parent, home ownership, and dwellings needing major repairs.

Geriatric Oral Health Care Delivery in the United States of America

The growing elderly population (≥65 years) imposes great challenges to oral health delivery systems. In the USA, the elderly continue to exhibit a high prevalence of chronic oral disorders. Further, poor dental access has long remained a concern and a barrier toward oral health improvement. Lack of dental insurance is a prominent contributor to the access problem. The main reason for the lack of dental insurance is the loss of employer benefits after retirement and the current transition to a national insurance program (Medicare) with insignificant dental benefits. Dental care needs to be established earlier in life through an appropriate model of care that considers the level of dependency of the elderly. The goals of dental treatment for the elderly are different from those for any other age group, and there is an increased need for the provision of dental care in regions with large elderly populations. This paper provides an overview of the challenges imposed on the health care delivery system in the USA with regard to the provision of oral health care to older adults and discusses consideration for future improvement.

Oral health in patients taking psychotropic medications: Results from a pharmacy-based pilot study

ObjectivesIndividuals with mental illness face an increased risk of oral disease compared with those without mental illness. The goals of this study were to examine the self-reported oral health and dental access of individuals filling psychotropic medication prescriptions and to determine whether pharmacy patients would choose to speak with a pharmacist about their oral health if given the option to do so. DesignPharmacists across 6 community pharmacies within a local chain identified and surveyed adult patients filling prescriptions for psychotropic medications. Surveys included questions about oral health, dry mouth, and dental care utilization. SettingSix community pharmacy locations. ParticipantsAdults (≥18 years of age) filling prescriptions for psychotropic medications. InterventionNot applicable. Main outcome measuresSelf-reported oral health, dental utilization, desire to discuss oral health with a pharmacist. ResultsParticipants (N = 178) filling prescriptions were mostly (65.9%) female with a mean age of 48.2 years (SD 14.3, range 19-82 years). One in 4 (24.9%) said their mouths “always” or “frequently” felt dry; these individuals were significantly more likely to have last seen a dentist for emergency (rather than routine) treatment (P <0.01) and rated their oral health as significantly worse (P <0.001) than participants whose mouths “never” or “occasionally” feel dry. A small percentage (5.7%) requested to speak with pharmacists about oral health; they reported poorer oral health than those who opted not to speak with a pharmacist (P <0.05). ConclusionOne in 4 patients reported having dry mouth, and those with dry mouth reported significantly worse oral health than patients without dry mouth. Although dry mouth and poor oral health were common in this sample of individuals taking psychotropic medications, this did not consistently translate into seeking information regarding oral health. Future research will focus on pharmacist-initiated oral health interventions with high-risk patients.

Assessing the Oral Health Needs of African American Men in Low-Income, Urban Communities.

Despite improvements in oral health status in the United States, pronounced racial/ethnic disparities exist. Black men are less likely to visit the dentist, are twice as likely to experience tooth decay, and have a significantly lower 5-year oral cancer survival rate when compared to White men. The Minority Men's Oral Health Dental Access Program employed a community-based participatory research approach to examine the oral health barriers and opportunities for intervention among Black men in a low-income, urban neighborhood. A cross-sectional study design was implemented through a self-administered survey completed among 154 Black males. The majority reported not having dental insurance (68.8%). Most frequently cited oral health care barriers were lack of dental insurance and not being able to afford dental care. Attitudes related to the significance of dental care centered on cancer prevention and feeling comfortable with one's smile. The impact of oral health on daily life centered on social interaction, with men citing insecurities associated with eating, talking, and smiling due to embarrassment with how their teeth/mouth looked to others. Multivariate logistic regression revealed that those who had difficulty finding dental care were 4.81 times (odds ratio = 4.65, 95% confidence interval [1.80, 12.85]) more likely to report no dental insurance, and 2.73 times (odds ratio = 3.72; 95% confidence interval [1.12, 6.70]) more likely to report poor oral health. Community-based participatory approaches include assessment of neighborhood residents affected by the health issue to frame interventions that resonate and are more effective. Social, physical, and infrastructural factors may emerge, requiring a multilevel approach.

Comparison of supplied amount of pit and fissure sealing on the first permanent molars by age and disparity of dental accessibility using National Health Insurance data

Comparison of supplied amount of pit and fissure sealing on the first permanent molars by age and disparity of dental accessibility using National Health Insurance data