Unmet Dental Need Research Articles

The Effects of National Health Insurance Denture Coverage Policies for the Elderly on the Unmet Dental Needs of the Edentulous Elderly

As the elderly population increases, they are increasingly affected by oral health problems. Therefore, efforts are being made to improve the oral health of older people, alleviate mental discomfort, and reduce unmet dental needs. This study was conducted to confirm the relationship between the National Health Insurance Elderly Denture Coverage and the unmet dental need for the edentulous elderly, as part of the protection policy. We analyzed the 2011 and 2013 Community Health Survey data of the edentulous elderly, aged 75 years or older, before 2012. In order to more precisely confirm the effects of the denture donation policy on unmet dental care, basic life recipients who were subject to the free elderly prosthetic project were excluded from the analysis. The final analysis included 20,400 subjects. According to our investigation of the factors that affect the unmet dental needs of the elderly, the National Health Insurance Elderly Denture Coverage did not affect unmet dental needs. The statistically significant variables that affected the unmet dental needs of the elderly were education and income levels, which are representative socioeconomic status variables. The lower the level of education, the unhealthier the dental care experience, and income levels showed a similar tendency. The elderly who have a low socioeconomic status are more likely to experience unmet dental needs because they lack the knowledge and socioeconomic ability to pay for dental care. Therefore, the policy for health protection of the entire elderly population should be continuously expanded. In addition, the socioeconomically vulnerable groups may have health problems due to the restriction of medical use, which may lead to quality of life deterioration.

Transportation Barriers and Use of Dental Services among Medicaid-Insured Adults.

This study explores how travel distance and other transportation barriers are associated with dental utilization in a Medicaid expansion population. We analyzed data from the Iowa Dental Wellness Plan (DWP), which provides comprehensive dental benefits for low-income adults aged 19 to 64 y as part of Iowa's Medicaid expansion. Transportation and geographical characteristics were evaluated as enabling factors within the framework of Andersen's behavioral model of health services use. In March 2015, a random sample of DWP members ( n = 4,800) was surveyed; adjusted survey response rate was 30% ( n = 1,258).The questionnaire was based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey and assessed need for dental care, use of dental services and transportation to visits, and self-perceived oral health status. Respondent and dentist addresses were geocoded and used to calculate distance to the nearest DWP general dentist. A logistic regression model predicting utilization of dental care was developed using variables representing each domain of the behavioral model. Most respondents (57%) reported a dental visit since enrolling. Overall, 11% of respondents reported unmet dental need due to transportation problems. Median distance to the nearest general dentist was 1.5 miles. In the adjusted model, travel distance was not significantly associated with the likelihood of dental utilization. However, other transportation-related issues were significantly associated with utilization, including concern about cost of transportation and driver/passenger status. As concern about transportation cost increased, likelihood of having a dental visit decreased. Targeted approaches to assisting low-income populations with transportation barriers should be considered in designing policies and interventions to improve access to dental care. Knowledge Transfer Statement: The results of this study can be used by policy makers and public health planners when designing programs and interventions to improve access to dental care. Consideration of transportation availability and costs could improve utilization of routine dental care, especially among low-income populations.

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.

Associations among dental insurance, dental visits, and unmet needs of US children

BackgroundIn this study, the authors explored the associations between dental visits and unmet dental needs of children on the basis of their insurance type in the United States. MethodsThe authors used the National Health Interview Surveys from 1997 through 2014 to collect data on dental visits, unmet dental needs, and type of insurance for children aged 2 to 17 years in the United States. Unmet dental need was based on not receiving needed dental care during the past year because of financial constraints. Insurance types reported were private, Medicaid or public, other, and uninsured. The authors performed Pearson correlation coefficient analyses and used descriptive summary statistics. ResultsThe number of uninsured children decreased by 58% from 1997 through 2014 with a substantial shift from private to public insurance coverage. Regardless of type, dental insurance status was associated positively with the use of dental services and negatively associated with levels of unmet dental needs. Unmet needs in the public insurance group decreased consistently since 2009. There was a significant negative correlation (P < .05) between dental visits and unmet dental needs with respect to public insurance, whereas there was no significant correlation for private insurance. ConclusionsDental insurance played a significant role in children’s use of dental services and their level of unmet dental needs. Practical ImplicationsThe shift toward the use of public insurance along with a significant association between unmet needs and dental visits support the effectiveness of publicly funded programs in facilitating the use of dental services in the United States.

A Multilevel Approach on Self-Reported Dental Caries in Subjects of Minority Ethnic Groups: A Cross-Sectional Study of 6440 Adults.

Regional contextual factors and dental caries using multilevel modeling related to adults in minority ethnic groups have been scantily explored. The influence of the socioeconomic context on self-reported dental caries (SRDC) in individuals of minority ethnic groups (IEG) in Colombia was studied. Data from the 2007 National Public Health Survey were collected in 34,843 participants of the population. The influence of different factors on SRDC in IEG was investigated with logistic and multilevel regression analyses. A total of 6440 individuals belonged to an ethnic group. Multilevel analysis showed a significant variance in SRDC that was smaller in IEG level than between states. Multilevel multivariate analysis also associated SRDC with increasing age, lower education level, last dental visit >1year, unmet dental need and low Gross Domestic Product (GDP). Minority ethnic groups were at risk to report higher dental caries, where low GDP was an important variable to be considered.

Association between unmet dental needs and school absenteeism because of illness or injury among U.S. school children and adolescents aged 6–17 years, 2011–2012

BackgroundWe assessed the prevalence of dental disease among U.S. children and adolescents aged 6–17years, as well as the impact of unmet dental needs on school absenteeism because of illness/injury within the past 12months. MethodsData were from the 2011/2012 National Survey of Children's Health (n=65,680). Unmet dental need was defined as lack of access to appropriate and timely preventive or therapeutic dental healthcare when needed within the past 12months. The impact of unmet dental needs on school absenteeism was measured using a multivariate generalized linear model with Poisson probability distribution (p<0.05). ResultsWithin the past 12months, 21.8% (10.8 million) of all U.S. children and adolescents aged 6–17years had “a toothache, decayed teeth, or unfilled cavities.” Of all U.S. children and adolescents aged 6–17years, 15.8% (7.8 million) reported any unmet dental need (i.e., preventive and/or therapeutic dental need) within the past 12months. The mean number of days of school absence because of illness/injury was higher among students with an unmet therapeutic dental need in the presence of a dental condition compared to those reporting no unmet dental need (β=0.25; p<0.001). ConclusionsEnhanced and sustained efforts are needed to increase access to dental services among underserved U.S. children and adolescents.

The Impact of Medicaid Reform on Children's Dental Care Utilization in Connecticut, Maryland, and Texas.

ObjectiveTo measure the impact of Medicaid reforms, in particular increases in Medicaid dental fees in Connecticut, Maryland, and Texas, on access to dental care among Medicaid-eligible children.Data2007 and 2011–2012 National Survey of Children’s Health.Study DesignDifference-in-differences and triple differences models were used to measure the impact of reforms.Principal FindingsRelative to Medicaid-ineligible children and all children from a group of control states, preventive dental care utilization increased among Medicaid-eligible children in Connecticut and Texas. Unmet dental need declined among Medicaid-eligible children in Texas.ConclusionsIncreasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.

Predictors of Unmet Dental Need in Children With Autism Spectrum Disorder: Results From a National Sample

ObjectiveUnmet dental need in children with autism spectrum disorder (ASD) is common. We tested hypotheses that lacking a medical home or having characteristics of more severe ASD is positively associated with having unmet dental need among children with ASD. MethodsUsing data from the 2009 to 2010 National Survey of Children with Special Health Care Needs, we analyzed 2772 children 5 to 17 years old with ASD. We theorized that unmet dental need would be positively associated with not having a medical home and having characteristics of more severe ASD (eg, parent reported severe ASD, an intellectual disability, communication, or behavior difficulties). Prevalence of unmet dental need was estimated, and unadjusted and adjusted odds ratios, 95% confidence intervals, and P values were computed using survey methods for logistic regression. ResultsNationally, 15.1% of children with ASD had unmet dental need. Among children with ASD, those without a medical home were more apt to have unmet dental need than those with a medical home (adjusted odds ratio, 4.46; 95% confidence interval, 2.59–7.69). Children with ASD with intellectual disability or greater communication or behavioral difficulties had greater odds of unmet dental need than those with ASD without these characteristics. Parent-reported ASD severity was not associated with unmet dental need. ConclusionsChildren with ASD without a medical home and with characteristics suggestive of increased ASD-related difficulties were more apt to have unmet dental need. Pediatricians might use these findings to aid in identifying children with ASD who might not receive all needed dental care.

Dental care utilization and unmet dental needs in older Korean Americans.

The study explored predictors of dental care utilization and unmet dental needs in older Korean Americans, considering predisposing, enabling (dental insurance, acculturation, and family network), and need (self-rated oral health) variables. Multivariate regression models were used to evaluate the data from 209 Korean Americans (aged ≥ 60) surveyed in Central Texas. Participants with strong family networks and fair/poor self-ratings of oral health reported higher numbers of dental visits in the past year. The likelihood of having an unmet dental need increased when participants had less education, a shorter stay in the United States, no dental insurance coverage, lower levels of acculturation, more limited family networks, fair/poor self-ratings of oral health, and fewer numbers of dental visits. Our findings underscore the vulnerability of individuals who are culturally and linguistically isolated and lack family resources, and they highlight the importance of incorporating social and cultural factors in intervention efforts.

Unmet restorative treatment needs among orphanage children of Uttara Kannada District

Objective: To evaluate the unmet restorative treatment need among orphanage children of Uttara Kannada District. Materials and Methods: A cross-sectional study was done to evaluate the unmet restorative treatment need among orphanage children of Uttara Kannada district. DFMT, PUFA and Specific caries index were used to evaluate the dental caries. Mouth mirror, explorers, CPI probes were used to examine dental caries under artificial light. Results: A total of 256 children were surveyed for unmet dental treatment need out of which 138 were girls. 80% of the children were caries free in permanent dentition while only 48% were caries free with respect to deciduous dentition using DMFT/dft indices. Pulpal involvement was seen among 31% of the children using PUFA index. Absolute treatment need with DT and dt indices were 91 and 545 in number while with specific caries index it was seen to be 705. Conclusion: The unmet restorative treatment need among the orphanage children was high and use of conventional indices alone might result in underestimation of treatment needs. Type of restorative treatment needs like pulpal/restorative, occlusal/non-occlusal, esthetic/non esthetic restorations were underestimated with conventional indices.

Disparities in Unmet Dental Need and Dental Care Received by Pregnant Women in Maryland

To examine prenatal dental care needs, utilization and oral health counseling among Maryland women who delivereda live infant during 2001-2003 and identify the factors associated with having a dental visit and having an unmet dental need during pregnancy. Pregnancy Risk Assessment Monitoring System is an ongoing population based surveillance system that collects information of women's attitudes and experiences before, during, and shortly after pregnancy. Logistic regression was used to model dental visits and unmet dental need using predictor variables for Maryland 2001-2003 births. Less than half of all women reported having a dental visit and receiving oral health advice during pregnancy. Twenty-five percent of women reported a need for dental care, of which 33% did not receive dental care despite their perceived need. Multivariate modeling revealed that racial minorities, women who were not married and those with annual income <$40,000 were least likely to have a dental visit. Women who were not married, had low annual income, were older than 40years of age, had an unintended pregnancy and received prenatal care later than desired were most likely to have an unmet dental need during pregnancy. Despite reported needs and existing recommendations to include oral health as a component of prenatal care, less than half of pregnant women have a dental visit during their pregnancy. One-third of women with a dental problem did not have a dental visit highlighting the unmet need for dental care during pregnancy.

Perspectives on Community Dental Clinics and Oral Health Inequities in British Columbia

This study investigates the expansion of community dental clinics to address oral health inequities in the province of British Columbia (BC) from the perspectives of dental professionals and allied service-providers. Sixty-three people participated in individual and group interviews with dentists (n=4), dental hygienists (n=30), dental clinic staff (n=17), and other health care and social service providers (n=12). We identified two service-models: a volunteer-charitable (VC) model typically operating part-time mostly to relieve pain and a not-for-profit (NFP) model open full-time usually within a community health centre with paid staff providing basic dental services. Community dental clinics are increasing in number to fill a gap in the oral health care of disadvantaged people in BC. Staff in these clinics raised questions indirectly about distributive justice and health care inequity by suggesting that the unmet dental need of vulnerable people requires political attention and that restricted dentistry for underserved communities is socially unacceptable.

Unmet dental need in community-dwelling adults with mental illness: Results from the 2007 Medical Expenditure Panel Survey

Mental illness (MI) affects approximately one in five U.S. adults, and it is associated with oral disease and poor dental treatment outcomes. Little is known about dental care utilization or unmet dental need in this population. The authors examined data regarding presence or absence of dental visits and unmet dental need in community-dwelling adults with MI from the 2007 Medical Expenditure Panel Survey. They tested differences between adults with and without MI by using multivariate logistic regression. Eighteen percent of adults (N = 19,368) had MI, and of these, 6.8 percent had unmet dental need. Although people with MI were not significantly more likely to have had a dental visit (46.3 percent) than were those without MI (42.2 percent; odds ratio [OR], 1.09; 95 percent confidence interval [CI], 0.97-1.23), they were significantly more likely to report unmet need (11.0 versus 5.3 percent; OR, 2.00; 95 percent CI, 1.67-2.41). Those with mood or anxiety disorders were most likely to report having an unmet dental need (P < .001 for all values). Although people with MI did not visit the dentist significantly more often than did adults without MI, their higher level of unmet need suggests that current use of dental services is not addressing their needs adequately. Dentists should be familiar with MI conditions as patients with MI may have greater unmet dental need.

Dental care provision by students on a remote rural clinical placement

In 2009, the School of Dentistry and Oral Health, Griffith University, commenced a clinical placement in a remote rural and Indigenous community in Australia. This paper analyses the type of treatment services provided from 2009 to 2011 by year, type of patient and age of patient. All treatment data provided were captured electronically using the Australian Dental Association (ADA) treatment codes. Audited reports were analysed and services categorised into six broad treatment types: consultation, diagnostic, preventive, periodontics, oral surgery and restorative services. The bulk of dental care episodes provided over the three-year period were for clinical examinations, restorative and oral surgery services. Preventive and periodontic services generally comprised less than 10% of the care provided. Over time fewer clinical examinations were conducted and restorative dentistry increased in the second and third years of the placement. There were no significant differences in the types of care provided to public and private patients. Clinical placement of final-year dental students in remote rural settings has helped address a largely unmet dental need in these regions. Dental student clinical placement is effective in providing care to communities in a remote rural setting. Student placements are, however, only able to deliver dental care in few remote rural communities, and therefore will make a negligible impact on the level of untreated dental disease in the short term. It is hoped that the experience will lead to more graduates serving some of their professional lives in remote communities.

The individual and program impacts of eliminating Medicaid dental benefits in the Oregon Health Plan.

We determined how elimination of dental benefits among adult Medicaid beneficiaries in Oregon affected their access to dental care, Medicaid expenditures, and use of medical settings for dental services. We used a natural experimental design using Medicaid claims data (n = 22 833) before and after Medicaid dental benefits were eliminated in Oregon in 2003 and survey data for continuously enrolled Oregon Health Plan enrollees (n = 718) covering 3 years after benefit cuts. Claims analysis showed that, compared with enrollees who retained dental benefits, those who lost benefits had large increases in dental-related emergency department use (101.7%; P < .001) and expenditures (98.8%; P < .001) and in all ambulatory medical care use (77.0%; P < .01) and expenditures (114.5%; P < .01). Survey results indicated that enrollees who lost dental benefits had nearly 3 times the odds (odds ratio = 2.863; P = .001) of unmet dental need, and only one third the odds (odds ratio = 0.340; P = .001) of getting annual dental checkups relative to those retaining benefits. Combined evidence from both analyses suggested that the elimination of dental benefits resulted in significant unmet dental health care needs, which led to increased use of medical settings for dental problems.

A Medical Home Versus Temporary Housing: The Importance of a Stable Usual Source of Care

Little is known about how the stability of a usual source of care (USC) affects access to care. We examined the prevalence of USC changes among low-income children and how these changes were associated with unmet health care need. We conducted a cross-sectional survey of Oregon's food stamp program in 2005. We analyzed primary data from 2681 surveys and then weighted results to 84087 families, adjusting for oversampling and nonresponse. We then ascertained the percentage of children in the Oregon population who had ever changed a USC for insurance reasons, which characteristics were associated with USC change, and how USC change was associated with unmet need. We also conducted a posthoc analysis of data from the Medical Expenditure Panel Survey to confirm similarities between the Oregon sample and a comparable national sample. Children without a USC in the Oregon population had greater odds of reporting an unmet health care need than those with a USC. This pattern was similar in national estimates. Among the Oregon sample, 23% had changed their USC because of insurance reasons, and 10% had no current USC. Compared with children with a stable USC, children who had changed their USC had greater odds of reporting unmet medical need, unmet prescription need, delayed care, unmet dental need, and unmet counseling need. This study highlights the importance of ensuring stability with a USC. Moving low-income children into new medical homes could disturb existing USC relationships, thereby merely creating "temporary housing."

Oral findings and health status among elderly Iraqi patients (aged 65 and above)

Tujuan dari studi ini adalah (1) Mendapatkan rencana waktu penyelesaian pelaksanaan proyek, (2) Mendapatkan durasi optimal pelaksanaan proyek, (3) Mendapatkan total biaya pelakasanaan proyek. Setelah dilakukan analisis, didapatkan bahwa (1) Rencana waktu penyelesaian pelaksanaan proyek 275 hari, (2) Waktu penyelesaian proyek sesuai rekayasa ulang Netwok Planning dengan metode PERT, didapatkan waktu penyelesaian proyek 252 hari, dengan percepatan waktu terhadap Time Schedule original sebesar 23 hari,  (3) Hasil rekayasa ulang terhadap Network Planning dengan metode PERT dihasilkan durasi optimal berdasarkan durasi (te) 252 hari, dengan rincian biaya upah tenaga percepatan Rp51.262.500,00. Penghematan gaji karyawan dan biaya operasional sebesar Rp 50.715.000,00 sehingga selisih biaya percepatan 23 hari dan penghematannya sebesar Rp 547.500. Biaya total berdasarkan waktu optimal dari 275 hari sebesar Rp 24.972.450.794,11, menjadi 252 hari sebesar Rp 24.972.450.794,11 + Rp 547.500,00 = Rp 24.972.998.294,11

The Impact of Title VII on General and Pediatric Dental Education and Training

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Effects of the State Children's Health Insurance Program on Access to Dental Care and Use of Dental Services

To provide national estimates of implementation effects of the State Children's Health Insurance Program (SCHIP) on dental care access and use for low-income children. The 1997-2002 National Health Interview Survey. The study design is based on variation in the timing of SCHIP implementation across states and among children observed before and after implementation. Two analyses were conducted. The first estimated the total effect of SCHIP implementation on unmet need for dental care due to cost in the past year and dental services use for low-income children (family income below state SCHIP eligibility thresholds) using county and time fixed effects models. The second analysis estimated differences in dental care access and use among low-income children with SCHIP or Medicaid coverage and their uninsured counterparts, using instrumental variables methods to control for selection bias. Both analyses controlled for child and family characteristics. When SCHIP had been implemented for more than 1 year, the probability of unmet dental care needs for low-income children was lowered by 4 percentage points. Compared with their uninsured counterparts, those who had SCHIP or Medicaid coverage were less likely to report unmet dental need by 8 percentage points (standard error: 2.3), and more likely to have visited a dentist within 6 or 12 months by 17 (standard error: 3.7) and 23 (standard error: 3.6) percentage points, respectively. SCHIP program type had no differential effects. Consistent results from two analytical approaches provide evidence that SCHIP implementation significantly reduced financial barriers for dental care for low-income children in the U.S. Low-income children enrolled in SCHIP or Medicaid had substantially increased use of dental care than the uninsured.

The Effect of Rural Residence on Dental Unmet Need for Children With Special Health Care Needs

Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. To examine the effects of rural residence on unmet dental need for CSHCN. We use the nationally representative National Survey of CSHCN Needs. We performed logistic regression to estimate the independent effects of rural residence on the likelihood of having an unmet dental need, using a measure of unmet need based on professional society recommendations and a measure based on parental report. Using either of the measures, a substantial percentage of CSHCN do not receive all needed dental care. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Our results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need. Traditional access barriers for rural children, such as inadequate provider supply and lack of insurance, may increase unmet needs both directly and indirectly, through their effects on parents' perceptions of need. Reducing unmet needs for dental care in rural children with special needs will require addressing both access issues and parents' understanding of dental care need.