Point-of-care characterization and risk-based management of oral lesions in primary dental clinics: A simulation model.

OBJECTIVES: Oral potentially malignant disorders (OPMDs) encompass histologically benign, dysplastic, and cancerous lesions that are often indistinguishable by appearance and inconsistently managed. We assessed the potential impact of test-and-treat pathways enabled by a point-of-care test for OPMD characterization. MATERIALS AND METHODS: We constructed a decision-analytic model to compare life expectancy of test-treat strategies for 60-year-old patients with OPMDs in the primary dental setting, based on a trial for a point-of-care cytopathology tool (POCOCT). Eight strategies of OPMD detection and evaluation were compared, involving deferred evaluation (no further characterization), prompt OPMD characterization using POCOCT measurements, or the commonly recommended usual care strategy of routine referral for scalpel biopsy. POCOCT pathways differed in threshold for additional intervention, including surgery for any dysplasia or malignancy, or for only moderate or severe dysplasia or cancer. Strategies with initial referral for biopsy also reflected varied treatment thresholds in current practice between surgery and surveillance of mild dysplasia. Sensitivity analysis was performed to assess the impact of variation in parameter values on model results. RESULTS: Requisite referral for scalpel biopsy offered the highest life expectancy of 20.92 life-years compared with deferred evaluation (+0.30 life-years), though this outcome was driven by baseline assumptions of limited patient adherence to surveillance using POCOCT. POCOCT characterization and surveillance offered only 0.02 life-years less than the most biopsy-intensive strategy, while resulting in 27% fewer biopsies. When the probability of adherence to surveillance and confirmatory biopsy was ≥ 0.88, or when metastasis rates were lower than reported, POCOCT characterization extended life-years (+0.04 life-years) than prompt specialist referral. CONCLUSION: Risk-based OPMD management through point-of-care cytology may offer a reasonable alternative to routine referral for specialist evaluation and scalpel biopsy, with far fewer biopsies. In patients who adhere to surveillance protocols, POCOCT surveillance may extend life expectancy beyond biopsy and follow up visual-tactile inspection.

Factors associated with conducting planning for secondary oral health care services in Brazil.

BACKGROUND: Planning in health services specifically aims to improve the health status of a given population, guaranteeing access with equity and justice, as well as streamlining the response of the health system to the needs perceived by the community. This research aims to identify the factors associated with planning Specialized Dental Clinics (SDCs). METHODS: Secondary data were used from the external evaluation of the database of the first National Program for Access and Quality Improvement of SDCs (NPAQI-SDCs) and the informed Outpatient Information System of the Unified Health System (OIS/UHS), which contains data on the specialized dental procedures performed at SDCs. It consisted of a quantitative study in which Pearson chi-square statistical tests (p < 0.05) and a multivariate logistic regression were applied with odds ratio (OR) estimate. RESULTS: The results indicated that the realization of planning in SDCs was associated with lower coverage of the Oral Health Team of the Familiy Health Strategy in a municipality (OR = 1.4; 95% CI: 1.0-1.9, p = 0.049), additional training for managers (p = 0.038), the practice of self-assessment (OR = 8.2; 95% CI: 5.8-11.6; p = 0.000) and meeting service production targets (OR = 1.9; 95% CI: 1.2-3.2; p = 0.011). CONCLUSION: The results indicate that the work processes of the SDCs, especially with regard to service management, are essential to the proper functioning of the service and the practice of planning is linked to the technical capacity and commitment of service managers.

Universal access to oral health care for Australian children: comparison of travel times to public dental services at consecutive census dates as an indicator of progressive realisation.

Progressive realisation of equitable access to health services is a fundamental measure of a state's resolve to achieve universal health coverage. The World Health Organization has reprioritised the importance of oral health services as an integral element of the roadmap towards health equity. This study sought to determine whether there is an indication of progressive realisation of equitable spatial access to public dental services for Australians <18 years of age through a comparison of travel times to the nearest public dental clinic at successive census dates. The distribution of children classified by rural remoteness and level of socioeconomic disadvantage, as well as the location of public dental clinics at the 2011 and 2016 Australian Bureau of Statistics censuses, was mapped using geographic imaging software. OpenRouteService software was used to calculate the travel time by car between each statistical census district and the nearest public dental clinic. There has been an improvement in the percentage of the population <18 years of age living within a reasonable travel time of a public dental clinic. The most socioeconomically disadvantaged groups in more densely populated areas have better spatial access to publicly funded dental services than less disadvantaged groups. Children living in very remote areas continue to experience lengthy travel times to access fixed oral health services.

Satisfação dos usuários atendidos na Clínica Integral de Odontologia da Universidade Federal de Pernambuco e fatores associados / Patients satisfaction in Dental School Clinics of the Federal University of Pernambuco and associated factors

Objetivo: avaliar a satisfação dos usuários atendidos nas clínicas integrais do curso de Odontologia da Universidade Federal de Pernambuco e a associação com fatores relacionados ao paciente, ao acesso e ao atendimento. Método: trata-se de um estudo descritivo, quantitativo, de corte transversal, partindo de uma amostra de conveniência, realizado com 81 pacientes adultos, de ambos os sexos. Foi aplicado um questionário semiestruturado com questões do Questionário de Avaliação dos Serviços de Saúde Bucal (QASSAB), uma questão de ansiedade ao tratamento odontológico (Dental Anxiety Question modificada) e dados individuais do paciente, como sexo, idade, escolaridade, local de residência e procedimentos realizados. Resultados: os resultados demonstraram que os usuários consideraram a obtenção de uma vaga como razoável ou fácil (75,3%), e o tempo na fila de espera como razoável ou curto (66,7%). A maioria dos participantes respondeu que o motivo da procura por atendimento na clínica era o fato de não ter dinheiro para pagar o tratamento particular, e 40,7% dos pacientes manifestaram algum sinal de ansiedade. Houve uma avaliação positiva do ambiente físico do serviço por parte dos usuários, para a maioria das variáveis pesquisadas. No entanto, apenas a variável organização foi significativamente associada com a satisfação dos usuários. Conclusão: de forma geral, os resultados encontrados nesta pesquisa indicam um bom nível de satisfação, porém, tornam-se necessárias reavaliações periódicas para obtenção de informações importantes que possibilitem melhorias na estrutura e no atendimento das clínicas.(AU)

Objective: to evaluate patient satisfaction at the Dental School Clinics at the Federal University of Pernambuco, Brazil, and the association with factors related to the patient, access and care. Method: this is a descriptive, quantitative, cross-sectional study, based on a convenience sample, conducted with 81 adult patients, of both sexes. A semi-structured questionnaire was applied with questions from the Oral Health Services Assessment Questionnaire (QASSAB), a question of anxiety to dental treatment (modified Dental Anxiety Question) and individual patient data, such as sex, age, education, place of residence and procedures performed. Results: the results showed that users considered obtaining a place as reasonable or easy (75.3%) and the time in the queue as reasonable or short (66.7%), most participants answered that the reason why they chose theservice was the fact that they did not have the money to pay for private treatment and 40.7% of the patients showed some sign of anxiety. There was a positive evaluation of the physical stucture of the service by users, for most of the variables surveyed. However, only the organization variable was significantly associated with user satisfaction. Conclusion: in general, the results found in this research indicate a good level of satisfaction, however, periodic reassessments are necessary to obtain important information that will allow improvements in the structure and care of clinics.(AU)

Assessment of prevalence of dental caries and the associated factors among patients attending dental clinic in Debre Tabor general hospital: a hospital-based cross-sectional study.

BACKGROUND: Dental caries is the most common dental health problem caused by the interaction of bacteria on tooth enamel. Risk factors for dental caries include salivary composition and inadequate fluoride. However, other factors, such as standard of living, behavior, hygiene, eating habits, social status and socio-demographic factors, also contribute to the evolution of caries. Therefore, this study aimed to determine the prevalence of dental caries and associated factors among patients attending the dental clinic in Debre Tabor General Hospital in North West Ethiopia. METHOD: An institution based cross-sectional study was conducted among 280 systematically selected patients attending Debre Tabor General Hospital dental clinic from May 8-20, 2017. The data were collected using pre-tested questionnaire and oral examination by a qualified dental professional. Basic hygienic procedures were observed during an oral examination. The teeth were examined for dental caries by the presence of decay, missing and filled teeth. The data were entered into Epi-Info version 3.5 and cleaned and analyzed using SPSS version 20. Descriptive summary of the data and logistic regression were used to identify possible predictors using odds ratio with 95% confidence interval and P-value of 0.05. RESULTS: A total of 280 subjects participated in the study; among whom 129 (46.1%) were female and nearly two-thirds of the respondents 208 (74.3%) attended formal education. The study revealed k8that the overall prevalence of dental caries was 78.2%. Dental caries was lower among respondents who had good oral hygiene status (AOR = 0.05, 95% CI, 0.02, 0.81). Dental caries was higher among participants who earned less than 5000 Eth Birr per month (AOR = 8.43, 95% CI, 2.6, 27.2). Dental caries was lower among respondents who had good knowledge (AOR = 0.51, 95% CI, 0.03, 0.64). CONCLUSIONS: Prevalence of dental caries was high and found public health problem. Socioeconomic status, educational level, and poor oral hygiene practices were associated factors for dental caries. Health promotion about oral hygiene and integration of services are supremely important for the prevention of the problem of dental caries.

The equity of access to primary dental care in São Paulo, Brazil: A geospatial analysis.

OBJECTIVES: Brazil is one of the largest countries in the world, in terms of geography and population. Most Brazilians reside in the south and south-eastern regions, with notable numbers in the regions' megacities, such as São Paulo city. Healthcare provision in such a complex environment is difficult. Thus, a clear understanding of the distribution - or rather, the maldistribution - of these services is fundamental for optimising the allocation of human and financial resources to areas of greatest privation. The present study aimed to determine the distribution of primary dental clinics in São Paulo city. METHODS: A total of 4,101 primary dental clinics in São Paulo city were identified and geocoded. Clinic locations were integrated with the city's 19,128 constituent census tracts - each containing sociodemographic data for the 11,252,204 residents - using Geographic Information Systems (GIS). RESULTS: Approximately two-thirds (64.8%) of the population resided within 0.5 km of a primary dental clinic, and a further 23.9% were within 1 km. Populations more than 1 km out were typically characterised as sociodemographically disadvantaged. Primary dental clinics were also more sparsely distributed in the city's peripheral census tracts than central census tracts. CONCLUSION: Primary dental clinics are maldistributed in São Paulo city, with disadvantaged populations having less spatial access than their advantaged counterparts.

Are Dental Schools Part of the Safety Net?

This article examines the current safety net activities of dental schools and reviews strategies by which schools could care for more poor and low-income patients. The primary data come from the annual Survey of Dental Education, a joint American Dental Education Association (ADEA) and American Dental Association (ADA) activity. The analyses use descriptive statistics and are intended to give ballpark estimates of patients treated under varying clinical scenarios. Some 107.4 million people are underserved in comparison to utilization rates for middle-income Americans. In 2013-14, pre- and postdoctoral students treated about 1,176,000 disadvantaged patients. This is an estimate; the actual value may be 25% above or below this number. The impact of potential strategies for schools to provide more care to poor and low-income patients are discussed; these are larger class size, more community-based education, a required one-year residency program, and schools' becoming part of publicly funded safety net clinics. While dental schools cannot solve the access problem, they could have a major impact if the payment and delivery strategies discussed were implemented. This article was written as part of the project "Advancing Dental Education in the 21st Century."

An Investigation into Patient Non-Attendance and Use of a Short-Message Reminder System at a University Dental Clinic.

Non-attended appointments in health care facilities create inefficiencies and loss of clinical productivity: clinical teaching hours are reduced, impacting students' ability to meet the competencies necessary for professional registration. The aim of this study was to assess demographic and time-related factors for patient non-attendance at a dental school clinic in Australia. Appointment data were extracted from the patient management system for the years 2011 and 2012. Data included the status of appointment (attended, cancelled, or failed to attend [FTA]) and an array of demographic and time-related factors. Multinomial logistic regression was conducted to assess relationships between these factors and appointment status. Attendance rates were also compared by year following implementation of a short message service (SMS) reminder at the beginning of 2012. The results showed that, of 58,622 appointments booked with students during 2011 and 2012, 68% of patients attended, 23% cancelled, and 9% were FTA. The percentage of non-attended (cancelled or FTA) appointments differed by demographic and time-related factors. Females were 7% less likely to be FTA, those aged 16-24 years were five times more likely to be FTA, and early morning appointments were 18% less likely to be cancelled and FTA. With the SMS reminder system, the odds of a cancellation were 15% higher, but FTAs were 14% lower (both were statistically significant differences). This study found that failing to attend an appointment was significantly related to a number of factors. Clinical scheduling and reminder systems may need to take these factors into account to decrease the number of teaching hours lost due to patients' missing their appointments.

Telemedicine Consultations in Oral and Maxillofacial Surgery: A Follow-Up Study.

PURPOSE: The purpose of this study was to follow up on the previous study in evaluating the efficiency and reliability of telemedicine consultations for preoperative assessment of patients. MATERIALS AND METHODS: A retrospective study of 335 patients over a 6-year period was performed to evaluate success rates of telemedicine consultations in adequately assessing patients for surgical treatment under anesthesia. Success or failure of the telemedicine consultation was measured by the ability to triage patients appropriately for the hospital operating room versus the clinic, to provide an accurate diagnosis and treatment plan, and to provide a sufficient medical and physical assessment for planned anesthesia. Data gathered from the average distance traveled and data from a previous telemedicine study performed by the National Institute of Justice were used to estimate the cost savings of using telemedicine consultations over the 6-year period. RESULTS: Practitioners performing the consultation were successful 92.2% of the time in using the data collected to make a diagnosis and treatment plan. Patients were triaged correctly 99.6% of the time for the clinic or hospital operating room. Most patients (98.0%) were given sufficient medical and physical assessment and were able to undergo surgery with anesthesia as planned at the clinic appointment immediately after telemedicine consultation. Most patients (95.9%) were given an accurate diagnosis and treatment plan. The estimated amount saved by providing consultation by telemedicine and eliminating in-office consultation was substantial at $134,640. CONCLUSION: This study confirms the findings from previous studies that telemedicine consultations are as reliable as those performed by traditional methods.

Assessment of volatile organic compounds and particulate matter in a dental clinic and health risks to clinic personnel.

This study was conducted to assess (1) levels of volatile organic compounds (VOCs) and particulate matter (PM) in a dental clinic in southern Taiwan and (2) dental care personnel's health risks associated with due to chronic exposure to VOCs. An automatic, continuous sampling system and a multi-gas monitor were employed to quantify the air pollutants, along with environmental comfort factors, including temperature, CO2, and relative humidity at six sampling sites in the clinic over eight days. Specific VOC compounds were identified and their concentrations were quantified. Both non-carcinogenic and carcinogenic VOC compounds were assessed based on the US Environmental Protection Agency's Principles of Health Risk Assessment in terms of whether those indoor air pollutants increased health risks for the full-time dental care professionals at the clinic. Increased levels of VOCs were recorded during business hours and exceeded limits recommended by the Taiwan Environmental Protection Agency. A total of 68 VOC compounds were identified in the study area. Methylene methacrylate (2.8 ppm) and acetone (0.176 ppm) were the only two non-carcinogenic compounds that posed increased risks for human health, yielding hazard indexes of 16.4 and 4.1, respectively. None of the carcinogenic compounds increased cancer risk. All detected PM10 levels ranged from 20 to 150 µg/m(3), which met the Taiwan EPA and international limits. The average PM10 level during business hours was significantly higher than that during non-business hours (P = 0.04). Improved ventilation capacity in the air conditioning system was recommended to reduce VOCs and PM levels.

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.

Examining continuity of care for Medicaid-enrolled children receiving oral health services in medical offices.

Children living in poverty encounter barriers to dentist visits and disproportionally experience dental caries. To improve access, most state Medicaid programs reimburse pediatric primary care providers for delivering preventive oral health services. To understand continuity of oral health services for children utilizing the North Carolina (NC) Into the Mouths of Babes (IMB) preventive oral health program, we examined the time to a dentist visit after a child's third birthday. This retrospective cohort study used NC Medicaid claims from 2000 to 2006 for 95,578 Medicaid-enrolled children who received oral health services before age 3. We compared children having only dentist visits before age 3 to those with: (1) only IMB visits and (2) both IMB and dentist visits. Cox proportional hazards regression was used to estimate the time to a dentist visit following a child's third birthday. Propensity scores with inverse-probability-of-treatment-weights were used to address confounding. Children with only IMB visits compared to only dentist visits before age 3 had lower rates of dentist visits after their third birthday [adjusted hazard ratio (AHR) = 0.41, 95 % confidence interval (CI) 0.39-0.43]. No difference was observed for children having both IMB and dentist visits and only dentist visits (AHR = 0.99, 95 % CI 0.96-1.03). Barriers to dental care remain as children age, hindering continuity of care for children receiving oral health services in medical offices.

Trends in the geographic distribution of dental clinics in Japan.

AIM: In Japan, along with the increase in the number of dentists, the number of dental facilities has continuously increased as well. This study aimed to examine whether the increase in the number of dental clinics in Japan has led to an improvement in their geographic distribution. METHODS: We analysed the number of dental clinics and population in all municipalities in Japan as of 2000, 2005 and 2010. We obtained data on the population from the population census and data on the number of dental clinics from the Survey of Medical Institutions. The number of municipalities was 3,258 in 2000 but had dropped to 1,750 by 2010 due to municipal mergers so population and dental data for other years were recalculated based on 2010 municipal boundaries. Lorenz curves and Gini coefficients were used to assess the distribution of dental clinics per 100,000 persons. RESULTS: The mean number of dental clinics per 100,000 persons among all municipalities was 49.9 in 2000, 52.2 in 2005 and 53.4 in 2010. The Gini coefficient for the clinics in the whole country was 0.172 in 2000, 0.164 in 2005 and 0.153 in 2010. CONCLUSION: The results suggest that the regional inequalities in the availability of dentists have been reduced gradually as the number of dental clinics has increased.

[Analysis of outpatient care in Brazilian municipalities with and without specialized dental clinics, 2010]. / Análise da produção ambulatorial em municípios com e sem centros de especialidades odontológicas no Brasil em 2010.

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.

Análise da produção ambulatorial em municípios com e sem centros de especialidades odontológicas no Brasil em 2010 / Analysis of outpatient care in Brazilian municipalities with and without specialized dental clinics, 2010 / Análisis de la producción ambulatoria en municipios con y sin centros de especialidades dentales en Brasil, 2010

O objetivo foi descrever a produção de serviços especializados em municípios brasileiros com e sem Centros de Especialidades Odontológicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informática do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatística. Utilizou-se regressão binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atenção básica, periodontia e cirurgia. Após controle por fatores sociodemográficos, os municípios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atenção básica. No modelo final, com variáveis de estrutura dos serviços, os municípios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variáveis de estrutura, mais gastos em saúde e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na produção municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito não é explicado por variáveis de estrutura.

The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.

El objetivo fue describir la producción de los servicios especializados en los municipios brasileños con y sin Centros Especializados Dentales (CEDs) y estudiar los factores asociados. Los datos fueron recogidos a partir de los siguientes sistemas: Departamento de Informática del SUS, Atlas del Desarrollo Humano y el Instituto Brasileño de Geografía y Estadística. Fueron utilizadas regresiones binomiales negativas infladas con ceros para ajustar las tasas de los procedimientos de endodoncia, atención primaria, periodoncia y cirugía. Después de controlar los factores sociodemográficos, los municipios con CEDs presentan tasas más altas que los sin CEDs, excepto para la tasa de atención primaria. En el modelo final, incluyendo los factores de la estructura de servicio, municipios con CEDs tipo III mostraron una tasa de procedimientos de endodoncia 2,08 (IC95%: 1,26; 3,44) veces mayor. Entre estos factores, los municipios con mayor gasto en salud y mayores tasas de dentistas en el sistema público se asociaron con tasas más altas de todos los procedimientos. Se concluye que los centros parecen tener un efecto positivo en la producción ambulatoria, principalmente para endodoncia y este efecto no se explica por las variables de estructura.

The association between oral health literacy and failed appointments in adults attending a university-based general dental clinic.

OBJECTIVES: The purpose of this study is to determine the association between personal characteristics, a person's oral health literacy, and failing to show for dental appointments at a university dental clinic. METHODS: A secondary data analysis was conducted on data collected from 200 adults at a university dental clinic between January 2005 and December 2006. In the original study, an oral health literacy instrument, the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D), was administered, sociodemographic and health information seeking behavior was gathered, and electronic records were reviewed. RESULTS: Descriptive and bivariate analyses and a classification and regression tree (CART) analysis were conducted. Seeking health information through fewer sources vs. multiple sources was the strongest predictor of failing to show. The subjects' oral health literacy, as measured by the REALM-D List 3 score, was the next most significant variable. Classification and regression tree analyses also selected gender, chief complaint, age, and payment type as predictor variables. CONCLUSIONS: Multiple factors contribute to failing to show for dental appointments. However, individuals who use fewer sources of oral health information, a subset of health literacy skills, are more likely to fail to show for dental appointments.

Dental caries among children visiting a mobile dental clinic in South Central Kentucky: a pooled cross-sectional study.

BACKGROUND: Dental caries is one of the most common chronic childhood diseases affecting a large portion of children in the United States. The prevalence of childhood dental caries in Kentucky is among the highest in the nation. The purposes of this study are to (1) compare sociodemographic differences between caries and no caries groups and (2) investigate factors associated with untreated dental caries among children who visited a mobile dental clinic in South Central Kentucky. METHODS: Study subjects were children aged 6 to 15 years who participated in the school-based dental sealant program through the mobile dental clinic operated by the Institute for Rural Health at Western Kentucky University between September 2006 and May 2011 (n = 2,453). Descriptive statistics were calculated for sociodemographic factors (age, gender, race/ethnicity, insurance status, and urban versus rural residential location) and caries status. We used chi-square tests to compare sociodemographic differences of children stratified by caries and no caries status as well as three levels of caries severity. We developed a logistic regression model to investigate factors associated with untreated dental caries while controlling for sociodemographic characteristics. RESULTS: The proportion of children having untreated dental caries was 49.7% and the mean number of untreated dental caries was 2.0. The proportion of untreated dental caries was higher in older children, children with no insurance and living in rural residential locations, and caries severity was also higher in these groups. Odds ratio indicated that older ages, not having private insurance (having only public, government-sponsored insurance or no insurance at all) and rural residential location were associated with having untreated dental caries after controlling for sociodemographic characteristics of children. CONCLUSIONS: Untreated dental caries was more likely to be present in older children living in rural areas without insurance. Health interventionists may use this information and target rural children without having proper insurance in order to reduce geographic disparities in untreated dental caries in South Central Kentucky.

Assessing the community clinic replacement effect on private Medicaid practices in oral health care within rural environments.

OBJECTIVES: Children in Medicaid/CHIP public coverage programs who reside in rural counties have limited access to dental care services. Shortages of dental professionals in rural areas impede utilization of dental care. Public and private initiatives are attempting to address this crisis. Missourians instituted deregulatory policies and invested in community-based initiatives. METHODS: Using a Medicaid/CHIP claims administrative dataset from 2004 to 2007, this research explored patterns of utilization to assess the impact of these efforts. RESULTS: The number of participating private dental office providers declined over the study period, and the number of children utilizing clinics increased. Trends are being observed within the public health dental care market demonstrating clinics are replacing private dentists as providers of Medicaid/CHIP dental services. CONCLUSIONS: Allowing greater market entry through deregulation could provide states with greater improvements to their public dental health infrastructure.

Systems for the provision of oral health care in the Black Sea countries. Part 11: Serbia.

This paper gives an overview of the provision of health care in the Republic of Serbia. It then gives details of the system for the provision of oral health care, the education of dentists and dental staff, epidemiological data, and costs. It includes details of the state (public) and private sectors of health and dental care in Serbia. Private health and oral health care is based mainly on a number of practices that provide medical and dental care to the population. The state sector has a wider range of types of provision, including complex health care institutions. The number of employees in the private health and dental sector is much smaller than the number of employees in the public sector. Far fewer patients seek private medical and dental care than visit a doctor and dentist in the state sector, which still provides the bedrock for the health system in Serbia.

Access to dental care and the capacity of the California dental care system.

The authors estimated the following levels of technical efficiency for three types of dental practices in California where technical efficiency is defined as the maximum output that can be produced from a given set of inputs: generalists (including pediatric dentists), 96.5 percent; specialists, 77.1 percent; community dental clinics, 83.6 percent. Combining this with information on access, it is estimated that the California dental care system in 2009-10 could serve approximately 74 percent of the population.