Preventive dental service use and oral health-related quality of life in Brazilian older adults.

BACKGROUND: Information on the use of preventive dental services and associated variables is needed to guide policy for the old adult population and consequently promote better oral health-related quality of life (OHRQoL). OBJECTIVE: To investigate the association between preventive dental service use and OHRQoL by older Brazilians. MATERIALS AND METHODS: This cross-sectional study was carried out using the baseline data of participants of the Brazilian Longitudinal Stud of Aging (ELSEI-Brazil) who were aged 60 years or more. Associations with the use of preventive dental services were carried out using Poisson regression models with robust variance, adjusting for confounders. RESULTS: The final sample consisted of 5432 older adults. Almost all (90.7%) participants reported not having sought preventive dental services in the last year. Individuals who used dental services for prevention had fewer impacts on their OHRQoL (RR: 0.74; [95% CI: 0.57-0.97]). CONCLUSION: Preventive dental service use is associated with a better OHRQoL in older Brazilians. Policies to improve access to preventive dental services may result in improved OHRQoL in this age group.

Are adults with autism receiving regular preventive dental services?

PURPOSE/AIM: To investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care. MATERIALS AND METHODS: De-identified data was collected from electronic health records of 18-year-old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care. RESULTS: Sample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits. CONCLUSIONS: Only one in every three adults with autism had at least one preventive dental visit per year.

Does Preventive Care Reduce Severe Pediatric Dental Caries?

INTRODUCTION: Tertiary oral health services (caries-related surgery, sedation, and emergency department visits) represent high-cost and ineffective ways to improve a child's oral health. We measured the impact of increased Texas Medicaid reimbursements for preventive dental care on use of tertiary oral health services. METHODS: We used difference-in-differences models to compare the effect of a policy change among children (≤9 y) enrolled in Medicaid in Texas and Florida. Linear regression models estimated 4 outcomes: preventive care dental visit, dental sedation, emergency department use, and surgical event. RESULTS: Increased preventive care visits led to increased sedation visits (1.7 percentage points, P < .001) and decreased emergency department visits (0.3 percentage points, P < .001) for children aged 9 years or younger. We saw no significant change in dental surgical rates associated with increased preventive dental care reimbursements. CONCLUSION: Increased access to preventive dentistry was not associated with improved long-term oral health of Medicaid-enrolled children. Policies that aim to improve the oral health of children may increase the effectiveness of preventive dentistry by also targeting other social determinants of oral health.

Quality appraisal of economic evaluations done on oral health preventive programs-A systematic review.

OBJECTIVES: If economic evaluations are to be used by decision makers, such evidence has to be robust so that the relevant policy maker use them. This study was undertaken with the purpose of identifying economic evaluations done on oral health preventive programs and to assess the standard of economic evidence in this field. METHODS: A systematic search was conducted using four major electronic databases in order to search for economic evaluations done on oral health preventive programs. This included economic evaluations that were published between January 1975 and May 2018 on preventive interventions for periodontal disease, oral cancer screening, and other common oral health conditions. To avoid duplications with previous studies, for dental caries interventions, this review included studies from April 2012 and May 2018. "Guidance to undertaking reviews in health care," developed by York University, was used to assess the quality of reporting in the evaluations, using which strengths and shortcomings were identified. RESULTS: A total of 2026 records were initially found. After title and abstract screening, and elimination by full text review, 33 relevant economic evaluations were identified. Majority of the economic evaluations included were conducted on dental caries prevention; a few were done on oral cancer screening, periodontal disease, and general preventive dentistry (health promotion, oral hygiene etc.). CONCLUSIONS: In comparison to the findings observed in previous reviews, there has been improvements in the quality of reporting in economic evaluations. Several areas still in need for improve were identified (e.g., productivity costs, currency and prices, and generalizability issues).

Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children.

OBJECTIVES: Dental caries is the most common chronic childhood disease that occurs in a continuum and can be prevented by children and their parents' adherence to recommended oral health behaviors. Theory-driven tools help practitioners to identify the causes for poor adherence and develop effective interventions. This study examined the Expanded Theory of Planned Behaviour (TPB) Model by adding the concept of Sense of Coherence (SOC) to predict parental adherence to preschooler's preventive dental visits. METHODS: Data regarding socio-economic demographics were collected from parents of children aged 2-6 years. Constructs of TPB including parental attitudes, subjective norms (SN), Perceived Behavioural Control (PBC), and intention to attend preventive dental visits for their preschoolers were collected by questionnaire, alongside parents' sense of coherence (SOC). Dental attendance was measured by asking if the child had a regular dental visit during the last year. Structural Equation Modeling Analysis (SEMA) was carried out to identify significant direct and indirect (mediated) pathways in the extended TPB model. RESULTS: Three hundred and seventy-eight mothers (mean age = 34.41 years, range 22-48) participated in the study. The mean age of children was 3.92 years, range: 2-6), and 75.9% had dental insurance. Results of the final model showed that predisposing factors (child's birthplace and mother's birthplace) significantly predicted enabling resources (family monthly income and child's dental insurance status); both predicted the TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, contrary to expectation, intention did not significantly predict dental attendance in the past 12 months. Parent's SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model. CONCLUSIONS: The expanded TPB model explained a great deal of variance in preschooler's dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers; in particular, such strategies should focus specifically on enhancing parental SOC including empowerment.

Prevalência de oclusopatias em jovens de 12 anos de idade: impactos físicos, sociais e emocionais / Prevalence of malocclusions in 12-year-olds: physical, social and emotional impacts

As oclusopatias representam um importante problema de saúde pública por apresentarem alta prevalência, possibilidade de prevenção, tratamento e promoverem prejuízos significantes na qualidade de vida dos indivíduos acometidos. Assim, torna-se fundamental a realização de estudos que investiguem a distribuição, a severidade e as consequências das oclusopatias em diferentes populações, visando contribuir para o desenvolvimento de estratégias e políticas públicas que minimizem a instalação e o agravamento das oclusopatias. Entretanto, nota-se que não há consenso sobre qual índice de oclusopatias melhor se adequa para a realização de estudos epidemiológicos, oferecendo critérios completos para classificar a presença, severidade e a necessidade de tratamento ortodôntico. Nesse contexto, a presente pesquisa teve como objetivos: realizar uma revisão de literatura sobre os índices de oclusopatias e analisar suas aplicações na saúde pública; e investigar a prevalência, severidade e necessidade de tratamento das oclusopatias e seus impactos na qualidade de vida relacionada à saúde bucal em adolescentes de 12 anos de idade. A revisão incluiu trabalhos nacionais e internacionais publicados nas bases de dados Pubmed, SciELO, Web of Science, Scopus, Bireme e Embase. A busca nas bases de dados considerou o período de 1899 a 2019 e utilizou os seguintes termos: saúde pública, métodos epidemiológicos, índices, levantamentos epidemiológicos, odontologia preventiva, maloclusão, oclusopatias e ortodontia. Foram incluídas publicações sobre o desenvolvimento e uso de índices de oclusopatias em estudos clínicos e epidemiológicos, sem restrições de metodologia e linguagem. Os títulos e resumos dos artigos encontrados foram avaliados e as versões completas das publicações elegíveis foram obtidas para leitura e análise. Cinquenta e dois índices e suas variações foram identificados e, desses, a maioria destinava-se a avaliações individuais, portanto sua utilização em saúde pública foi dificultada pelos requisitos de sua aplicação, como a necessidade de especialistas, análise de modelos de gesso, exames complementares como radiografias cefalométricas e fotografias, equipamentos específicos, necessidade de acompanhamento longitudinal dos casos, e avaliações exclusivamente objetivas ou subjetivas. Os índices apresentaram aspectos positivos ao analisarem parcialmente as condições físicas, funcionais, psicológicas e sociais, entretanto, ainda é um desafio encontrar um índice unânime para avaliação da necessidade de tratamento ortodôntico e os impactos das oclusopatias sobre a qualidade de vida dos indivíduos, com aplicabilidade em saúde pública. A segunda etapa desta pesquisa consistiu em um estudo observacional, transversal, analítico, do tipo inquérito, realizado com 453 adolescentes de 12 anos, matriculados em escolas públicas do município de Araçatuba-SP. A oclusão foi avaliada por meio do Índice de Estética Dental (DAI), enquanto o Child Perceptions Questionnaire11-14 (CPQ11-14) foi utilizado para avaliar a qualidade de vida relacionada à saúde bucal. Os escores do CPQ11-14 foram comparados de acordo com o sexo e presença de oclusopatia por meio do teste de Mann-Whitney. A análise segundo a severidade da oclusopatia foi realizada por meio do teste de Kruskal-Wallis. A correlação entre a severidade da oclusopatia e a qualidade de vida relacionada à saúde bucal foi avaliada com base nos resultados dos escores do DAI e do CPQ11-14 por meio do teste de correlação de Spearman. A prevalência de oclusopatia definida ou superior foi de 53,86%, enquanto a oclusopatia muito grave ou incapacitante foi observada em 18,76% dos adolescentes. Houve correlação positiva significativa (r = 0,7006; p <0,0001) entre os escores do DAI e do CPQ11-14. Adolescentes com oclusopatias apresentaram escores totais do CPQ11-14, assim como escores dos domínios bem-estar emocional e social, significativamente maiores (p <0,05) comparados àqueles sem oclusopatia. O escore total do CPQ11-14 foi significativamente maior (p = 0,0251) nos adolescentes do sexo feminino (16,91 + 10,52) em relação aos do sexo masculino (14,61 + 9,70). A presença de oclusopatias foi elevada, com predomínio de oclusopatias classificadas como definidas, e com necessidade de tratamento eletivo. Essa condição impactou negativamente a qualidade de vida relacionada à saúde bucal dos adolescentes, principalmente os aspectos emocionais e sociais. O impacto das oclusopatias em diferentes aspectos da qualidade de vida deve ser considerado na elaboração de estratégias de diagnóstico e tratamento(AU)

Malocclusion represents an important public health problem because it has a high prevalence, possibility of prevention, treatment and promotes significant losses in the life of affected individuals. Thus, it is essential to carry out studies that investigate the distribution, severity and consequences of malocclusions in different populations, aiming to contribute to the development of strategies and public policies that minimize the installation and aggravation of malocclusions. However, it is noted that there is no consensus on which rate of malocclusion is best suited to carry out epidemiological studies, offering complete criteria to classify the presence, severity, and the need for orthodontic treatment. In this context, the present research had as objectives: to carry out a literature review on the rates of malocclusion and to analyze its applications in public health; and to investigate the prevalence, severity and need for treatment of malocclusions and their impact on oral health-related quality of life in 12-year-old adolescents. The review included national and international works published in the databases Pubmed, SciELO, Web of Science, Scopus, Bireme and Embase. The search in the databases considered the period from 1899 to 2019 and used the following terms: public health, epidemiological methods, indexes, epidemiological surveys, preventive dentistry, malocclusion, and orthodontics. Publications on the development and use of malocclusion indexes were included in clinical and epidemiological studies, without restrictions on methodology and language. The titles and abstracts of the articles found were evaluated and the full versions of the eligible publications were obtained for reading and analysis. Fifty-two indices and their variations were identified and, of these, most were intended for individual evaluations, therefore their use in public health was hampered by the requirements of their application, such as the need for specialists, analysis of plaster models, complementary exams such as cephalometric radiographs and photographs, specific equipment, the need for longitudinal monitoring of cases, and exclusively objective or subjective evaluations. The indices showed positive aspects when partially analyzing physical, functional, psychological and social conditions, however, it is still a challenge to find a unanimous index to assess the need for orthodontic treatment and the impacts of malocclusions on the quality of life of individuals, with applicability in public health. The second stage of this research consisted of an observational, cross-sectional, analytical, survey-type study carried out with 453 12- year-old adolescents enrolled in public schools in the city of Araçatuba-SP. Occlusion was assessed using the Dental Aesthetics Index (DAI), while the Child Perceptions Questionnaire11-14 (CPQ11-14) was used to assess oral health-related quality of life. The scores of CPQ11-14 were compared according to gender and presence of malocclusion using the Mann-Whitney test. The analysis according to the severity of the malocclusion was performed using the Kruskal-Wallis test. The correlation between the severity of malocclusion and oral health-related quality of life was assessed based on the results of the DAI and CPQ11-14 scores using the Spearman correlation test. The prevalence of defined or higher malocclusion was 53.86%, while very severe or disabling malocclusion was observed in 18.76% of adolescents. There was a significant positive correlation (r = 0.7006; p <0.0001) between the DAI and CPQ11-14 scores. Adolescents with malocclusions had total CPQ11-14 scores, as well as scores in the emotional and social well-being domains, significantly higher (p <0.05) compared to those without malocclusion. The total score of CPQ11-14 was significantly higher (p = 0.0251) in female adolescents (16.91 + 10.52) compared to male adolescents (14.61 + 9.70). The presence of malocclusions was high, with a predominance of malocclusions classified as defined, and in need of elective treatment. This condition had a negative impact on the quality of life related to the adolescents' oral health, especially the emotional and social aspects. The impact of malocclusions on different aspects of quality of life must be considered when developing diagnostic and treatment strategies(AU)

Comparison of potential long-term costs for preventive dentistry treatment of post-orthodontic labial versus lingual enamel cavitations and esthetically relevant white-spot lesions: a simulation study with different scenarios.

BACKGROUND: Post-orthodontic white-spot lesions (WSL) in esthetically relevant incisor and canine areas impair dentofacial esthetics, and preventive dentistry treatment is definitely required in case of enamel cavitations. The incidence of lingual post-orthodontic WSL and cavitation following lingual MB treatment has been reported to be distinctively decreased compared to labial MB treatment. Moreover, lingual WSL do not impair dentofacial esthetics. It was the objective of this study to calculate consequential costs of preventive dental care necessary to recover labial or lingual post-orthodontic cavitations as well as esthetically relevant WSL following either labial or lingual MB interventions. METHODS: MB treatments (labial / lingual) were simulated in 1,000,000 patients between the ages of 12-18Y, with a median residual life time expectancy of 58Y based on local mortality tables. Range of MB Tx duration was 9-45 mo. Frequencies of post-orthodontic (labial / lingual) enamel damages were derived from large-scale WSL incidence studies. Anterior composite survival rates were based on a systematic review on the subject. Within the context of the German dental fee system (GOZ 2.3 and 3.5 fee increments), simulation of costs for enamel damage treatment and re-treatment (maximum: 5x) were based on single-surface composite restorations for lingual or labial cavitations and labial WSL treatment; and lingual WSL fluoridation. RESULTS: Overall mean total costs for Tx and re-Tx of both WSLs and cavitations may sum up to 1718.91 Eur in the high-cost (GOZ 3.5) scenario for conventional MB cases, versus 19.94 Eur for lingually treated cases, given that renewal of simulated single-surface restorations takes place at 15-year intervals. When focussing on patients diagnosed with least of one WSL, and/or cavitation, these mean costs increase up to 2332.35 Eur for conventionally treated MB patients, or 65.03 Eur for lingual MB patients. CONCLUSION: Costs for repeated treatment of post-orthodontic enamel damages produced by conventional vestibular fixed appliances may easily exceed the initially higher costs associated with lingual orthodontic treatment. Judged economically in the long term, lingual MB Tx may be considered as a more cost-effective solution for a correction of malocclusion.

Ending the neglect of global oral health: time for radical action.

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.

[Opinions about oral care: an online questionnaire among readers of NTvT]. / Meningen over mondzorg: een online-onderzoek onder NTVT-lezers.

By means of a brief online questionnaire with 12 statements about the organisation, quality and impact of oral care in the Netherlands, the readers of the Netherlands Journal of Dentistry (NTVT) were asked to express their opinions on a number of important subjects concerning oral care in the Netherlands with respect to health economic matters. A total of 237 readers (61% men, 39% women) completed the online questionnaire. 70% of them were working as dentists and had been active in a practice for between 31 and 40 years. According to the study, a shift from curing to prevention was considered to be necessary. Most of the respondents also thought inequality in oral health in the Netherlands is increasing and people avoid going to the dentist due to the associated costs. In conclusion, most oral care providers appear to be reasonably positive about Dutch oral care. Attention for prevention, appreciation of oral health and the reduction of inequality in oral care continue to be necessary.

[Sinking your teeth into economic evaluations: application and importance in oral health]. / Economische evaluaties aan de tand gevoeld: belang en toepassing in de mondzorg.

Health economics deals with issues about the use of scarce resources in healthcare. An important branch of health economics concerns economic evaluations, which consist of a comparison of the costs and effects of 2 or more treatments. The role and importance of economic evaluations in oral care are increasing but are not yet as evident as in other areas of healthcare (such as pharmacy). An economic evaluation provides a broad picture of the costs and health benefits of a particular diagnostic or treatment strategy, resulting in a cost-effectiveness ratio (expressed, for example, as costs per quality-adjusted life year gained). The results are intended for use in policy-making, such as decisions about in- or exclusion from the basic benefits package. To date, only a limited number of economic evaluations of oral care have been carried out, mainly focused on caries. It is important to be able to demonstrate that the treatment provided in oral care is cost-effective. Oral care may put itself in a vulnerable position in the distribution of scarce resources when the costeffectiveness of its treatments is uncertain.

Preventive dental care use for children with special health care needs in Washington's Access to Baby and Child Dentistry program.

BACKGROUND: Preschool-aged children with special health care needs (CSHCN) from low-income households are at increased risk of developing poor oral health. The study goal was to assess preventive dental care use for CSHCN enrolled in Medicaid within Washington state's Access to Baby and Child Dentistry (ABCD) program. METHODS: The authors analyzed 2012 Medicaid eligibility and claims files for children younger than 6 years in the ABCD program (N = 206,488). The authors used medical diagnosis and eligibility data to identify each child's special needs status (no or yes). The outcome was preventive dental care use (no or yes). The authors used modified Poisson regression models to estimate crude and covariate-adjusted prevalence rate ratios. RESULTS: Of the 206,488 children in the study, 2.1% were CSHCN, and 114,570 used preventive dental care (55.5%). CSHCN used preventive care at rates similar to those of children without special health care needs (SHCN) (54.7% and 55.5%, respectively; P = .32). After adjustment for confounding variables, CSHCN were significantly less likely to use preventive dental care than were children without SHCN (prevalence rate ratio, 0.91; 95% confidence interval, 0.88 to 0.94; P < .001). Older preschool-aged children were significantly more likely to use preventive dental care than were younger preschool-aged children. A significantly higher proportion of preventive medical care users also used preventive dental care. CONCLUSIONS: CSHCN who were enrolled in Medicaid in Washington's ABCD program were less likely to use preventive dental care than were children without SHCN who were enrolled in Medicaid. PRACTICAL IMPLICATIONS: Future intervention research investigators should evaluate ways to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN receiving Medicaid.

The VidaSana Study: Recruitment Strategies for Longitudinal Assessment of Egocentric Hispanic Immigrant Networks.

We disseminate the recruitment strategies used in the five-year VidaSana study (started in 2017) in the Midwest region of the United States, targeting recently arrived Hispanic immigrants. VidaSana aims to follow immigrants within six months of arrival for 24 months to (1) characterize features of networks (personal and community) that improve or undermine dental health; and (2) further refine methods to quantify the evolution of egocentric networks, using social network methodology. We implemented several strategies to promote and recruit potential participants into the study. We collaborate with agents serving Indiana's Hispanic communities using three levels of visibility. The broad level includes radio advertisements, TV interviews, newspaper advertisements, and targeted Facebook advertisements. Intermediate level visibility includes posting flyers in schools, employment agencies, immigrant welcome centers, and Hispanic businesses; making announcements at church/temple and school events; tabling at community, church and school events; and a pervasive adaptation of our strategies to the requirements of our partners. Lastly, the individualized level includes direct referrals by partners through word of mouth. From the initial 13 months of recruitment (494 screened contacts and 202 recruited participants), the most successful recruitment strategies appear to be a combination of intermediate- and individual-level strategies; specifically, face-to-face recruitment at school events, direct referrals from our community partners, and tabling at community/school/church events. The current interim findings and future final findings will help guide recruitment and retention strategies for studies focused on immigrants in the current climate of heightened immigration regulations and enforcement.

Distribution of Preventive Dental Care during Pregnancy in Rhode Island, 2012 to 2015.

AIMS: To examine the distribution of preventive dental care for pregnant women in Rhode Island. METHODS: The data used were obtained from the 2012 to 2015 Rhode Island Pregnancy Risk Assessment Monitoring System (RIPRAMS). Statistical analyses were conducted for respondents who had valid information for both preventive dental care receipt and race/ethnicity to examine population differences in the receipt of preventive dental care. RESULTS: Respondents who identified as Hispanic and had more than 12 years of education had higher odds for preventive dental care receipt in Rhode Island between 2012 to 2015 compared to non-Hispanic whites. Furthermore, respondents with lower household income were the least likely to have received preventive dental care. This was especially true for black and non-Hispanic women who reported being neither black nor white. CONCLUSION: Preventive dental care in Rhode Island between 2012 and 2015 did not meet the perinatal and Infant Oral Health Quality Improvement (PIOHQI) target of 60% in minority populations.

Report of the National Investigation of Resources for Oral Health in China.

OBJECTIVE: To investigate the current status and distribution of resources for oral health in China, by means of analysing national data from the National Investigation of Resources for Oral Health. METHODS: The National Investigation of Resources for Oral Health in China was performed in 2015, in parallel with the 4th National Oral Health Survey of China (2015 to 2016). A structured questionnaire on resources for oral health was used to collect the data of professional institutions and stomatological/dental workforce in each province. For each province, the local Investigation Group was responsible to summarise the status and distribution of institutions with stomatological/dental departments and stomatological/dental workforce. Descriptive analysis of resources for oral health was performed to learn about the number and percentage of each category both for each province and nationally. The ratio of number of stomatological/dental workforce to population was also calculated and compared with the criteria of the World Health Organisation (WHO). RESULTS: There were totally 75,399 stomatological/dental departments nationally in all professional institutions in the mainland of China, most of which were set in institutions of primary health care services. Institutions of private sectors accounted for a higher proportion (69.8%) which was over two-fold compared to that of public ones (30.2%). General hospitals were the major part of hospitals with stomatological/dental departments compared with stomatological/dental specialised hospitals. Stomatological/dental clinics were the majority of institutions of primary health care services, compared to community health care service centres/stations and township health care services. Amongst all professional institutions of public health with stomatological/dental departments, 35.0% were maternal and child health care services and 11.2% were institutions for prevention and control of oral diseases. The total number of stomatological/dental workforce in the country was 314,347, among whom 171,587 (54.6%) were stomatologists/dentists. The ratio of number of stomatologists/dentists to population was 1:7,768 nationally, which was lower than the WHO standard of 1:5,000. CONCLUSION: The National Investigation of Resources for Oral Health in China exhibited the current status and distribution of resources for oral health over the country, whereas insufficiencies of stomatological/dental workforce and institutions and inequalities of their distribution were found nationally. This could provide some policy suggestions for the health authorities in China to promote oral health in the Chinese population in the future.

Factors associated with seeking preventive dental care: an integrative model exploration of behaviors in Mexican immigrants in Midwest America.

BACKGROUND: Mexican immigrants in the United States suffer from poor oral health. The objective of the current study was to explore the utility of applying theory-based factors associated with seeking preventive dental care in a sample of Mexican American adults. METHODS: Data were collected from a cross-sectional survey of a sample of 157 people of Mexican origin (64% female; age 34 ± 11 years) recruited primarily from church congregations and lay community organizations in Central Indiana. Using the Integrative Model of Behavioral Prediction as the guiding framework, structural equation modeling was used to test factors associated with intention to seek preventive dental care. RESULTS: Attitude towards seeking preventive dental care (estimate = 0.37; p < .0001) and self-efficacy for seeking preventive dental care (estimate = 0.68; p < .0001) were associated with intention to seek preventive dental care. The association between dental beliefs and intention to seek preventive dental care was mediated by attitude and self-efficacy (indirect effect = 0.26, p = .002), and the association between past behavior and intention to seek preventive dental care was mediated by self-efficacy (indirect effect = 0.26, p = .003). CONCLUSIONS: These findings suggest that interventions to increase preventive dental care seeking behavior among Mexican Americans should focus on changing attitudes toward seeking preventive dental care and on increasing self-efficacy to seek preventive dental care. Findings also support the use of interventions to influence dental beliefs.

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.

The Evidence for Caries Management by Risk Assessment (CAMBRA®).

A system for Caries Management by Risk Assessment (CAMBRA®) has been developed in California. The purpose of this article is to summarize the science behind the methodology, the history of the development of CAMBRA, and the outcomes of clinical application. The CAMBRA caries risk assessment (CRA) tool for ages 6 y through adult has been used at the University of California, San Francisco (UCSF), for 14 y, and outcome studies involving thousands of patients have been conducted. Three outcomes assessments, each on different patient cohorts, demonstrated a clear relationship between CAMBRA-CRA risk levels of low, moderate, high, and extreme with cavitation or lesions into dentin (by radiograph) at follow-up. This validated risk prediction tool has been updated with time and is now routinely used at UCSF and in other settings worldwide as part of normal clinical practice. The CAMBRA-CRA tool for 0- to 5-y-olds has demonstrated similar predictive validity and is in routine use. The addition of chemical therapy (antibacterial plus fluoride) to the traditional restorative treatment plan, based on caries risk status, has been shown to reduce the caries increment by about 20% to 38% in high-caries-risk adult patients. The chemical therapy used for high-risk patients is a combination of daily antibacterial therapy (0.12% w/v chlorhexidine gluconate mouth rinse) and twice-daily high-concentration fluoride toothpaste (5,000 ppm F), both for home use. These outcomes assessments provide the evidence to use these CRA tools with confidence. Caries can be managed by adding chemical therapy, based on the assessed caries risk level, coupled with necessary restorative procedures. For high- and extreme-risk patients, a combination of antibacterial and fluoride therapy is necessary. The fluoride therapy must be supplemented by antibacterial therapy to reduce the bacterial challenge, modify the biofilm, and provide prevention rather than continued caries progression.

Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States.

OBJECTIVE: To quantify the impact of multiyear utilization of preventive dental services on downstream dental care utilization and expenditures for children. DATA SOURCES/STUDY SETTING: We followed 0.93 million Medicaid-enrolled children who were 3-6 years old in 2005 from 2005 to 2011. We used Medicaid claims data of Alabama, Georgia, Mississippi, North Carolina, South Carolina, and Texas. STUDY DESIGN: We clustered each state's study population into four groups based on utilization of topical fluoride and dental sealants before caries-related treatment using machine learning algorithms. We evaluated utilization rates and expenditures across the four groups and quantified cost savings of preventive care for different levels of penetration. DATA EXTRACTION METHOD: We extracted all dental-related claims using CDT codes. PRINCIPAL FINDINGS: In all states, Medicaid expenditures were much lower for children who received topical fluoride and dental sealants before caries development than for all other children, with a per-member per-year difference ranging from $88 for Alabama to $156 for Mississippi. CONCLUSIONS: The cost savings from topical fluoride and sealants across the six states ranged from $1.1M/year in Mississippi to $12.9M/year in Texas at a 10 percent penetration level. Preventive dental care for children not only improves oral health outcomes but is also cost saving.