The Connection between Socioeconomic Inequalities and the Appearance of the Toothlessness in Mostar.

BACKGROUND: To determine the existence of the toothlessness within the patients in the area of Mostar. The aim is to determine the topography of toothlessness within the population of Mostar, according to Kennedy classification. The aim is to connect measures of socioeconomic status with the appearance of the toothlessness. To develop a model that includes a form of toothlessness and the socioeconomic status of the patients in Mostar. SUBJECTS AND METHODS: The study was conducted at the Health Center in Mostar and the Regional Medical Center in Mostar. The research was cross-sectional study. It included 800 patients who regularlyoccurred to the dental ambulance because of the toothlessness and because of the prosthodontics treatment. The measurement was conducted by the dentist based on the anonymous research cardboard at the first examination of the patient. The dentist will determine the topography of the toothlessness according to Kennedy classification and the etiology of the toothlessness. RESULTS: In the total sample of respondents, the toothlessness was significantly higher represented (P<0.001). The manifestation of thetoothlessness was significantly higher among temporary employees and the retirees (P<0.001). In the total sample, toothlessness affected the sociological status of a higher percentage of the respondents (P<0.001). CONCLUSION: In our study, in a total sample of respondents, toothlessness was significantly higher represented (90% of respondents). The influence on the sociological status of the patient is most visible in the groups with the lower material status.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis.

OBJECTIVE: To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS: A Markov model was developed to capture long-term clinical and economic outcomes. The model's population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost - in BRL, and effectiveness - measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS: Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS: The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis / Custo-efetividade da prótese implanto-suportada comparada à prótese total convencional

ABSTRACT OBJECTIVE To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS A Markov model was developed to capture long-term clinical and economic outcomes. The model's population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost - in BRL, and effectiveness - measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

RESUMO OBJETIVO Conduzir uma análise de custo-efetividade das alternativas para tratamento reabilitador do edentulismo mandibular no contexto do Sistema Único de Saúde (prótese total implanto-suportada e prótese total convencional). MÉTODOS Foi desenvolvido um modelo de Markov para captar os resultados clínicos e econômicos de longo prazo. A população do modelo consistiu em uma coorte hipotética de 1.000.000 pacientes, com 55 anos, desdentados totais mandibulares e sem contraindicações médicas para a realização de procedimentos cirúrgicos. A perspectiva de análise adotada foi a do Sistema Único de Saúde. Com base no modelo proposto, calculamos o custo (em reais) e a efetividade, medida pelo ano de prótese ajustado à qualidade (QAPY). O horizonte temporal da análise foi de 20 anos. RESULTADOS Considerando o desconto de 5% nos custos e efeitos, a razão de custo-efetividade incremental da prótese total implanto-suportada em relação à prótese total convencional (R$ 464,22/QAPY) foi menor que o limiar de disposição a pagar adotado no modelo (R$ 3.050,00/QAPY). CONCLUSÕES Os resultados desta análise econômica mostraram que a reabilitação de edêntulos mandibulares por meio da prótese total implanto-suportada é muito custo-efetiva em comparação à prótese total convencional, de acordo com os limites de custo-efetividade empregados.

The social gradient in oral health: Is there a role for dental anxiety?

OBJECTIVE: To evaluate the contribution of dental anxiety to social gradients in different oral health outcomes and whether social gradients in oral health persist once dental anxiety is removed from the population examined. METHODS: Data from 9035 British adults were analysed. Participants' socioeconomic position (SEP) was measured through education and household income. Dental anxiety was measured with the Modified Dental Anxiety Scale. Poor subjective oral health, oral impacts on quality of life and edentulism among all adults and the number of teeth, the number of decayed, missing and filled surfaces (DMFS) and sextants with pocketing among dentate adults were the oral health outcomes. The contribution of dental anxiety to absolute and relative social inequalities in each oral health outcome (measured with the Slope and Relative Index of Inequality [SII and RII], respectively) was estimated from regression models without and with adjustment for dental anxiety and quantified with the percentage attenuation. Interactions between each SEP indicator and dental anxiety were used to test what would happen if dental anxiety were removed from the whole population. RESULTS: The largest contribution of dental anxiety to explaining oral health inequalities was found for education gradients in perceived outcomes (11%-13%), but dental anxiety explained <4% of social gradients in edentulism. Among dentate adults, dental anxiety accounted for <5% and <7% of education and income gradients, respectively. Only four of the 24 interactions tested were statistically significant. Hence, the education- and income-based SII and RII for oral impacts were nonsignificant among anxiety-free adults but were significant at higher levels of dental anxiety. CONCLUSIONS: Little support was found for the role of dental anxiety in explaining social inequalities in various perceived and clinical oral health measures. Oral health inequalities were found among both nondentally anxious and anxious participants.

Individual- and community-level social gradients of edentulousness.

BACKGROUND: Community-level factors as well as individual-level factors affect individual health. To date, no studies have examined the association between community-level social gradient and edentulousness. The aim of this study was to investigate individual- and community-level social inequalities in edentulousness and to determine any explanatory factors in this association. METHODS: We analyzed the data from the Japan Gerontological Evaluation Study (JAGES). In 2010-2012, 112,123 subjects aged 65 or older responded to the questionnaire survey (response rate = 66.3%). Multilevel logistic regression analysis was applied to determine the association between community-level income and edentulousness after accounting for individual-level income and demographic covariates. Then, we estimated the probability of edentulousness by individual- and community-level incomes after adjusted for covariates. RESULTS: Of 79,563 valid participants, the prevalence of edentulousness among 39,550 men (49.7%) and 40,013 women (50.3%) were both 13.8%. Living in communities with higher mean incomes and having higher individual-level incomes were significantly associated with a lower risk of edentulousness (odds ratios [ORs] by 10,000 USD increments were 0.37 (95% confidence interval [CI] [0.22-0.63]) for community-level and 0.85 (95% CI [0.84-0.86]) for individual-level income). Individual- and community-level social factors, including density of dental clinics, partially explained the social gradients. However, in the fully adjusted model, both community- and individual-level social gradients of edentulousness remained significant (ORs = 0.43 (95% CI [0.27-0.67]) and 0.90 (95% CI [0.88-0.91]), respectively). One standard deviation changes in community- and individual-level incomes were associated with 0.78 and 0.84 times lower odds of edentulousness, respectively. In addition, compared to men, women living in communities with higher average incomes had a significantly lower risk of edentulousness (p-value for interaction < 0.001). CONCLUSIONS: Individual- and community-level social inequalities in dental health were observed. Public health policies should account for social determinants of oral health when reducing oral health inequalities.

Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study.

BACKGROUND: Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. METHODS: Two patient cohorts were followed up longitudinally in this study: the "All-on-4 treatment concept group" and the "historical group." The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. RESULTS: The total adjusted cost for patients receiving All-on-4 treatment concept averaged at $42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was $57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of $7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. CONCLUSIONS: When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.

A randomized trial on simplified and conventional methods for complete denture fabrication: cost analysis.

PURPOSE: This study aimed to quantify the costs of complete denture fabrication by a simplified method compared with a conventional protocol. MATERIALS AND METHODS: A sample of edentulous patients needing conventional maxillary and mandibular complete dentures was randomly divided into group S, which received dentures fabricated by a simplified method, and group C, which received conventionally fabricated dentures. We calculated direct and indirect costs for each participant including unscheduled procedures. This study assessed 19 and 20 participants allocated into groups S and C, respectively, and comparisons between groups were conducted by the Mann-Whitney and Student's t-test (α = 0.05). RESULTS: Complete denture fabrication demanded median time periods of 173.2 and 284.5 minutes from the operator for groups S and C respectively, and 46.6 and 61.7 minutes from the dental assistant (significant differences, p < 0.05). There was no difference between groups regarding postinsertion adjustments. Group S showed lower values for costs with materials and time spent by patients than group C during the fabrication stage, but not during adjustments. CONCLUSIONS: The median direct cost of complete denture treatment was 34.9% lower for the simplified method. It can be concluded that the simplified method is less costly for patients and the health system when compared with a conventional protocol for the rehabilitation of edentulous patients.

[Significance of dental implants for health care]. / Stellenwert oraler Implantate im Rahmen der Gesundheitsversorgung.

Nowadays, endosseous titanium implants must be considered as an evidence-based treatment concept for the replacement of missing teeth. The economic evaluation of scientific evidence suggests that patient satisfaction and oral health-related quality of life may be improved by mandibular implant-retained overdentures over conventional dentures. However, despite promising survival rates reported for dental implants, an increase in the prevalence of peri-implant diseases is emerging. Accordingly, concepts for quality management in education, research, and practice are essential to further improve medical care in implant dentistry.

[Preventive strategies in prosthetic dentistry]. / Präventionsorientierte Strategien in der prothetischen Zahnmedizin.

Despite the success in preventing oral diseases, the prevalence of tooth loss in the German population remains high and increases with age. Today, the advances in prosthetic dentistry allow necessary tooth replacement following preventive strategies-after considering benefits and risks. Modern treatment options improve the overall prognosis of the stomatognathic system and the quality of life of the affected patients significantly. Hereby, adverse iatrogenic effects can be minimized or even completely avoided by extending the traditional treatment spectrum, e.g., using adhesively fixed restorations and implant-supported restorations, and refraining from placing restorations that are unnecessary from the medical point of view. Generally, patients benefit greatly from prosthetic treatment and the achieved health gain is remarkably high. It encompasses not only the recovery of the impaired oral functions but also extends to the whole human organism, including nutrition, digestion, musculoskeletal system, as well as mental and social well-being.

Dental care expenditures and retirement.

OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS). METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables. RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status. CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.

Secular trends in socio-economic disparities in edentulism: USA, 1972-2001.

For health care planning and policy, it is important to determine whether socio-economic disparities in edentulism, an ultimate marker of oral health, have improved over time. The aim of this study was to investigate the socio-economic disparities in edentulism between 1972 and 2001. Representative samples of the United States population, 25-74 years old, were obtained from NHANES I (1972), III (1991), and 1999-2002. Differences in the edentulism prevalence between high and low socio-economic positions (SEP) were compared. Differences in edentulism prevalence remained stable over approximately three decades (p = 0.480), being 10.6 percentage points in 1972, 12.1 percentage points in 1991, and 11.3 percentage points in 2001. Exploratory subgroup analyses suggested that disparities decreased for those individuals reporting a dental visit in the prior year and those reporting never having smoked. In conclusion, the absolute prevalence difference in edentulism between low and high socio-economic positions has remained unchanged over the last three decades.

A cost comparison of mandibular two-implant overdenture and conventional denture treatment.

PURPOSE: This article compares the cost of mandibular two-implant overdenture treatment to that of conventional denture treatment in an academic teaching hospital. MATERIALS AND METHODS: Sixty edentulous patients (aged 65 to 75 years) participated in a randomized clinical trial. All patients received a new maxillary complete denture and either a mandibular conventional denture (n = 30) or an implant overdenture on two unsplinted implants (n = 30). Resource-based microcosting of direct and indirect costs (eg, expenses and time cost to patients) of all scheduled and unscheduled visits was conducted through 1 year following delivery of the prostheses. RESULTS: Mean direct costs (1999 CD dollars) for scheduled visits in the implant and conventional groups were 2,332 dollars and 814 dollars, respectively, and mean indirect costs were 1,150 dollars and 810 dollars, respectively. Differences between the two groups were significant. Twenty-six patients in each group had unscheduled visits during the study at a median direct cost for the overdentures of 85 dollars and 64 dollars for the conventional dentures. Median indirect costs for unscheduled visits were 163 dollars and 202 dollars, respectively. These differences were not significant. Mean total costs of the overdentures were 4,245 dollars and 2,316 dollars for the conventional dentures, and the between-group difference was significant. CONCLUSION: The direct cost of mandibular two-implant overdenture treatment was 2.4 times higher than that of conventional denture treatment. When indirect costs were added, the implant-to-conventional total cost ratio estimate was 1.8. These cost data can now be combined with estimates of the efficacy of the two types of prosthesis so practitioners and patients can make informed decisions about these prosthodontic treatment concepts.

Demographic and socio-economic factors associated with dental health among older people in NSW.

OBJECTIVE: To investigate the association between oral health status and social, economic and demographic factors in community-dwelling older people in New South Wales (NSW). METHODS: Binary and multinomial logistic regression analyses were used to examine the associations between measures of oral health status (edentulous/dentate, and the frequency of toothache or mouth or denture problems in the previous 12 months) and demographic and socio-economic factors using data from the NSW Older People's Health Survey 1999. RESULTS: After adjusting for other factors, being edentulous was associated with being older, having no private dental insurance, being female, leaving school at less than 15 years of age, not being financially comfortable, not being a homeowner, living in a rural area, and being unable to travel alone. Among both dentate and edentulous people, increasing age and being able to travel independently were associated with decreased reporting of toothache, mouth or denture problems; while not being financially comfortable was associated with increased reporting of toothache or mouth or denture problems. The frequency of mouth or denture problems was not found to be independently associated with having private dental insurance nor with holding a health concession card. CONCLUSIONS: Among older people in NSW, oral health is associated with a range of demographic and socio-economic factors. The results suggest that better oral health among older people is associated with a capacity to pay out-of-pocket dental expenses rather than with private dental insurance or having access to public-funded dental care.