Dental Care Delivery System Research Articles

Dental Care for Aging Populations in Denmark, Sweden, Norway, United Kingdom, and Germany

This article reviews access to and financing of dental care for aging populations in selected nations in Europe. Old age per se does not seem to be a major factor in determining the use of dental services. Dentition status, on the other hand, is a major determinant of dental attendance. In addition to perceived need, a variety of social and behavioral factors as well as general health factors have been identified as determinants of dental service use. Frail and functionally dependent elderly have special difficulties in accessing dental care; private dental practitioners are hesitant to provide dental care to these patients. One reason may be that the fee for treating these patients is too low, considering high dental office expenses. Another reason may be problems related to management of medically compromised patients. This raises an important question: does inadequate training in geriatric dentistry discourage dentists from seeking opportunities to treat geriatric patients? Overall, the availability of dental services, the organization of the dental health care delivery system, and price subsidy for dental treatment are important factors influencing access to dental care among older people in Europe as well as in the United States.

Traditional medicine development for medical and dental primary health care delivery system in Africa

Traditional African Medicine (TAM) is our socio-economic and socio-cultural heritage, servicing over 80% of the populations in Africa. Although, it has come a long way from the times of our ancestors, not much significant progress on its development and utilization had taken place due to colonial suppression on one hand, foreign religions in particular, absolute lack of patriotism and political will of our Governments, and then on the other hand, the carefree attitudes of most African medical scientists of all categories. It is incontrovertible that TAM exhibits far more merits than demerits and its values can be exploited provided the Africans themselves can approach it with an open mind and scientific mentality. The degree of sensitization and mobilization by the World Health Organization (WHO) has encouraged some African countries to commence serious development on TAM. The African Regional Director of the WHO has outlined a few guidelines on the responsibilities of all African nations for the realistic development of TAM, in order to sustain our health agenda and perpetuate our culture. The gradual extinction of the forests and the inevitable disappearance of the aged Traditional Medical Practitioner should pose an impending deadline for us to learn, acquire and document our medical cultural endowment for the benefit of all Africans and indeed the entire mankind. Key Words: Traditional African Medicine practice, TAM and PHC, WHO and TAM, herbal production, herbal dentistry Afr. J. Trad. Comp. Alt. Med. , 2005, 2 (1): 46-61

Designing and implementing a school‐based dental program for students with developmental disabilities

Students with developmental disabilities in Atlantic County Special Services School District (ACSSSD) receive on-site dental care through a program created by UMDNJ-New Jersey Dental School (NJDS). The program's goal was to coordinate dental school resources with those of a school district, county agencies and the Delta Dental Foundation to provide quality dental services to the students, aged 3-21 years. The University developed a Needs Assessment Survey and distributed 450 surveys to the students' parent/guardian(s). Completed surveys were returned by 131 respondents. Of the 131 children represented, 75 had not been seen by a dentist within the past year. In response to guardian reported access problems, UMDNJ-NJDS and ACSSSD developed a school-based dental care delivery system and a program for health promotion and disease.

Oral health care systems for elderly in Asia and Japan

More than one‐third of the world population live in Asian countries, and Aging causes the health problems of not only systemic diseases but also oral health in these countries. The purpose of this symposium was to grasp the oral health care systems for aged people in Asian countries. I had already asked to check the percentage of elderly population over 65‐years‐old and their oral health care systems (e.g. oral health status, dental visit and dental care delivery systems, insurance systems, dental manpower, and institutional care for the elderly).Oral health care compromised for the elderly should not be solely based on the activity of dentists, but also interdisciplinary health care teams including dental hygienists, nurses, health workers, and medical doctors. However, these team care systems are not satisfactory at present.Speakers from five countries (China, India, Korea, Thailand, and Japan) presented their systems of oral health care for healthy and compromised elder people. We discussed suitable oral health care systems for each country and the integration of oral health to general health promotion.

Ethical Principles and the Delivery of Children's Oral Health Care

Fundamental ethical principles provide a framework for evaluating children's oral health care and current policies. Principles of justice reveal fundamental inequities in the delivery of children's oral health care. The dental care delivery system rations services by ability to pay and personal choice and places at a disadvantage children who are in the poorest age group, who do not make their own decisions, and who depend upon adults for access to health care. All major theories of justice are consistent with a societal obligation to provide basic health care for children, including oral health care. Beneficence requires physicians and dentists to help the individual child-patient but also obligates others and the society to advocate for children in view of their vulnerability and the importance of oral health to their well-being and future opportunities. Respect for autonomy requires that decisions about children's health care be made in the best interests of the child and in conjunction with families. Such decisions will be grounded in the context of the child's development and his social, family, cultural, and environmental circumstances. Advocacy for a just distribution of resources to children is morally required of physicians and dentists in view of the professions' implicit contract to serve society, public funding of professional education, and the professionals' special knowledge of children's health needs. Pediatricians in particular have an important role to play but often lack the knowledge to promote or effectively advocate for children's oral health. Conversely, dentists may not fully understand critical contextual issues in children's lives.

Children's Oral Health Services: Organization and Financing Considerations

This article highlights prominent issues concerning children's oral health and provides an overview of the structure, organization, and financing of dental services for children in the United States. The size, composition, characteristics, and distribution of the dental workforce and the arrangements that facilitate the delivery and financing of dental services are discussed. Features of the current dental care delivery system are examined within the context of primary care. Suggestions for creating meaningful change to enhance access through expanded, integrated systems are presented as part of a concluding challenge.

Patient Satisfaction with the Comprehensive Care Model of Dental Care Delivery

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

WORK FORCE TRENDS THAT INFLUENCE DENTAL SERVICE CAPACITY

Although the total number of active private dentists increased by 21.7 percent between 1982 and 1995, the number of active private part-time dentists increased by 104 percent, while the number of active private full-time dentists increased by 8 percent. Thus, the total number of hours active private dentists spent in the office has not increased to the same extent as the number of active private dentists. During the same period, however, the average number of hours spent treating patients increased, indicating that dentists are becoming more efficient in directing their office hours toward clinical dentistry. The distribution of active private part-and full-time dentists and the actual number of hours they spent in the dental office and spent treating patients provide a more complete picture of the capacity of the dental care delivery system than only looking at the increase in the total number of dentists.

Oral health status and related behaviours of U.S. nursing home residents, 1995.

The 1995 U.S. National Nursing Home Survey. A descriptive overview of reported oral health status and related behaviours for residents. Cross-sectional survey. 8,056 residents. Interviews by knowledgeable staff, examination of charts and/or personal knowledge. Information on the overall condition of oral health, edentulous status, presence/absence of dentures, difficulty chewing or biting, dental care received in past month, and method of payment for dental services in addition to personal characteristics and medical information. Fifteen percent of the residents were described as having excellent or very good oral health. Forty-one percent of the residents had difficulty chewing and biting. Almost one half of nursing home residents (47%) were totally edentulous. Twenty-six percent of residents had dental services paid for during the past month. Nursing home residents have multiple known barriers to oral health: ability to pay, extended periods of time without direct access to the dental care delivery system, and serious chronic medical conditions. There are serious deficiencies in achieving one of the US national health objectives: ensuring adequate oral health care for institutionalized individuals.

Ethnicity, aging, and oral health outcomes: a conceptual framework.

An expanded version of Andersen's Behavioral Model of Health Services Utilization is used as the theoretical and analytical framework for the International Collaborative Study of Oral Health Outcomes (ICS-II). The conceptual framework for understanding determinants of oral health is based on a "systems" perspective. The framework posits that characteristics of the external environment, the dental care delivery system, and the personal characteristics of the population influence oral health behaviors. The expanded behavioral model conceptualizes health behaviors (oral hygiene practices and dental services utilization) as intermediate dependent variables, which in turn influence oral health outcomes (evaluated, perceived, patient satisfaction). The framework is presented with an increased focus on the effects of race-ethnicity and age cohort, the major exogenous variables used in this study for systematic assessment of the differences in the multitude of factors influencing oral health. The framework can be applied by policy analysis and health services managers to help describe, predict, and explain population-based health behaviors and health outcomes.

ICS-II USA research design and methodology.

The purpose of the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II) was to provide policy-markers and researchers with detailed, reliable, and valid data on the oral health situation in their countries or regions, together with comparative data from other dental care delivery systems. ICS-II used a cross-sectional design with no explicit control groups or experimental interventions. A standardized methodology was developed and tested for collecting and analyzing epidemiological, sociocultural, economic, and delivery system data. Respondent information was obtained by household interviews, and clinical examinations were conducted by calibrated oral epidemiologists. Discussed are the sampling design characteristics for the USA research locations, response rates, samples size for interview and oral examination data, weighting procedures, and statistical methods. SUDAAN was used to adjust variance calculations, since complex sampling designs were used.

A dental school's role in developing a rural, community-based, dental care delivery system for individuals with developmental disabilities.

The long-standing problem of access to dental care for persons with developmental disabilities in rural Northern California has been addressed in several communities by a unique community-based program. The goal was to create a coalition to coordinate dental school resources with those of a consortium of agencies to address problems in the local communities. This program established a community-based model demonstrating the provision of quality preventive and therapeutic dental services to these individuals. Through this program, dental care delivery systems were formed in three rural communities involving local community dentists and agency personnel. The role of the dental school was: (1) to establish and then work with a consortium of hospitals, agencies, dentists, and other dental personnel; (2) to train local dental personnel; (3) to establish and equip hospital dental facilities; (4) to conduct dental screening and triage clinics; (5) to consult with local agencies and dentists; (6) to act as a referral center for patients with complex medical situations; and (7) to develop and disseminate preventive dentistry training materials.

Dental Recall Status and Unscheduled Dental Attendances in British Warships

When deployed away from base, men and women aboard seagoing vessels have restricted access to dental care. Situations may arise in which untreated disease, acute infections, failing restorations, or trauma result in pain or discomfort. Military dental health care delivery systems seek to minimize episodes of dental pain through routine screening by recall and delivery of treatment. A 12-month survey of all unscheduled attendances aboard British warships was conducted to establish the frequency and nature of cases, particularly with respect to recall status. One thousand three hundred forty-one reports were received from 66 ships and shore-based clinics, equivalent to approximately 52 occurrences per 1,000 personnel per year. The nature of the causes was widely varied. Significant relationships were apparent for recall status (treatment required) and the reported causes of dental caries (odds ratio [OR] 4.16, 95% confidence interval [CI] 1.34-13.8), periapical abscess (OR 3.19, CI 1.06-10.03), and failed restorations (OR 4.22, CI 1.31-15.01). In terms of mean time elapsed since last dental visit, those cases in the Fit/Fleet Ready group went 154 days, whereas those in the Treatment Required dental recall group went a mean of only 95 days.

DELIVERY SYSTEMS FOR PRESCHOOL CHILDREN

The United States dental care delivery system generally performs well for those who gain access and can afford necessary care; however, many segments of the population with significant levels of dental disease find it difficult or impossible to avail themselves of the potential benefits that the system has to offer. Preschool children are no exception, and they often receive little or no consideration in epidemiologic studies or policy development. Increasing awareness and improving preschooler's access to needed services will require fundamental changes in attitudes, policies, and behaviors on the part of the public, public officials, and health care professionals, including those within the dental profession.

Longitudinal Study of Knowledge and Attitudes towards Dental Care among Young Danish Adults

The purpose of this report is to analyse determinants of knowledge and attitudes concerning dental health and care in three groups of young adults during three years of study and to analyse whether changes in knowledge and attitudes could be ascribed to differences in utilization of dental services, dental care delivery system, and other sociodemographic and dental variables. The young Danish adults (N = 808) participated in three different dental programs from age 16 to 19. Of these, 505 responded to questionnaires measuring knowledge and attitudes both at the start and at the end of the study. Multiple regression analysis showed that knowledge and attitude scores at the start of the study were the strongest predictors for scores at the end, whereas social class had significant effect on knowledge, and women had more positive attitudes than men. A considerable proportion had lower knowledge and more negative attitudes after than before the study. More positive perceptions of dentists' provision of oral health instruction were found in the group who had dental care in the public child dental service. The effectiveness of dental health education in routine dental care is seriously questioned.

Dental Health Personnel Planning: a Review of the Literature

Dental personnel planning is important in formulating policy in dental education, dental public health programs, and dental care delivery systems. The purpose of this literature review is to illustrate the use of dentist-to-population ratios, need-based models, and demand-based models in the determination of appropriate supply of dental personnel. A historical perspective is provided that demonstrates how political manipulation and subjectivity have characterized the use of these models by organized dentistry, the federal government, and others. The lack of pertinent data and the inability to predict economic, social, political, and epidemiologic trends weaken the applicability of each model in determining future personnel levels. Considering the long-term consequences of the use of each model in personnel planning, caution is urged in using any of the presently available models.

Relationships between price and two components of quality of dental services.

Failure to account for differences in service attributes can lead to biased estimates and erroneous inferences regarding relationships between price and quality in studies of the dental care delivery system. This study examined relationships between prices of several common dental procedures and two components of the structure and process dimensions used in quality of care assessments. Results from ordinary least squares regression analysis demonstrated a significant positive relationship between price and an index of technical quality for two restorative services provided by general practitioners, even when controlling for market area characteristics. Additional analyses revealed that prices charged by general practitioners for specific services typically were lower on average and demonstrated greater variation than those charged by specialists for the same procedures. These findings highlight the need to consider service differentiation, including quality variation, in empirical studies involving the pricing of dental services.

スウェーデンの歯科保健医療制度

スウェーデンの歯科保健医療制度

Periodontal treatment requirements of recently incarcerated prison inmates.

The purpose of this study was to determine the needs for preventive dentistry counselling, prophylaxis and calculus removal and periodontal therapy among recently incarcerated state prison inmates. As a result of clinical and radiographic examinations of 637 male inmates, these requirements were determined for the total sample and for four age groups, three ethnic groups, six crime‐type groups, three residency groups, five intelligence quotient groups and first offenders and recidivists. Among the total sample, 93% of the men needed preventive counselling, prophylaxes and calculus removal; 32% required Type I and/or Type II periodontal treatment. Young men required less periodontal therapy than older inmates. Caucasians needed fewer segments of treatment than Hispanics. Sex offenders required less prophylaxes and calculus removal than men convicted of burglary, larceny and drug‐related crimes. Treatment requirements were not related to residency, recidivism or intelligence quotient. The findings indicate extensive requirements for periodontal and adjunctive therapy among incarcerated men and should influence resource allocation in prison dental care delivery systems.

Identification of practice problems in dentistry

This paper examines the use of dental insurance claim data for studying the dental care delivery system. Several research projects are described including investigations of the amount, types and causes of variation in dental practice patterns, the cost-effectiveness of different patterns of care in producing oral health, the feasibility of focused utilization review systems and the selection of continuing education topics and participants. The importance of these and other data information systems to the future practice of dentistry and medicine is stressed.