Unmet Need For Dental Care Research Articles

Unmet Dental Care Needs of The Low-Income Elderly in South Korea: Applying the Andersen behavioural model.

Retirement reduces income and increases dental care needs for the elderly, but there are few studies on unmet dental care needs among the low-income elderly. This study aimed to identify actors associated with unmet dental care needs of low-income elderly people in South Korea. Secondary analysis of 2020 KNHANES data relating to 1,016 elderly individuals (65+) below median income. Unmet dental care needs were higher for women at 28.9% (p ⟨0.001), those with a middle school education at 28.5% (p ⟨ 0.05), individuals who rated their health as "poor" at 31.3%, those reporting feelings of depression at 44.8% (p ⟨ 0.001), individuals who rated their oral health as "poor" at 36.2% (p ⟨ 0.001), and those who experienced toothache at 37.2% (p ⟨ 0.001). In regression analysis women (Risk Ratio = 1.59, 95% CI 1.09-2.32), people with depression (RR = 2.29, 95% CI 1.01-5.15), those who perceived their oral health as "poor" (3.20, 95% CI 1.90-5.32) and those toothache (1.88, 95% CI 1.27-2.76) had higher unmet dental needs. Substantial unmet dental care needs exist among the low-income retired elderly. Comprehensive public oral health policies and community programs are needed for this population group.

Association between Unmet Dental-Care Needs and the Intention to Use Mobile Healthcare Services among Soldiers

Association between Unmet Dental-Care Needs and the Intention to Use Mobile Healthcare Services among Soldiers

The Effects of Health and Unmet Dental Care Needs on the Health-Related Quality of Life in Korea Older Adults: A Nationwide Study

Background: The purpose of this cross-sectional study was to assess the relationship between oral health, unmet dental needs and health-related quality of life in South Korea older adults. Methods: The present study used raw data from the 2019~2020 Korea National Health and Nutrition Examination Survey, and analyzed 4956 participants aged over 65 yr. Hierarchical multiple regression analysis was used for associations between oral health, unmet dental needs, and HRQoL. Results: The EQ-5D index differed according to tooth pain, chewing difficulty, speaking problem, subjective oral health status, oral examination, and unmet dental care needs (P<0.001). In the model 2, male, under 75 yr of age, high school graduate or higher, employed, living with a spouse, no stress, good subjective health status, no speaking problem, and no unmet dental care needs were associated with higher EQ-5D index (Adj R2 = 27.6%, P<0.001). Conclusion: To improve the HRQoL of older adults in South Korea, oral health problems need to be minimized through oral disease prevention and oral health education programs.

Determinants of Dental Care Utilization, Unmet Dental Care Need, and Barriers among Women of Reproductive Age in the United States

Introduction: Dental care is integral to general health but is often isolated from the healthcare system nor discussed as part of overall health. The barriers to accessing needed dental care vary among socioeconomic and demographic groups. This study examined the disparities in dental care access and identified the socioeconomic and demographic factors associated with dental health needs among United States women. Methods: Using data from the 2017-2020 National Health and Nutrition Examination Surveys (NHANES), we conducted a Chi-square to assess the differences in the proportions of women who reported not getting their needed dental care and computed a weighted multivariate logistic regression to examine the factors associated with access to dental care use, unmet dental-care need, and reported reasons for unmet need. Results: Race, income, and education played a significant role in surveyed participants regarding dental care use and unmet dental care needs. Non-Hispanic Blacks and other minority racial-ethnic groups, including multi-racial groups, were likelier to have never used dental care than non-Hispanic Whites. Furthermore, non-Hispanic Whites with less than a high school education were likelier to have never used dental care than those with a high school education. Groups more likely to report an unmet need were women with PIR < 1.00. Moreover, between 1.00 and 1.99 compared to PIR ≥ 2.00 and women without health insurance compared to those with health insurance. Conclusion: Expanding insurance coverage for dental care and improving access for women with poor health may improve racial-ethnic and education-level disparities, specifically in African American women's unmet dental care needs.

Impact of the COVID-19 Pandemic on the Provision of Dental Care by the Public Dental Services of Cyprus

Background: During 2020 dentists were included in the group of health professionals that were directly affected by the pandemic. This study aimed to capture the impact of the pandemic in the provision of dental care through the Public Dental Services (PDS) of Cyprus in 2020 and 2021 (during pandemic) compared to 2019 (pre pandemic). More specifically, it examined the consequences in the number of visits, the average number of patients per day, the proportion of new patients to the total number of visits, and the type of services provided. Methodology: Statistical data from the PDS were analyzed with the help of SPSS2. Results: Cyprus PDS statistics show a national decline in the number of visits of 41.3% in 2020 compared to 2019 (p < 0.01) and a further decline of 9.6% in 2021 (compared to 2020). The decline in the average number of patients per day (37.6%) in 2019-21 was less than the decline in the average number of visits (47.0%). Similarly, there was a 34.7% decrease in work volume (p < 0.01) between 2019 and 2020 and a further 2.8% decrease in 2021. These decreases were not consistent both between different types of centres and between different districts. In terms of treatments offered nationwide, the largest decrease in 2020 was in dental scaling (53.5%), followed by dental examinations (47.9%), composite fillings (47.5%) and amalgam (45.4%). The share of the most affected dental treatment (scaling, examination, composite and amalgam) in the total workload has decreased from 51% in 2019 to 40% in 2020 (p < 0.01). The least affected dental work in 2020 was temporary fillings, which increased by 6.6%. In 2021, the profile of care provision changed as there was an increase in composite fillings, up 45.7% compared to 2020 (p<0.01), while all other types of dental work continued to decline. The share of the most affected dental treatments (scaling, examination, composite and amalgam) in the total workload increased (from 40% in 2020 to 43.9% in 2021), but still significantly lower than in 2019 (pre-pandemic - 51%). Interestingly, the share of extractions in total workload increased from 16.6% in 2019 to 21.5% in 2021. Conclusion: The COVID-19 pandemic and the subsequent restrictive measures imposed had a negative impact on the provision and seeking of dental care by the PDS. The decline in the frequency of dental visits, if sustained over a longer period of time and not reversed, will have a negative impact on the level of oral health of people living in Cyprus and will increase the unmet need for dental care. The increase in extractions is expected to have a negative impact on the level of oral health, as it is the most radical dental treatment and the need for prosthetic rehabilitation will also increase. In addition, the economic impact of COVID-19 and the global economic instability, which has reduced family incomes, is expected to drive more patients to the public sector, where fees are quite low, adding to already burdened waiting lists. People with lower socio-economic status are expected to bear the highest burden, which will increase oral health inequalities.

The urgent need for valid data on access to healthcare in Europe.

The probability of experiencing an unmet need for medical or dental care can be expressed either (a) as a proportion of the whole population studied or (b) as a proportion of those who had a need. Only (b) yields a valid measure of access to care. Using (a) combines access to care with state of health. Unfortunately, the main data source used by researchers (the European Union Survey of Income and Living Conditions, EU-SILC) uses method (a), rendering the literature to date subject to unknown errors. The authors argue that there is an urgent need for Eurostat to publish data using method (b).

Relationship between Precarious Employment and Unmet Dental Care Needs among Korean Workers: A Longitudinal Panel Study.

Background and Objectives: Precarious workers experience certain conditions, such as low income, instability in employment, and lack of social security. Precarious employment has increased barriers to the use of dental care services, resulting in more unmet dental care needs. The aim of this study was to identify unmet dental care needs among precarious workers in Korea's labor market, using data from the Korea Health Panel Survey (2011-2017). Materials and Methods: Based on job and income security criteria, four groups were formed: Group A (individuals with job and income security), Group B (individuals reporting job security with income insecurity), Group C (individuals reporting job insecurity with income security), and Group D (individuals with job and income insecurity). We measured self-reported unmet dental need or the inability to receive necessary dental care owing to the past economic burdens. Panel logistic regression analyses were performed to determine the effect of precarious employment on unmet dental care needs for all participants. Results: Approximately 16% of the respondents reported having unmet dental care needs. Unmet dental care needs owing to economic reasons were higher among male workers in groups C and D than among male workers in Group A. In particular, male workers aged 50 years and above in Group B were 3.36 times more likely to have unmet dental care needs than those in Group A. In Group D, female workers showed a high probability of having dental care needs owing to economic reasons. Moreover, female workers aged 18-49 years witnessed an increase in unmet dental care needs. Conclusions: Korean workers with unstable employment and/or income are at a higher risk of having unmet dental care needs owing to financial factors. The findings suggest an urgent need to implement robust national health insurance policies to improve efforts aimed at reducing unmet dental care needs that potentially decreases the disparity in oral health among precariously employed workers. Furthermore, it is necessary to implement comprehensive labor market policies such as sickness benefits for those in precarious employment.

Factors Associated with Unmet Dental Care Needs among Korean Adult Cancer Survivors: Cross-Sectional Analysis of the 2016-2018 KNHANES.

This study aimed to identify the factors associated with unmet dental care needs among Korean adult cancer survivors. This cross-sectional study used data from the seventh (2016–2018) Korea National Health and Examination Survey. It included 339 adult cancer survivors. Participants’ experience of unmet dental care needs was assessed using a health questionnaire survey. Moreover, the subjective oral health status (i.e., toothache) and behavior (i.e., toothbrushing and oral examination) were assessed through oral health interviews. The data were analyzed using descriptive statistics, chi-squared test, and logistic regression analysis. The rate of experience of unmet dental care needs among cancer survivors was 29.5%. Cancer survivors with limitations in performing daily activities of living were more likely to experience unmet dental care needs than cancer survivors without activity limitations ([aOR] = 2.14, [95%CI] = 1.04–4.40). Moreover, cancer survivors who did undergo oral examination within the past year were more likely to experience unmet dental care needs than cancer survivors who underwent oral examination ([aOR] = 2.49, [95%CI] = 1.22–5.07). Korean cancer survivors experienced unmet dental care needs when they did not receive an oral examination or had activity limitations. This study’s findings provide insight into social and behavioral factors associated with unmet dental care needs among Korean cancer survivors.

Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg

ObjectivesWe investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability...

Unmet dental care need in West of Iran: determinants and inequality

Purpose The purpose of this study was to assess the self-perceived need, seeking and use of dental care and its main determinants in Kurdistan province, Iran. Design/methodology/approach A total of 1,056 adults in Kurdistan province were included in this cross-sectional study. Multistage sampling approach was used to select the samples. Data on sociodemographic characteristics, economic status, self-perceived need, seeking and use of dental care were collected using a self-administrated questionnaire. Multivariate logistic regression model was used to assess factors affecting the use of dental care. In addition, socioeconomic inequality relating to dental care needs and use of dental care were examined using concentration curve and concentration index. Findings In this study, unmet dental care need was 62.7%. There was a perceived need for dental care among 13.7% (n = 145) of the participants in the past month, with only 39.3% (n = 57) seeking the care. The most important reasons for unmet dental care need were “Could not afford the cost” and “Insurance did not cover the costs.” Multivariate logistic regression showed that supplementary insurance status and household economic status were identified as main determinants affecting dental care-seeking behavior. The result of concentration index revealed that seeking dental care was more concentrated among the rich, whereas the perceived dental care need is more prevalent among the poor. Originality/value This study demonstrated that the prevalence of unmet dental care needs is high in the study setting. Also, financial barrier was identified as the main determinant of unmet dental care needs.

Associations between Dental Checkups and Unmet Dental Care Needs: An Examination of Cross-Sectional Data from the Seventh Korea National Health and Nutrition Examination Survey (2016–2018)

To identify gender- and age-related associations between adult dental checkups and unmet dental care needs, we analyzed data of 14,000 participants, from the Seventh Korea National Health and Nutrition Examination Survey (2016–2018). Data were collected via self-report questionnaires and interviews. The complex sample chi-square test and multiple logistic regression analysis indicated that 31.7% of participants had unmet dental care needs. Within the previous 12 months, 56.5% did not undertake dental checkups, and 29.3% did not use a dental service. Odds ratios (ORs) of the unmet dental needs were 8.87 (confidence interval (CI) = 7.80–10.09, p < 0.001) for those who did not use dental services and 1.28 (CI = 1.13–1.44, p < 0.001) for those who did not have dental checkups. Significant age-dependent associations between those not receiving dental checkups and the rate of unmet dental care included men and women aged 50–59 years and women ≥70 years. However, unmet dental care needs for men aged ≥70 years not undergoing dental checkups were not statistically significant (p = 0.311). Overall, it was found that the use of dental service and dental checkups were the influencing factors for unmet dental care needs.

What is the association between income loss during the COVID-19 pandemic and children’s dental care?

BackgroundThe degree to which children experience unmet need for dental care during the COVID-19 pandemic and its association with pandemic-related household job or income loss are unknown. MethodsThe authors performed a cross-sectional household survey of 348 families in Pittsburgh, Pennsylvania, from June 25 through July 2, 2020. Unmet need for child dental care and pandemic-related household job or income loss were assessed using caregiver self-report. ResultsCaregivers reported that the greatest unmet child health care need during the COVID-19 pandemic was dental care (16%), followed by medical care for a well visit or vaccination (5%). Approximately 40% of caregivers reported job loss or a decrease in household income due to the COVID-19 pandemic. The authors found a significant association between the probability of unmet child dental care and pandemic-related household job or income loss (P = .022). Losing a job or experiencing a decrease in income due to the COVID-19 pandemic was associated with unmet child dental care (relative risk, 1.77; 95% confidence interval, 1.08 to 2.88). ConclusionsIn this sample, 3 times as many households reported unmet dental care for a child compared with unmet medical care. Unmet child dental care was more common in households where pandemic-related job or income loss occurred. Practical ImplicationsIf unmet dental care continues as a result of the COVID-19 pandemic, nontraditional strategies for delivering dental care can be considered to improve access to dental care for children, such as teledentistry and oral health prevention services in primary care settings.

Income-related inequalities in unmet dental care needs in Spain: traces left by the Great Recession

BackgroundDental health is an important component of general health. Socioeconomic inequalities in unmet dental care needs have been identified in the literature, but some knowledge gaps persist. This paper tries to identify the determinants of income-related inequality in unmet need for dental care and the reasons for its recent evolution in Spain, and it inquires about the traces left by the Great Recession.MethodsData from the EU-SILC forming a decade (2007–2017) were used. Income-related inequalities for three years were measured by calculating corrected concentration indices (CCI), which were further decomposed in order to compute the contribution of different factors to inequality. An Oaxaca-type decomposition approach was also used to analyze the origin of changes over time. Men and women were analyzed separately.ResultsPro-rich inequality in unmet dental care needs significantly increased over time (CCI 2007: − 0.0272 and − 0.0334 for males and females, respectively; CCI 2017: − 0.0704 and − 0.0776; p < 0.001). Inequality showed a clear “pro-cycle” pattern, growing during the Great Recession and starting to decrease just after the economic recovery began. Gender differences only were significant for 2009 (p = 0.004) and 2014 (p = 0.063). Income was the main determinant of inequality and of its variation along time -particularly for women-, followed by far by unemployment –particularly for men-; the contributions of both were mainly due to changes in elasticites.ConclusionsThe Great Recession left its trace in form of a higher inequality in the access to dental care. Also, unmet need for dental care, as well as its inequality, became more sensitive to the ability to pay and to unemployment along recent years. To broaden public coverage of dental care for vulnerable groups, such as low-income/unemployed people with high oral health needs, would help to prevent further growth of inequality.

Exploring the Intersection between Social Determinants of Health and Unmet Dental Care Needs Using Deep Learning.

The goals of this study were to develop a risk prediction model in unmet dental care needs and to explore the intersection between social determinants of health and unmet dental care needs in the United States. Data from the 2016 Medical Expenditure Panel Survey were used for this study. A chi-squared test was used to examine the difference in social determinants of health between those with and without unmet dental needs. Machine learning was used to determine top predictors of unmet dental care needs and to build a risk prediction model to identify those with unmet dental care needs. Age was the most important predictor of unmet dental care needs. Other important predictors included income, family size, educational level, unmet medical needs, and emergency room visit charges. The risk prediction model of unmet dental care needs attained an accuracy of 82.6%, sensitivity of 77.8%, specificity of 87.4%, precision of 82.9%, and area under the curve of 0.918. Social determinants of health have a strong relationship with unmet dental care needs. The application of deep learning in artificial intelligence represents a significant innovation in dentistry and enables a major advancement in our understanding of unmet dental care needs on an individual level that has never been done before. This study presents promising findings and the results are expected to be useful in risk assessment of unmet dental care needs and can guide targeted intervention in the general population of the United States.

Concordance of Data on Children's Unmet Health Care Needs Between 2 National Surveys.

We used public data from 2 national surveys to determine how survey mode and questionnaire wording potentially impact estimated prevalence and predictors of children's unmet health care needs. Data from 2016-2017 were obtained for the National Health Interview Survey (NHIS), where interviewers ask caregivers about each type of unmet health care need in person, and the National Survey of Children's Health (NSCH), a self-administered questionnaire asking a general question about any unmet health care needs, with subparts about specific types of unmet needs. Weighted proportions and multivariable logistic regression were used to analyze each data set. The weighted proportion of any unmet health care needs was significantly higher in the NHIS (7.5%; 95% confidence interval [CI], 7.0-8.1; N = 17 723) than in the NSCH (3.3%; 95% CI, 2.9-3.7; N = 65 766). When analyzing specific unmet needs, unmet need for dental care was significantly higher according to the NHIS (4.2% vs 1.9% in the NSCH), as was unmet need for vision care (1.7% vs 0.8%). Conversely, estimates of unmet need for medical care were comparable between the surveys (1.4% and 1.0%). On multivariable analysis, predictors of unmet health care needs, such as being uninsured, had effect sizes of similar magnitude in both surveys. The NHIS design, asking about each type of unmet need in person, may have been more conducive to identifying the full range of unmet health care needs among children. However, our results did not indicate that this was a source of bias in multivariable regression analysis.

Factors of Unmet Dental Care Needs among Oral Health Problems and Dental Care Patients

Factors of Unmet Dental Care Needs among Oral Health Problems and Dental Care Patients

Unmet Dental Care Need and Associated Barriers by Race/Ethnicity among US Adults.

Ability to access needed dental care may vary among population subgroups. We assessed 1) the differences in the proportions of adults who reported unmet dental care needs in the past 12 months and the associated barriers (structural, financial, and cognitive) in 2015 to 2016 versus 2003 to 2004 by race/ethnicity and 2) the subgroups that are more likely to report unmet dental care needs. Data of 10,029 respondents aged ≥19 y from the 2003-2004 and 2015-2016 National Health and Nutrition Examination Surveys were used. Chi-square tests assessed the differences in the proportions of adults who reported not getting the needed dental care between the periods. A multiple logistic regression model was run to identify characteristics that were significantly associated with unmet need after adjusting for other factors. Overall, 19.4% of the adults reported an unmet dental care need in 2015 to 2016, as compared with 21% in 2003 to 2004. The overall unmet dental care need decreased only in the Hispanic groups (34% to 28%, P = 0.045) between 2003-2004 and 2015-2016. Between the periods, unmet need decreased among Hispanics aged 19 to 64 y (35% to 28%, P = 0.02), Hispanics with some college education or above (33.5% to 21.0%, P = 0.008), and nonpoor Hispanic adults (29.8% to 20.4%, P = 0.048). No significant differences were observed in the proportions of adults reporting structural (P = 0.09), financial (P = 0.86), or cognitive (P = 0.07) barriers between the periods. When compared with their counterparts, nonelderly adults, women, Hispanics, adults with a high school education, those with less than a high school education, and poor adults were significantly more likely to report unmet dental care needs. Racial and ethnic disparities in accessing and receiving the needed dental care still exist. Financial barriers to dental care are the most commonly cited reasons for not getting the needed dental care. The results of the study will inform policy makers, public health planners, and dental professionals about subgroups that still face difficulty in receiving the dental care they need. Policy makers should develop new policies to mitigate the financial barriers that are still prevalent. Dental professionals can mitigate the public's cognitive and financial barriers by educating the community through outreach programs and by providing services to low-income populations at reduced charges or through alternative payment plans.

Unmet Dental Care Needs among Korean National Health Insurance Beneficiaries Based on Income Inequalities: Results from Five Waves of a Population-Based Panel Study.

This study investigates whether self-employed beneficiaries experience greater difficulties in accessing dental care than insured employees based on their income level. This analysis uses 2011–2015 data from the Korea Health Panel, a population-based and nationally representative sample, covering 7083 participants aged 18 years and older. We measured barriers to dental access based on unmet needs or the inability to receive necessary dental care owing to the past year’s economic burdens. The type of health insurance and household income are considered independent variables. We applied multiple panel logistic regressions and two-panel logistic regression models with a fixed-effects approach to analyze the data. Self-employed beneficiaries were 1.16 times (95% confidence interval (CI) = 1.08–1.24) more likely to experience unmet dental needs than were insured employees. Insured employees and self-employed beneficiaries belonging to the lowest income bracket were 1.76 times (95% CI = 1.53–2.03) and 2.33 times (95% CI = 1.89–2.87) more likely to have unmet needs than those in the highest income bracket. Self-employed beneficiaries were 1.31 times (95% CI = 1.21–1.43) more likely to experience unmet dental needs caused by economic burdens than are insured employees. Insured employees of the lowest income quintile were 4.15 times (95% CI = 3.41–5.05) more likely to experience unmet needs caused by economic burdens, while the odds ratio for self-employed beneficiaries was 5.47 (95% CI = 4.05–7.39). Our findings indicate gaps in unmet dental needs between self-employed beneficiaries and insured employees. The government should adopt strategies to reduce unmet needs among marginalized groups and redefine the role of national health insurance.

Oral Health-Related Quality of Life Among Publicly Insured Mental Health Service Outpatients With Serious Mental Illness.

The study investigated factors associated with unmet need for dental care and oral health-related quality of life (OHQoL) among individuals with serious mental illness receiving outpatient care in a public mental health program serving a largely low-income population, mostly from racial-ethnic minority groups. Cross-sectional interview data were collected from a convenience sample (N=150) of outpatients. Adjusted risk ratios (ARRs) and adjusted risk differences (ARDs) were estimated by logistic regression models to examine the independent contribution of sociodemographic and clinical factors to low OHQoL and past-year unmet dental need, defined as inability to obtain all needed dental care. More than half of participants reported low OHQoL (54%) and a past-year dental visit (61%). Over one-third (39%) had past-year unmet dental need. Financial barriers (ARR=3.16) and nonfinancial barriers (ARR=2.18) were associated with greater risk for past-year unmet dental need after control for age, gender, high dental anxiety, and limited English proficiency. ARDs for financial and nonfinancial barriers indicated absolute differences of 40 and 27 percentage points, respectively. Unmet dental need (ARR=1.31), xerostomia severity (ARR=1.20), and a schizophrenia spectrum diagnosis (ARR=1.33) were associated with low OHQoL, after control for age and current smoking, with ARDs ranging from 11 to 15 percentage points. Improving oral health promotion, oral health service access, and the integration of the mental and oral health systems may help reduce the high prevalence of low OHQoL in this population, given that low OHQoL is partly driven by unmet dental need.

HRSA-funded Health Centers Are an Important Source of Care and Reduce Unmet Needs in Primary Care Services.

Evidence indicates the unmet need for primary care services including medical, mental health, and dental care is greater among uninsured and Medicaid beneficiaries than privately insured individuals, many of whom use Health Resources and Services Administration-funded health centers (HRSA HCs). We examined differences in rates of unmet need between low-income uninsured and Medicaid patients of HRSA HCs and safety-net clinics in general or private physicians. We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians. We used a nationally representative survey of low income, adult patients who identified HRSA HCs as their usual source of care. We used the National Health Interview Survey to independently identify low-income individuals whose usual source of care was clinics (National Health Interview Survey clinics) or physicians (National Health Interview Survey physicians) in the general population. Dependent variables were unmet need and delay in medical care, and unmet need for prescription medications, mental health, and dental care. The primary independent variable of interest was the usual source of care. We controlled for potential confounders. We found the probability of unmet need for medical and dental care to be lower among HRSA HC patients than individuals whose usual source of care were not HRSA HCs. HRSA HC patients have lower probabilities of unmet need for medical and dental care. This is likely because HRSA HCs provide accessible, affordable, and comprehensive primary care services. Expanding capacity of these organizations will help reduce unmet need and its consequences.