Use Of Dental Care Services Research Articles

Use of dental care services among adolescents living with HIV on antiretroviral treatment in Kampala, Uganda: a cross-sectional study

ObjectiveThe primary purpose of this study was to assess the prevalence and socio-behavioral determinants of ever-use of dental care services among adolescents aged 10–18 years, living with HIV, on Antiretroviral treatment (ART), and attending selected HIV clinics in Kampala, Uganda.MethodsA cross-sectional study was carried out between March and September 2020. The study conveniently recruited 154 adolescents between 10 and 18 years old from 4 specific HIV clinics in Kampala. Andersen’s behavioral model guided the selection of variables, with the ever-use of dental care services as the outcome and predisposing, enabling, need-related factors and personal dental health practices as exposure variables. Data were analyzed using Fischer’s exact test for cross-tabulation and modified Poisson regression for multivariate analysis.ResultsThe prevalence of ever-use of dental care services was 12.3%. The adolescents aged 14–18 had higher odds of using dental care services (Prevalence ratio (PR) of 3.35 than those aged 10–13 years. Fear of the spread of HIV was negatively associated with ever-use of dental care services (PR of 0.06). Participants who were afraid of going to the dentist had higher odds of using dental care services (PR of 2.98) than those not afraid. Failure to receive dental treatment because it was not part of the medical appointment had a positive association with the ever-use of dental care services (PR of 4.50). Those who were satisfied with their dental condition had lower odds of using dental care services. The bad oral odor was positively associated with the ever-use of dental care services (PR of 2.80). The use of soap for toothbrushing was positively associated with the ever-use of dental care services (PR of 2.51).ConclusionThe study found a low frequency of dental care use among HIV-infected adolescents in Kampala, Uganda, with age being a predisposing factor. Enabling factors included fear of HIV spread, medical-dental appointment incoordination, and satisfaction with the dental condition and bad oral odor while under personal dental health practices. The use of soap for toothbrushing was an important association with dental care. Nevertheless, these study results cannot be generalized to the entire HIV adolescent population in Uganda.

How an increase in income affects the use of dental care services among a low-income population: evidence from the Finnish basic income experiment

BackgroundPrevious research has shown that the use of dental care services has a significant socioeconomic gradient. Lower income groups tend to use dental care services less, and they often have poorer dental health than higher income groups. The purpose of this study is to evaluate how an increase in income affects the use of dental care services among a low-income population.MethodsThe study examines the causal effect of increasing cash transfers on the use of dental care services by utilizing unique register-based data from a randomized field experiment conducted in Finland in 2017–2018. The Finnish basic income experiment introduced an exogenous increase in the income of persons who previously received basic unemployment benefits. Register-based data on the study population’s use of public and private dental care services were collected both for the treatment group (N = 2,000) and the control group (N = 173,222) of the experiment over a five-year period 2015–2019: two years before, two years during, and one year after the experiment. The experiment’s average treatment effect on the use of dental care services was estimated with OLS regressions.ResultsThe Finnish basic income experiment had no detectable effect on the overall use of dental care services. However, it decreased the probability of visiting public dental care (-2.7% points, -4.7%, p =.017) and increased the average amount of out-of-pocket spending on private care (12.1 euros, 29.8%, p =.032). The results suggest that, even in a country with a universal public dental care coverage, changes in cash transfers do affect the dental care patterns of low-income populations.

Trends in dental care utilisation among the elderly using longitudinal data from 14 European countries: A multilevel analysis.

The use of dental care among older people is low compared to other forms of health care, with significant health consequences. However, the evidence on the extent to which countries' welfare systems and socio-economic factors influence the uptake of dental care by older people is limited. This study aimed to describe trends of dental care utilisation, and to compare use of dental care with other types of healthcare services among the elderly, considering different socio-economic factors and welfare systems in European countries. Multilevel logistic regression analysis was performed using longitudinal data from four waves (between Wave 5 and 8) of the Survey of Health, Ageing and Retirement in Europe database, with a follow-up period of 7 years. The study sample included 20,803 respondents aged 50 years or older from 14 European countries. The annual dental care attendance was the highest in Scandinavian countries (85.7%), however, improving trends of dental attendance was recognized in Southern and Bismarckian countries (p<0.001). The difference in use of dental care services between socio-economic groups was expanding over time regarding low- and high-income level and residential area. A more marked difference was observed between social groups in dental care utilisation compared to other forms of care. Income level and unemployed status had significant effect on forgoing dental care due to cost and unavailability. The observed differences between socioeconomic groups may highlight the health consequences of the different organization and financing of dental care. The elderly population could benefit from adopting policies aiming to reduce the financial barriers to dental care usage, especially in Southern and Eastern European countries.

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.

The mediating role of social capital in socioeconomic inequalities of oral health behaviours among Brazilian older adults.

Knowledge of the possible pathways linking socioeconomic status (SES) to oral health-related behaviours can improve the understanding of inequalities in oral health. Therefore, in this study, it was investigated whether social capital mediates the relationship between SES and oral health behaviours. Through a cross-sectional study, data were analysed from participants aged ≥60 years from the Brazilian National Health Survey 2019 (n=21 575). Structural equation modelling was used to test the direct and indirect pathways from a latent variable for SES to a latent variable for oral health behaviours: daily flossing, toothbrushing frequency and the use of dental care services. The maximum likelihood estimator was used for complex samples with robust standard errors, and the final model demonstrated an adequate fit. The findings demonstrated that a higher SES was directly associated with better oral health-related behaviours (standardized coefficient [SC]: 0.82; [90% CI: 0.78-0.85]) and indirectly via structural social capital (SC: 0.05; [90% CI: 0.02-0.07]). The total effect of SES on oral health-related behaviours was (SC: 0.87, [90% CI: 0.85-0.89]). The findings demonstrate that structural social capital in older Brazilian adults might partly mediate the pathways to socioeconomic inequalities in oral health behaviours. However, there is a direct effect on oral health behaviours, reinforcing the hypothesis that SES is associated with oral health, based on paths that link income inequality to oral health.

Dental visits and depression mediating the association of socioeconomic status with oral health behaviors.

Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.

Factors associated with women's autonomy regarding dental health care utilization in Bengaluru - A cross sectional study

Background: Preventive dental care benefits people of all ages and genders' oral health. Among many conceptual implications, autonomy suggests the power to alter one's fate and environment, among other things. Little is known about women's autonomy and factors influencing dental health-care utilization in India. This study was designed to assess knowledge, attitude, and oral hygiene practices and its association with women's autonomy and dental care utilization. Materials and Methods: A cross-sectional study was conducted among 400 women aged 18 years or older in Bengaluru Urban District. Questionnaires were employed to assess women's autonomy, knowledge, attitude, oral hygiene practices, and dental care service utilization. Descriptive statistics and bivariate and regression analyses were carried out. The P < 0.05 was considered statistically significant. Results: More than half of the women (61.3%) had a high level of autonomy. Women with a high level of autonomy had more knowledge, a more positive attitude, and better dental hygiene habits. Autonomy, knowledge, and attitude were all significant independent predictors of women's use of dental care services. Conclusions: Women's autonomy was found to influence knowledge, attitude, and oral hygiene practices which in turn are associated with dental health-care service utilization.

Moral hazard in Australian private health insurance: the case of dental care services and extras cover

We assess ex post moral hazard in Australian private health insurance (PHI) relating to dental care services (so-called extras cover) using the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey. Cross-sectional probit regressions specify dental care use as a function of dental care demand and endogenous PHI policy holding, including self-assessed health condition, health risk factors and socio-economic controls including age, income, education, family structure and welfare status. We find that ex post moral hazard results in the additional use of dental care services by PHI holders. Further, dynamic analysis indicates that PHI, no matter how sporadic, is always associated with significantly more likely use of dental care services, increasing when continuously held, suggesting strong persistence in moral hazard.

The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran

BackgroundDental healthcare is the costliest and single most source of the financial barrier to seeking and use of needed healthcare. Hence, this study aims to analyses impact of out-of-pocket (OOP) payments for dental services on prevalence catastrophic healthcare expenditure (CHE) among Iranian households during 2018.MethodsWe performed a cross-sectional analysis to determine the prevalence rate of CHE due to use of dental healthcare services among 38,858 Iranian households using the 2018 Household Income and Expenditure Survey (HIES) survey data of Iran. The WHO approach was used to determine the CHE due to use of dental care services at the 40% of household capacity to pay (CTP). Multiple logistic regression models were used to obtain the odds of facing with CHE among households that paid for any dental healthcare services over the last month while adjusting for covariates included in the model. These findings were reported for urban, rural areas and also for low, middle and high human development index HDI across provinces.ResultsThe study indicated that the prevalence of CHE among households that used and did not used dental services over the last month was 16.5% (95% CI: 14.9 to 18.3) and 4.3% (95% CI: 4.1 to 4.6), respectively. The adjusted odds ratio (AOR) for the covariates revealed that the prevalence of CHE for the overall households that used dental healthcare service was 6.2 times (95% CI: 5.4 to 7.1) than those that did not use dental healthcare services. The urban households that used dental healthcare had 7.8 times (95%CI: 6.4–9.4) while the rural ones had 4.7 times (95% CI: 3.7–5.7) higher odds of facing CHE than the corresponding households that did not use dental healthcare services.ConclusionsThe study indicates that out-of-pocket costs for dental care services impose a substantial financial burden on household’s budgets at the national and subnational levels. Alternative health care financing strategies and policies targeted to the reduction in CHE in general and CHE due to dental services in particular are urgently required in low and middle income countries such as Iran.

Moral Hazard in Ancillary Private Health Insurance in Australia

We assess moral hazard in Australian ancillary or extras (nonhospital) private health insurance (PHI) relating to dental care services using the longitudinal data in the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Cross-sectional probit regressions specify dental care (the most important expenditure component of ancillary cover) as a function of endogenous PHI policy holding, self-assessed health condition, health risk factors and socioeconomic controls including age, income, education, family structure and welfare status. We find that moral hazard is present resulting in the possible overuse of dental care services by PHI holders, bearing in mind this is overuse in relative rather than absolute terms. However, we also find using dynamic analysis that while there is no evidence of pent-up demand (previously uninsured policyholders accessing more dental care services initially) any sort of PHI holding, however sporadic, is always associated with significantly more likely use of dental care services than persons that have never held PHI. This supports the role of PHI in fostering good health care behavior and possibly countering ex ante moral hazard.

Dental emergency: Scoping review.

Part of the oral health care in the care network encompasses users in emergency cases. This study proposed mapping the determinants of the use of dental care services within the health care network to address dental emergencies within the Brazilian Unified Health System (UHS) and to verify the main gaps in the research in this area. This is a scoping review that took place in 2018 using Andersen's behavioral model as a reference. A total of 16 studies, out of 3786 original articles identified, were included and reviewed. Two reviewers independently conducted the selection process and the decision was consensually made. The mapping of the determinants revealed a greater number of enabling factors and a larger gap in the results. Greater use of the emergency service was registered by people in pain, women, adults, those from an urban area, people with a lower income, and those with less education. In future studies, primary surveys are recommended, which include all ages, and analyze different groups of needs and users that take into account the country's northern region and the different subjects pointed out by this review.

The Impact of Discriminatory Healthcare Experiences on Use of Medicaid-funded Dental Care Services in California

The present study conceptualized that prior experience of discrimination in healthcare settings would be a barrier to using dental care services among Medicaid beneficiaries in the states where dental care is a covered benefit (e.g., California). Using a sample of adult Medicaid beneficiaries included in the 2017 California Health Interview Study (CHIS; N = 4779), the present study examined the impact of discriminatory healthcare experiences on their use of dental care services. Over 36% of the participants reported that they had experienced discrimination in healthcare settings, and about 40% had no dental visit in the past year. Prior experience of discrimination reduced the odds of using dental care services by 18% (Odds Ratio = 0.82, 95% Confidence Interval = 0.72−0.93, p < .01). Findings provide implications for promoting oral health and dental care among those socially disadvantaged by addressing discrimination in healthcare settings.

Factores asociados al uso de servicios de salud oral en adultos mayores peruanos: análisis secundario de encuesta poblacional, 2018

: To identify the prevalence and factors associated with the use of oral health services in Peruvian older adults (OA) during 2018. . Secondary analysis of data on 4,874 Peruvian OAs from the Demographic and Family Health Survey (ENDES) carried out in 2018. The use of oral health services was considered (yes/no) based on the six months prior to the application of the survey as a dependent variable. The independent variables were sex, age, area of residence, educational level, marital status, geographical domain, physical limitation, health insurance, spoken language, and welfare index quintile. A descriptive analysis was performed using absolute frequencies and weighted proportions, and a multivariate analysis using generalized linear models (Poisson regression). . From the total of OAs, 52.6% were women, 52.9% belonged to the 60-69 age group, 77% belonged to the urban area, and 81.1% had a health insurance. The prevalence of the use of dental care services in the last six months was 24.9%. Multivariate analysis found association with area of residence (p<0.001), higher educational level (p=0.001), health insurance affiliation (p<0.001), geographic domain (p=0.019), and all welfare index quintiles (p<0.001). . The prevalence of the use of dental care services in OAs was low, and its associated factors were the area of residence, educational level, health insurance, geographic domain, and welfare index quintiles.

Place of Birth Inequalities in Dental Care Use before and after the Economic Crisis in Spain

This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in adults aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for the years 2006 (before the crisis), 2014, and 2017 (after the crisis). Log-binomial regression was used to quantify the association between place of birth and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR: 1.36, 95% CI: 1.10–1.67) and Africa (PR: 1.16, 95% CI: 1.05–1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants relative to natives, with the greatest probability for those from Africa (PR: 1.71, 95% CI: 1.46–2.01) and Asia (PR: 1.3, 95% CI: 1.23–1.47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services.

Use of dental care services and related factors in students with special health care needs in a rehabilitation and education center

Introduction: People with special health care needs (SHCN) have a higher risk of contracting certain oral diseases, such as dental cavities and gingivitis, and a limited use of dental care services can significantly affect these risks. Objective: To assess the use of dental care services and related factors in students with SHCN. Materials and methods: This cross-sectional study included subjects from a rehabilitation and education center. The guardians were asked aboutwhether the students already made a dental appointment and about the last time they had visited their dentist. The students were examinedfor dental cavities. Fisher’s exact test for the association between the outcome and independent variables was employed. Results: The study sample comprised 51 guardians. Forty-seven students had already visited their dentist at least once, and 68% underwent a dental exam within the past year. A recent use of dental service (1 year or less) was more prevalent among female subjects, which did not present a history of dental cavities and about whose caregiversalready had received oral health information. Conclusion: Most of the participants already had visited their dentist and regularly usedental services. Caregivers should be encouraged to make regular dentist appointments for SHCN subjects, especially for those who already have oral problems, are male, and whose families have never received oral health information.

Use of dental care services and related factors in students with special health care needs in a rehabilitation and education center

People with special health care needs (SHCN) have a higher risk of contracting certain oral diseases, such as dental cavities and gingivitis, and a limited use of dental care services can significantly affect these risks. Objective: To assess the use of dental care services and related factors in students with SHCN. Materials and methods: This cross-sectional study included subjects from a rehabilitation and education center. The guardians were asked about whether the students already made a dental appointment and about the last time they had visited their dentist. The students were examined for dental cavities. Fisher’s exact test for the association between the outcome and independent variables was employed. Results: The study sample comprised 51 guardians. Forty-seven students had already visited their dentist at least once, and 68% underwent a dental exam within the past year. A recent use of dental service (1 year or less) was more prevalent among female subjects, which did not present a history of dental cavities and about whose caregivers already had received oral health information. Conclusion: Most of the participants already had visited their dentist and regularly use dental services. Caregivers should be encouraged to make regular dentist appointments for SHCN subjects, especially for those who already have oral problems, are male, and whose families have never received oral health information.

Knowledge, attitudes and self-reported practices toward children oral health among mother\u2019s attending maternal and child\u2019s units, Sal\xe9, Morocco

BackgroundThe occurrence of severe dental caries is particularly prevalent and harmful in children. A better understanding of parental factors that may be indicators of children’s risk of developing dental caries is important for the development of preventive measures.This study was conducted to assess knowledge, attitudes, and practices (KAP) of mothers in Salé, Morocco regarding oral health and their predictors.MethodsA cross-sectional KAP study was conducted of Mother and Child units in Salé, Morocco. Mothers attending the selected units from November 2014 to 29 January 2015 were recruited. Data were collected using a semi-structured questionnaire, administered by face-to-face interviews, to record socio-demographic factors and KAPs. The main outcome measures included knowledge about oral health diseases and preventive measures, and attitudes and practices related to oral health prevention measures and dental care. KAPs scores were then recoded based on responses and scores were determined for each KAP domain. Linear regression analysis was conducted to assess predictors of KAP scores.ResultsAmong 502 mothers included, 140 (27.8%) were illiterate and 285 (60.9%) were aware that fluoride has a beneficial effect in caries prevention. Mothers’ own practices about dental care were statistically related to their children’s use of dental care services (p < 0.001). Multiple linear regression analysis revealed that the knowledge score was associated with mother’s age (β = 0.05; 95% CI; p < 0.001), education level, and median income (β = 0.38; p = 0.04). Significant predictors of oral health-related practices were mother’s education level and children’s health status.ConclusionsLimited KAP scores were observed among the studied population. A great emphasis on oral health education and some risk factor modifications are recommended.

Socioeconomic inequalities in the use of dental care services during early childhood: an epidemiological survey.

The use of dental care services contributes to the improvement of children's healthy behaviors, reducing the prevalence of future dental problems. In this way, the purpose of this study was to describe the use of dental care service during early childhood and the possible socioeconomic inequalities in this use. Data from the Brazilian Oral Health Survey (SB Brasil, 2010) were used. Interviews with the children's parents and clinical examinations with the children were conducted in a 5-year-old representative sample. Descriptive, bivariate and multiple hierarchical statistical analyses were applied. Of the 7241 children included, 3812 (53.2%) had used dental care services at least once in their lifetimes, and 1872 (48.8%) had used services for check-up/prevention. The use of dental services was greater among children with a higher family income (P < 0.05). The use of check-ups was lower among children with non-White skin color (Black and Browns) and among those who did not live in state capitals (P < 0.05). Clinical conditions and self-perception were also associated with the use (P < 0.05). Socioeconomic differences in the general use of dental care and in its use for check-ups were identified during early childhood, indicating the presence of inequalities.

The use of dental care services in Alberta, Manitoba, and Newfoundland and Labrador: A comparative analysis

Public support for dental care in Canada is uniform. Universal coverage and access to health care in the country are narrowly limited to hospital‐based and physician‐based services—“medically necessary services.” In view of the variations in public support programs for dental care, our study examines differences in the use of dental care services among different socio‐economic groups in Alberta, Manitoba, and Newfoundland and Labrador. The study used 2012 Canadian Community Health Survey data. Our analyses find that in all the three provinces persons of lower socio‐economic status have lower utilization of dental care. However, the study further reveals that the gaps between age and household income groups was wider in Newfoundland and Labrador compared to the other provinces. These findings suggest that public support for dental care reduces socio‐economic disparities in the use of dental services.

Dental caries in adolescents and its association with their use of dental services

Objective: To assess the association between dental caries in adolescents and the use of dental care services in Brazil. Method: Cross-sectional study based on secondary data obtained in the last two National Oral Health Surveys (2003 - 2010), considering the estimated prevalence of dental caries and dental hygiene inadolescents aged 15 to 19 years and dental care services. Results: In Brazil, the dental care index (DCI) has increased on average from 41.2 (2003) to 50.8 (2010). The dental mutilation index (DMI) has decreased on average from 11.7 (2003) to 7.4 (2010). The healthy permanent teeth index (HPTI) showed an increase of 4.9%in the above period. In 2010, the Central West was the only region in the country to show a decrease in the dental care index (DCI). Conclusion: There have been quantitative improvements in regard to dental restoration (dental care), and qualitative improvements in what concerns to tooth loss in the oral health ofBrazilian adolescents.