Oral health-related quality of life in the LGBTIQ+ population: a cross-sectional study.

The aim of this cross-sectional study was to investigate the associations between oral health-related quality of life (OHRQoL) and socioeconomic and demographic variables, suicidal ideation, self-perception of oral health, and experiences of dental care in the Brazilian adult LGBTIQ+ population. A sample of 464 participants completed self-administered online questionnaires and provided information for OHRQoL assessment, using the OHIP-14 instrument at three hierarchical levels of explanatory variables: LGBTIQ+ identities; socioeconomic and demographic data and existential suffering; and self-perception of oral health and experience of dental care. The collected data were fitted to hierarchical multiple logistic regression models, in which the associations between each independent variable with the OHIP-14 prevalence outcome were analyzed. The OHIP-14-prevalence index showed that 33.2% of the participants answered 'frequently' or 'always', and the highest frequencies were obtained for the psychological discomfort (27.8%), psychological disability (18.3%), and physical pain (17.5%) domains. According to the adjusted final model, LGBTIQ+ individuals who were more likely to have their OHRQoL affected were those who were indifferent (OR=3.21; 95% CI: 1.26-8.20), dissatisfied (OR=10.45; 95% CI: 3.86-28.26), or very dissatisfied (OR=53.93; 95% CI: 12.12-239.93) with their oral health status, and also those who had or have difficulty accessing dental treatment (OR=2.06; 95% CI: 1.24-3.41) (p<0.05). It may be concluded that the OHRQoL of the investigated Brazilian LGBTIQ+ population showed associations with individual aspects and with access to dental services.

[Perceptions of the organization and the practice of dental healthcare by the professionals working in prisons]. / Perceptions de l'organisation et de la pratique des soins buccodentaires en milieu carcéral par les professionnels.

INTRODUCTION: Few studies have been conducted on the role and position of dental surgeons in prisons. Interestingly though, dental surgeons perform in a peculiar working environment, since the organizations are divided into two administrative structures: penitentiary and hospital administrations. Stakeholders’ perceptions of both the current oral healthcare organization in prisons and the interactions between prison and hospital administrations’ professionals will be at the core of this study. PURPOSE OF RESEARCH: This article aims at assessing hospital and penitentiary administration agents’ perceptions of oral healthcare practice in prison. This assessment is based on the analysis of 18 semi-structured interviews with prison directors, integration and probation officers, coordinating physicians and dentists. To do this, three analytical categories were established containing first contextual elements, second each professional culture and last actual and potential interactions. RESULTS: Dentists were identified as specific agents within prison’ sanitary units because of the separation between dentistry and other medical specialties. Indeed, the relation to the body, to self-image and self-esteem along with the specific positioning regarding medical secrecy and expertise required by prison staff make dentistry practice a separate field in prison. CONCLUSION: The results of this study highlight dentists’ specific positioning in prison sanitary units. They could be identified as helpful intermediaries in the building of interactions between penitentiary and hospital administrations thanks to the specificity of the dentistry practice which simultaneously provides health care and promotes the reconstruction of self-image and self-esteem, which are key factors of reintegration.

Dental Therapists in the United States: Health Equity, Advancing.

BACKGROUND: Dental therapists (DTs) are primary care dental providers, used globally, and were introduced in the United States (US) in 2005. DTs have now been adopted in 13 states and several Tribal nations. OBJECTIVES: The objective of this study is to qualitatively examine the drivers and outcomes of the US dental therapy movement through a health equity lens, including community engagement, implementation and dissemination, and access to oral health care. METHODS: The study compiled a comprehensive document library on the dental therapy movement including literature, grant documents, media and press, and gray literature. Key stakeholder interviews were conducted across the spectrum of engagement in the movement. Dedoose software was used for qualitative coding. Themes were assessed within a holistic model of oral health equity. FINDINGS: Health equity is a driving force for dental therapy adoption. Community engagement has been evident in diverse statewide coalitions. National accreditation standards for education programs that can be deployed in 3 years without an advanced degree reduces educational barriers for improving workforce diversity. Safe, high-quality care, improvements in access, and patient acceptability have been well documented for DTs in practice. CONCLUSION: Having firmly taken root politically, the impact of the dental therapy movement in the US, and the long-term health impacts, will depend on the path of implementation and a sustained commitment to the health equity principle.

Predictors of use of dental care by children in north-central Appalachia in the USA.

Use of dental services in childhood, especially preventive care, is associated with many important oral health outcomes throughout life. The Andersen behavioral model of healthcare utilization posits that predisposing characteristics, enabling resources, and need factors predict utilization in oral and other healthcare domains. Inequities that produce lower utilization of dental services in north-central Appalachia have been documented in comparison to the USA generally. Additionally, within Appalachia, there are disparities, such as those across different states related to varying public policies and resources supporting healthcare. Predictors of dental utilization in Appalachia have been a focus in adults, but less so in children. The aim of the current study was to understand predictors of dental utilization in children in north-central Appalachia in order to inform future research about how to intervene to address these disparities. In this study, there were 1,178 children, ages 1 through 10 years, from selected representative counties in West Virginia and Pennsylvania, along with a parent/caregiver, who were part of the Center for Oral Health Research in Appalachia (COHRA1) cohort. Use of dental services by their child was indicated by parents/caregivers, who also reported on sociodemographic, dental care-related anxiety and fear, and values and attitudes associated with oral healthcare. Results indicated that use of professional dental services by children was related to child age, dental anxiety and fear, and parental oral health values and attitudes. Older children in this age group, those who evidenced more dental care-related anxiety and fear, and whose parent/caregiver placed higher value on oral health and healthcare for themselves, were more likely to have had a dental visit in the past year.

Risk-based, 6-monthly and 24-monthly dental check-ups for adults: the INTERVAL three-arm RCT.

BACKGROUND: Traditionally, patients are encouraged to attend dental recall appointments at regular 6-month intervals, irrespective of their risk of developing dental disease. Stakeholders lack evidence of the relative effectiveness and cost-effectiveness of different recall strategies and the optimal recall interval for maintenance of oral health. OBJECTIVES: To test effectiveness and assess the cost-benefit of different dental recall intervals over a 4-year period. DESIGN: Multicentre, parallel-group, randomised controlled trial with blinded clinical outcome assessment at 4 years and a within-trial cost-benefit analysis. NHS and participant perspective costs were combined with benefits estimated from a general population discrete choice experiment. A two-stratum trial design was used, with participants randomised to the 24-month interval if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or 6-month recall interval. SETTING: UK primary care dental practices. PARTICIPANTS: Adult, dentate, NHS patients who had visited their dentist in the previous 2 years. INTERVENTIONS: Participants were randomised to attend for a dental check-up at one of three dental recall intervals: 6-month, risk-based or 24-month recall. MAIN OUTCOMES: Clinical - gingival bleeding on probing; patient - oral health-related quality of life; economic - three analysis frameworks: (1) incremental cost per quality-adjusted life-year gained, (2) incremental net (societal) benefit and (3) incremental net (dental health) benefit. RESULTS: A total of 2372 participants were recruited from 51 dental practices; 648 participants were eligible for the 24-month recall stratum and 1724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding between intervention arms in any comparison. For the eligible for 24-month recall stratum: the 24-month (n = 138) versus 6-month group (n = 135) had an adjusted mean difference of -0.91 (95% confidence interval -5.02 to 3.20); the risk-based (n = 143) versus 6-month group had an adjusted mean difference of -0.98 (95% confidence interval -5.05 to 3.09); the 24-month versus risk-based group had an adjusted mean difference of 0.07 (95% confidence interval -3.99 to 4.12). For the overall sample, the risk-based (n = 749) versus 6-month (n = 737) adjusted mean difference was 0.78 (95% confidence interval -1.17 to 2.72). There was no evidence of a difference in oral health-related quality of life between intervention arms in any comparison. For the economic evaluation, under framework 1 (cost per quality-adjusted life-year) the results were highly uncertain, and it was not possible to identify the optimal recall strategy. Under framework 2 (net societal benefit), 6-month recalls were the most efficient strategy with a probability of positive net benefit ranging from 78% to 100% across the eligible and combined strata, with findings driven by the high value placed on more frequent recall services in the discrete choice experiment. Under framework 3 (net dental health benefit), 24-month recalls were the most likely strategy to deliver positive net (dental health) benefit among those eligible for 24-month recall, with a probability of positive net benefit ranging from 65% to 99%. For the combined group, the optimal strategy was less clear. Risk-based recalls were more likely to be the most efficient recall strategy in scenarios where the costing perspective was widened to include participant-incurred costs, and in the Scottish subgroup. LIMITATIONS: Information regarding factors considered by dentists to inform the risk-based interval and the interaction with patients to determine risk and agree the interval were not collected. CONCLUSIONS: Over a 4-year period, we found no evidence of a difference in oral health for participants allocated to a 6-month or a risk-based recall interval, nor between a 24-month, 6-month or risk-based recall interval for participants eligible for a 24-month recall. However, people greatly value and are willing to pay for frequent dental check-ups; therefore, the most efficient recall strategy depends on the scope of the cost and benefit valuation that decision-makers wish to consider. FUTURE WORK: Assessment of the impact of risk assessment tools in informing risk-based interval decision-making and techniques for communicating a variable recall interval to patients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN95933794. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)] and will be published in full in Health Technology Assessment; Vol. 24, No. 60. See the NIHR Journals Library website for further project information.

Traditionally, dentists have encouraged both patients at low risk and patients at high risk of developing dental disease to attend their dental practices for regular 6-month 'check-ups'. There is, however, little evidence available for either patients or dentists to use when deciding on the best dental recall interval (i.e. time between dental check-ups) for maintaining oral health. In this study, we wanted to find out, for adult patients who regularly attend the dentist, what interval of time between dental check-ups maintains optimum oral health and represents value for money. A total of 2372 adults who regularly attended 51 different dental practices across Scotland, Northern Ireland, England and Wales were involved. Patients aged 18 years or over who received all or part of their care as NHS patients were randomly allocated to groups to receive a check-up either every 6 months, at an individualised recall interval based on their own risk of oral disease (risk-based recall), or every 24 months (if considered at low risk by their dentist). The recruited adults completed questionnaires at their first trial appointment and then every year of the 4-year study. Their attendance at recall appointments was recorded and they received a clinical assessment taken by study staff at the end of their involvement at year 4. After 4 years, there was no evidence of a difference in the oral health of patients allocated to a 6-month or variable risk-based recall interval. For patients considered by their dentists to be suitable for a 24-month recall interval, there was no difference between those in the 24-month, 6-month or risk-based recall intervals. However, people greatly value and are willing to pay for frequent dental check-ups. The recall strategy that offers the best value for money to patients and the NHS, therefore, depends on what people and decision-makers wish to value within a health-care system.

Benefits of Oral Health Education at Women, Infant, and Children (WIC) Clinic Visits: Assessments of Parent's Oral Health Beliefs, Behaviors and Dental Access in O'ahu, Hawai'i.

Improving oral health outcomes in Hawai'i for children and families remains a high priority. Children in the state are leading the nation with the highest caries rates, while women before, during, and after pregnancy are failing to receive regular and necessary dental care resulting in poor health outcomes. To answer for this need, an educational intervention was conducted among families enrolled in the Kapi'olani Medical Center for Women and Children's Women, Infant, and Children program (WIC) in O'ahu. The project included the following activities: (1) identification the oral health beliefs and behaviors of families, (2) providing oral health education to families, and (3) reassessing beliefs and behaviors in 3-6 months to document the impact of theeducation session. Participants consisted of 81 families resulting in the data on 176 children and 4 pregnant women. Of the 81 families, 40 representing84 children completed the follow-up oral health questionnaire. Results of the assessment and education demonstrated a positive impact on the family's oral health behaviors. Parents were 6.61 times as likely to report using fluoride toothpaste in the follow-up visit compared to their initial visit (95% confidence interval [CI] = 3.12-14.00). Additionally, statistically significant changes were noted in the frequency of children's daily tooth brushing (odds ratio [OR] = 2.15, 95% CI = 1.33-3.46), as well as in the incidence of children receiving fluoride varnish application over time (OR = 2.66, 95% CI = 1.50-4.73). These results provide further evidence that initiating a simple educational intervention can have a positive impact on oral health behaviors in groups that are at highest risk for developing dental disease in Hawai'i.

The extent and nature of dental anxiety in Australians experiencing homelessness.

High dental anxiety is a major barrier to accessing dental care and has been found to be experienced to a greater extent in the homeless population. No studies have investigated the extent and nature of dental anxiety in Australians experiencing homelessness and was the aim of this study. Participants were recruited from four not-for-profit organisations in inner Brisbane using convenience and snowball sampling. The Dental Anxiety Questionnaire (DAQ) and the Index of Dental Anxiety and Fear (IDAF-4C+ ) questionnaire and oral health screening were completed by people experiencing homelessness in Brisbane, Australia, and compared to population norms. Descriptive statistics were calculated, and non-overlapping confidence intervals considered significantly different. The majority of the participants (n = 66) were male, a current smoker, unemployed and living in government supported housing. Most of the participants rated their oral health as poor/fair (n = 46, 71.9%) and their oral function as good or higher (n = 34, 53.1%). Using the single-item DAQ, 28.2% (n = 19) of people experiencing homelessness had high dental anxiety, compared to 16% of the general Australian population. The mean summed IDAF-4C+ fear module score was 18.02 (CI 15.60-20.43), which was significantly higher than the Australian population (µ = 14.40, CI 13.93-14.86). The highest mean score in the IDAF-4C+ stimulus module was feeling embarrassed or ashamed as anxiety inducing (µ = 2.27, CI 1.89-2.64) and was significantly different from the general Australian population (µ = 1.40, CI 1.33-1.47). The poorer overall self-rated oral health by the homeless population may induce feelings of embarrassment or shame, highlighting the differing psychosocial aspect to dental anxiety experienced by this population. Managing dental anxiety is needed to improve accessing to dental care for this population. Multidisciplinary care from social workers, mental health workers and dental practitioners may be beneficial in managing fear.

Validation of a modified version of the Spanish Geriatric Oral Health Assessment Index (GOHAI-SP) for adults and elder people.

BACKGROUND: The Geriatric Oral Health Assessment Index (GOHAI) was developed and validated in 1990 and translated into Spanish in 1999. Since then, the original version has been used in numerous studies, but it has not been re-evaluated in terms of language in the new generations of older adults. The purpose of this study is to confirm the validity of the Spanish version of the Geriatric Oral Health Assessment Index (GOHAI-SP) after three decades to be used as part of an ongoing field trial. METHODS: The GOHAI-SP was pilot tested in a focus group to confirm linguistic comprehension. A version with minor language changes was administered to individuals with metabolic syndrome aged 55-75 years from one health care district in southern Spain as part of an ongoing field trial (PREDIMED-Plus). Clinical evaluation included assessment of dental and periodontal status. The psychometric properties of the GOHAI-SP were evaluated through stability and internal consistency measures, and concurrent and discriminant validity were assessed. RESULTS: The new version of the GOHAI-SP was administered to 100 individuals. The application time was reduced by 7 min. The alpha value for reliability was 0.87. The item-scale correlation coefficients ranged from 0.54 to 0.75, and the test-re-test correlation for the total score was 0.75. There were inverse correlations between GOHAI-SP scores and the number of lost teeth and the decayed-missing-filled teeth index (p < 0.001). CONCLUSIONS: The GOHAI-SP questionnaire remains a valid and useful tool to assess oral health-related quality of life in primary health care settings. A linguistic update of the questionnaire brought improvements to the instrument application. TRIAL REGISTRATION: The PREDIMED-Plus trial is registered in the ISRCTN registry with reference number ISRCTN89898870. Registration date: 4th July 2014.

Perinatal Oral Health Among Underserved Women: A Call to Action for North Carolina Patients, Providers and Policymakers.

INTRODUCTION: Knowledge gaps exist among providers and pregnant women about the importance and safety of oral health care around pregnancy. This article describes the current state of perinatal oral health and healthcare among underserved women in North Carolina (NC) and provides policy recommendations to improve their access to and utilization of dental services. METHODS: A descriptive analysis is provided using (a) 2016 oral health surveillance data of a convenience sample of 459 pregnant women across NC, (b) 2014-2016 Medicaid dental provider and dental services utilization data for the Medicaid for Pregnant Women (MPW) program, and (c) 2017 Medicaid dental benefits policy. Surveillance data was not linked to Medicaid dental services utilization data. RESULTS: Less than 20% of pregnant women surveyed reported having a dental visit during pregnancy and oral screenings revealed 33% had untreated caries. Medicaid data showed a steady decline since 2014 in percentage of MPW beneficiaries utilizing any dental service-less than 10% as of 2016. MPW dental benefits lapse at delivery because dental care is not considered pregnancy-related in NC policy. Only 20% of practicing NC dentists provided care to MPW beneficiaries in 2015. DISCUSSION: Inadequacies in oral health knowledge, beliefs and practices exist among pregnant women, health care professionals and policymakers. Statewide efforts are needed to promote a standard of perinatal care that emphasizes collaborative practice and addresses existing barriers at the patient, provider and policy levels.

Invading Deeply into Self and Everyday Life: How Oral Health-Related Problems Affect the Lives of Child Sexual Abuse Survivors.

This paper presents the findings of a study on how oral health-related problems affect the lives of Child Sexual Abuse (CSA) survivors seen from the viewpoint of 12 women and 4 men sexually abused as children. Study methods followed the principles of grounded theory approaches. During analysis, the core concept of invading deeply into self and everyday life was constructed on the basis of seven categories: causing serious oral health symptoms, triggering trauma-reactions, increasing emotional distress, shaping the understanding of self, intruding daily life practices, restraining social interactions, and generating financial difficulties. These findings help us to understand how deeply oral health-related problems invade the understanding of self and the everyday lives of CSA survivors, and how these problems interact with their existing considerable problems related to the aftermath of CSA. Attention to these problems may help CSA survivors to understand more about themselves as well as helping professionals, family members and friends to understand the challenges CSA survivors face in everyday life. Increased understanding may also assist professionals to focus on how CSA survivors can be helped in handling challenges associated with dental treatment, daily self-care and other problems related to oral health.

Oral healthcare experiences of humanitarian migrants in Montreal, Canada.

OBJECTIVE: To understand the oral healthcare experiences of humanitarian migrants in Montreal and their perceptions of ways to improve access to oral healthcare. METHODS: We used focused ethnography informed by a public health model of the dental care process. The adapted McGill Illness Narrative Interview (MINI) guided interviews of a purposeful sample of humanitarian migrants who received or needed dental care in Montreal. Each interview (50-60 min) was audio-recorded for verbatim transcription. Observation of dental care episodes occurred during mobile dental clinics in underserved communities over the same period (2015-2016). Data analysis combined deductive codes from the theoretical frameworks and inductive codes from interview transcripts and field notes to inform themes. RESULTS: We interviewed 25 participants (13 refugees and 12 asylum seekers) from 10 countries, who had been in Canada for a range of 1 month to 5 years. The dental care experiences of participants included delayed consultation, proximity to dental clinics, quality care, limited treatment choices, high cost, and long waiting times. A more inclusive healthcare policy, lower fees, integration of dental care into public insurance, and creation of community dental clinics were proposed strategies to improve access to dental care. CONCLUSION: Humanitarian migrants in this study experienced inadequate oral healthcare. Their lived experiences help us to identify gaps in the provision of oral healthcare services, and suggestions of participants have great potential to improve access to oral healthcare.

Attitudes and lifestyle factors in relation to oral health and dental care in Sweden: a cross-sectional study.

OBJECTIVE: The aim of the present study was to investigate attitudes to and perceptions of dental treatment and costs, self-assessed personal oral health status and dental self-care in an adult Swedish population, with special reference to potential associations between these factors and periodontal status. MATERIAL AND METHODS: The study population comprised 1577 subjects who had undergone radiographic dental examination. The subjects were grouped by severity of periodontitis, based on extent of bone loss, as none, mild/moderate or severe. Subjects answered a questionnaire about socioeconomic factors, oral care habits and attitudes to dental treatment. Other questions covered medical history, smoking and other life style factors. Associations were tested using the Chi-squared test and a logistic regression model. RESULTS: Compared to subjects with no periodontitis, those with mild/moderate or severe periodontitis were less likely to afford (p < .001), more often refrained from treatment due to costs (p < .001) and in the past year had experienced dental problems for which they had not sought treatment (p < .001). They also reported more anxiety in relation to dental appointments (p = .001). Regarding caries prevention, the severe periodontitis group used least fluoride products (p = .002). CONCLUSIONS: Swedish adults regard their oral health as important, those with periodontitis have a more negative perception of their oral health and are less prone to seek help. These discouraging findings suggest the need for targeted measures, which focus on improving the care of this group of patients.

Dog-assisted therapy in the dental clinic. Part B. Hazards and assessment of potential risks to the health and safety of the dental therapy dog.

Background: A dental therapy dog may help anxious patients in the dental clinic overcome their fear and facilitate the completion of necessary dental care. Dental clinic activities are associated with hazards that may pose potential risks to the health and safety of the dental therapy dog. Objectives: To describe potential hazards associated with risks to health and safety to therapy dogs in dental clinics and to present suggestions for risk minimisation by adopting best practices in dental clinic settings. Materials and method: Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of occupational hazards and risks in dental clinics, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed relative to their relevance for the health and welfare of a therapy dog present in a dental clinic setting. Results: Workplace hazards in the dental clinic that apply to both humans and therapy dogs are allergies, sharps injury, eye injury, stress, rhinitis, hearing impairment, and other hazards. Additional concerns associated with risks for the dental therapy dog are situations involving erratic patient behaviour and threats if the patient is an undisclosed disease carrier. Risks to the health and safety of the dental therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices. Conclusions: Best practice includes awareness amongst the clinic staff and the dog handler of all potential hazards in the dental clinic and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog. The dental therapy dog team must be specially trained to work in a dental clinic. Each treatment session has to be exclusively tailored to that specific appointment and the individual patient.

Dog-assisted therapy in the dental clinic: Part A-Hazards and assessment of potential risks to the health and safety of humans.

Background: Dog-assisted therapy in the dental clinic may be an attractive alternative to sedation for anxious patients. Including a dental therapy dog in a clinical setting introduces new hazards and potential risks to health and safety for both humans and animal. Objectives: The study aims to describe potential hazards associated with risks to humans by having a therapy dog present in the dental clinic and to provide guidance on best practices to minimise and control risks for the patients, the dentist, and the dental clinic staff. Materials and Methods: Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of hazards and risks associated with the use of therapy dogs in health care settings, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed with respect for the health and welfare of humans in a dental clinic setting that involves the presence of a therapy dog. Results: Potential risks to health and safety for humans in dental clinics that offer dog-assisted therapy can be categorised within four general categories of hazards: the dog as a source of zoonotic pathogens and human diseases, exposure to canine allergens, adverse animal behaviour, and dangers associated with high activity in a congested dental clinic operatory. Risks to humans are reduced by maintaining awareness amongst the dental clinic staff and the dog handler of all potential hazards in the dental clinic, and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog. Conclusions: Risks to the health and safety of humans in the presence of therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices.

Oral care as a life course project: A qualitative grounded theory study.

OBJECTIVE: To report on a theory to explain the oral health of older people over the life course. BACKGROUND: The study of ageing has burgeoned into a complex interdisciplinary field of research, yet there are few studies in oral health from the perspective of older people that bridge the gap between sociology and oral health related research. METHODS: A grounded theory study involving a convenience sample of 15 men and 28 women aged between 65 and 91 years across different levels of education. Data were subjected to grounded theory analysis using QSR NVivo 11.0 and where relevant phenomenological theory. RESULTS: Participants conceived of oral care as a life course project that resulted from an active plan to keep one's teeth into older age. This involved accessing the social world of dentistry, holding appropriate values, understanding the associated personality types, social practices, goals and outcomes. The life course project is a social project supported by social institutions. It involves ideas about appropriate ageing including how oral health is to be managed at different stages in the life course. The degree to which individuals are able to participate in this project is determined by both individual and social factors. CONCLUSIONS: The theory explains why the loss of a single tooth might be experienced as traumatic but also why older people adapt to their changing oral health. Oral health in older age represented a lifetime's investment in oral care. Future health policies should consider this lifetime investment when considering care for older people.

[Evaluation of satisfaction with dental care from the standpoint of adult Brazilian users: a multilevel analysis]. / Avaliação da satisfação com a assistência odontológica na perspectiva de usuários brasileiros adultos: análise multinível.

The scope of this paper was to evaluate the satisfaction regarding dental care services and to identify the association between dissatisfaction and contextual/individual variables. It involved a cross-sectional study of a representative sample of 8,943 adults from 177 municipalities, in which 14.9% of adults were dissatisfied. In the multiple analysis there was a greater chance of dissatisfaction with dental services among adults residing in cities with greater social inequality (OR: 1.53, 95% CI: 1.31-1.81) and with a lower proportion of dentists per inhabitant (OR: 1.17; 95% CI: 1.00-1.37); yellow/black/brown/indigenous (OR: 1.12; 95% CI: 0.99-1.27); lower schooling (OR: 1.14; 95% CI: 0.98-1.33); consultation due to oral problems (OR: 1.23; 95% CI: 1.04-1.44); (OR: 2.60; 95% CI: 2.53-3.02) and impact of oral disorders on daily performance (OR: 1.48; 95% CI: 1.30-1.69). The implementation or adequacy of public policies with the aim of improving satisfaction with dental services should prioritize those municipalities with greater social inequality and with fewer dentists and socially disadvantaged users, who self-perceive oral problems, are dissatisfied with their oral health and suffer impacts resulting from oral problems.

Objetivou-se avaliar a satisfação quanto aos serviços de assistência odontológica e identificar associação entre a insatisfação e as variáveis contextuais/individuais. Estudo transversal multinível de dados secundários de uma amostra representativa de 8.943 adultos de 177 municípios. Encontravam-se insatisfeitos 14,9% dos adultos. Registrou-se maior chance de insatisfação com os serviços odontológicos entre adultos que residiam em municípios com maior desigualdade social (OR:1,53;IC95%:1,31-1,81) e com menor proporção de dentistas por habitante (OR:1,17;IC95%: 1,00-1,37); amarelos/negros/pardos/indígenas (OR:1,12; IC95%: 0,99-1,27); menor escolaridade (OR:1,14; IC95%: 0,98-1,33); consulta por motivo de problemas bucais (OR:1,23; IC95%: 1,04-1,44); insatisfeitos com os dentes e boca (OR:2,60;IC95%:2,53-3,02) e com impacto das desordens bucais no desempenho diário (OR:1,48;IC95%:1,30-1,69). A implementação ou adequação de políticas públicas com o intuito de melhorar a satisfação com os serviços odontológicos deve priorizar os municípios com maior desigualdade social e com menos dentistas e usuários socialmente desfavorecidos, que autopercebem problemas bucais, insatisfeitos com sua saúde bucal e com impactos decorrentes dos problemas bucais.

Avaliação da satisfação com a assistência odontológica na perspectiva de usuários brasileiros adultos: análise multinível / Evaluation of satisfaction with dental care from the standpoint of adult Brazilian users: a multilevel analysis

Resumo Objetivou-se avaliar a satisfação quanto aos serviços de assistência odontológica e identificar associação entre a insatisfação e as variáveis contextuais/individuais. Estudo transversal multinível de dados secundários de uma amostra representativa de 8.943 adultos de 177 municípios. Encontravam-se insatisfeitos 14,9% dos adultos. Registrou-se maior chance de insatisfação com os serviços odontológicos entre adultos que residiam em municípios com maior desigualdade social (OR:1,53;IC95%:1,31-1,81) e com menor proporção de dentistas por habitante (OR:1,17;IC95%: 1,00-1,37); amarelos/negros/pardos/indígenas (OR:1,12; IC95%: 0,99-1,27); menor escolaridade (OR:1,14; IC95%: 0,98-1,33); consulta por motivo de problemas bucais (OR:1,23; IC95%: 1,04-1,44); insatisfeitos com os dentes e boca (OR:2,60;IC95%:2,53-3,02) e com impacto das desordens bucais no desempenho diário (OR:1,48;IC95%:1,30-1,69). A implementação ou adequação de políticas públicas com o intuito de melhorar a satisfação com os serviços odontológicos deve priorizar os municípios com maior desigualdade social e com menos dentistas e usuários socialmente desfavorecidos, que autopercebem problemas bucais, insatisfeitos com sua saúde bucal e com impactos decorrentes dos problemas bucais.

Abstract The scope of this paper was to evaluate the satisfaction regarding dental care services and to identify the association between dissatisfaction and contextual/individual variables. It involved a cross-sectional study of a representative sample of 8,943 adults from 177 municipalities, in which 14.9% of adults were dissatisfied. In the multiple analysis there was a greater chance of dissatisfaction with dental services among adults residing in cities with greater social inequality (OR: 1.53, 95% CI: 1.31-1.81) and with a lower proportion of dentists per inhabitant (OR: 1.17; 95% CI: 1.00-1.37); yellow/black/brown/indigenous (OR: 1.12; 95% CI: 0.99-1.27); lower schooling (OR: 1.14; 95% CI: 0.98-1.33); consultation due to oral problems (OR: 1.23; 95% CI: 1.04-1.44); (OR: 2.60; 95% CI: 2.53-3.02) and impact of oral disorders on daily performance (OR: 1.48; 95% CI: 1.30-1.69). The implementation or adequacy of public policies with the aim of improving satisfaction with dental services should prioritize those municipalities with greater social inequality and with fewer dentists and socially disadvantaged users, who self-perceive oral problems, are dissatisfied with their oral health and suffer impacts resulting from oral problems.

Improving the Quality of Dentistry (IQuaD): a cluster factorial randomised controlled trial comparing the effectiveness and cost-benefit of oral hygiene advice and/or periodontal instrumentation with routine care for the prevention and management of periodontal disease in dentate adults attending dental primary care.

BACKGROUND: Periodontal disease is preventable but remains the most common oral disease worldwide, with major health and economic implications. Stakeholders lack reliable evidence of the relative clinical effectiveness and cost-effectiveness of different types of oral hygiene advice (OHA) and the optimal frequency of periodontal instrumentation (PI). OBJECTIVES: To test clinical effectiveness and assess the economic value of the following strategies: personalised OHA versus routine OHA, 12-monthly PI (scale and polish) compared with 6-monthly PI, and no PI compared with 6-monthly PI. DESIGN: Multicentre, pragmatic split-plot, randomised open trial with a cluster factorial design and blinded outcome evaluation with 3 years' follow-up and a within-trial cost-benefit analysis. NHS and participant costs were combined with benefits [willingness to pay (WTP)] estimated from a discrete choice experiment (DCE). SETTING: UK dental practices. PARTICIPANTS: Adult dentate NHS patients, regular attenders, with Basic Periodontal Examination (BPE) scores of 0, 1, 2 or 3. INTERVENTION: Practices were randomised to provide routine or personalised OHA. Within each practice, participants were randomised to the following groups: no PI, 12-monthly PI or 6-monthly PI (current practice). MAIN OUTCOME MEASURES: Clinical - gingival inflammation/bleeding on probing at the gingival margin (3 years). Patient - oral hygiene self-efficacy (3 years). Economic - net benefits (mean WTP minus mean costs). RESULTS: A total of 63 dental practices and 1877 participants were recruited. The mean number of teeth and percentage of bleeding sites was 24 and 33%, respectively. Two-thirds of participants had BPE scores of ≤ 2. Under intention-to-treat analysis, there was no evidence of a difference in gingival inflammation/bleeding between the 6-monthly PI group and the no-PI group [difference 0.87%, 95% confidence interval (CI) -1.6% to 3.3%; p = 0.481] or between the 6-monthly PI group and the 12-monthly PI group (difference 0.11%, 95% CI -2.3% to 2.5%; p = 0.929). There was also no evidence of a difference between personalised and routine OHA (difference -2.5%, 95% CI -8.3% to 3.3%; p = 0.393). There was no evidence of a difference in self-efficacy between the 6-monthly PI group and the no-PI group (difference -0.028, 95% CI -0.119 to 0.063; p = 0.543) and no evidence of a clinically important difference between the 6-monthly PI group and the 12-monthly PI group (difference -0.097, 95% CI -0.188 to -0.006; p = 0.037). Compared with standard care, no PI with personalised OHA had the greatest cost savings: NHS perspective -£15 (95% CI -£34 to £4) and participant perspective -£64 (95% CI -£112 to -£16). The DCE shows that the general population value these services greatly. Personalised OHA with 6-monthly PI had the greatest incremental net benefit [£48 (95% CI £22 to £74)]. Sensitivity analyses did not change conclusions. LIMITATIONS: Being a pragmatic trial, we did not deny PIs to the no-PI group; there was clear separation in the mean number of PIs between groups. CONCLUSIONS: There was no additional benefit from scheduling 6-monthly or 12-monthly PIs over not providing this treatment unless desired or recommended, and no difference between OHA delivery for gingival inflammation/bleeding and patient-centred outcomes. However, participants valued, and were willing to pay for, both interventions, with greater financial value placed on PI than on OHA. FUTURE WORK: Assess the clinical effectiveness and cost-effectiveness of providing multifaceted periodontal care packages in primary dental care for those with periodontitis. TRIAL REGISTRATION: Current Controlled Trials ISRCTN56465715. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 38. See the NIHR Journals Library website for further project information.

Why do people renounce dental health care? An analysis of data from the Italian population.

OBJECTIVES: Oral diseases affect a large number of people in the world and have a great influence on their quality of life. Nevertheless, oral health promotion and prevention initiatives are lacking. The aim of this study was to identify characteristics of individuals in Italy who renounce dental care in order to better support institutional prevention campaigns. METHODS: Using data from the Italian National Institute of Statistic (ISTAT) survey "Health condition and use of health services", we divided the sample into two groups: individuals who renounced dental care even when needed and those who accessed dental healthcare. We then compared information about socio-economic and oral health profile of the two groups. RESULTS: People who renounced dental treatments are mostly young adults, smokers, belonging to the middle-low socioeconomic level, not married and unemployed. Economic resources are often the main reason behind renouncing dental treatments. CONCLUSIONS: Our study underlines that economic conditions play a leading role in renouncing dental care. In order to avoid additional costs to the Italian healthcare system, our proposal is to implement a specific prevention campaign for oral diseases, targeting young adults living in Italy.

Patients' satisfaction with dental care: a qualitative study to develop a satisfaction instrument.

BACKGROUND: To explore and better understand how patients evaluate satisfaction in dental care and elicit information from them to develop a dental satisfaction instrument. METHODS: Patients currently receiving dental treatment in a teaching hospital were invited to be part of a qualitative research project which involved focus group discussion. Focus groups were conducted in Cantonese and discussions were recorded (audio and video) and later transcribed. RESULTS: Thirty patients participated and a thematic analysis of data from four focus groups helped generate a questionnaire on dental satisfaction. Six themes were extracted from the contents of the focus group: (i) attitude, (ii) cost, (iii) convenience, (iv) pain management, (v) quality, and (vi) patients' perceived need for prevention of oral disease. Compared to the existing Dental Satisfaction Questionnaire (DSQ), majority of the dental satisfaction aspects mentioned in focus group discussions were similar to items in DSQ supporting its content validity. Focus groups covered more aspects including attitude of dental supporting staff, convenience of emergency services, admission of patients and treatment duration. Consideration of the clinical skills of the operator, hospital infection control, and knowledge on prevention of oral disease were also expressed. CONCLUSIONS: The focus group discussions elicited the views of patients not covered by DSQ items thereby suggesting areas for development of a new satisfaction questionnaire.