Network visualization to interpret which healthcare services are central to people living with HIV.

AIM: To employ network analysis to identify the central healthcare service needs of people living with HIV (PLWH) for integrated care. DESIGN: Cross-sectional survey. METHODS: A list of healthcare services was identified through literature reviews, expert workshops and validity evaluations by PLWH. A total of 243 PLWH participated at five hospitals and self-reported their need for healthcare services on a four-point Likert scale. Centrality of healthcare service needs was analysed using network analysis. RESULTS: The mean score for 20 healthcare service needs was 3.53 out of 4. The highest scoring need, "Precaution for interaction between antiretroviral therapy and other drugs," received a rating of 3.73 but had a centrality of only 0.31. The most central node in the network of healthcare service needs, "Information and coping with opportunistic infections," had a strength centrality of 1.63 and showed significant relationships with "non-HIV-related medical services (e.g., health check-ups)" and "Regular dental services." The correlation stability coefficient, which quantifies the stability of centrality, was 0.44 with an acceptable value. CONCLUSIONS: The most central need was information on opportunistic infections that had connections with many nodes in network analysis. By interpreting the relationships between needs, healthcare providers can design interventions with an integrative perspective. IMPLICATIONS FOR PATIENT CARE: Network visualization provides dynamic relationships between needs that are unknown from the score scale by presenting them graphically and qualitatively. IMPACT: Using network analysis to interpret need assessment offers an integrated nursing perspective. Coping with opportunistic infection is central to connecting the chain of healthcare. This study highlights the multifaceted understanding of patients' needs that nurses gain when they conduct network analysis. REPORTING METHOD: We adhered to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Did Dental Insurance Expansion Improve Dental Care Needs Among Korean Adults? Difference in Difference Analysis.

BACKGROUND: In 2012, the Korean government expanded dental insurance for the elderly to promote improved access to dental care. We examined the causal effect of this policy on dental care needs, focusing on low-income older adults. METHODS: We compared data before and after policy implementation using double difference (DD) and triple difference (DDD) analyses. We used the nationally representative data from the Korea National Health and Nutrition Examination Survey from 2010 and 2016-2018. Individuals aged ≥65 years were included in the treatment group, and individuals aged <65 years were included in the control group. RESULTS: Dental insurance expansion was associated with a paradoxical increase in perceived unmet dental needs among elderly individuals (8.8 percentage points increase, 95% CI: 4.7 to 13.0). However, there were improvements in dental prosthetics outcomes (denture wearing [4.0 percentage points, 95% CI: 0.2 to 7.9] and dental implants [5.0 percentage points, 95% CI: 2.1 to 7.9]; P < 0.01). Upon analyzing low-income elderly individuals using DDD analysis, we found that the insurance expansion led to a 21.6% smaller increase in unmet dental needs among low-income adults, compared to high-income adults (95% CI, -35.0 to -8.5; P < 0.01). CONCLUSION: Dental insurance expansion in South Korea resulted in improvements in access to dental prosthetic services overall. It also led to a smaller increase in unmet dental needs among low-income older adults, compared to high-income adults.

Factors predicting different times for brushing teeth during the day: multilevel analyses.

BACKGROUND: The most effective and simple intervention for preventing oral disease is toothbrushing. However, there is substantial variation in the timing of brushing teeth during the day. We aimed to identify a comprehensive set of predictors of toothbrushing after lunch and after dinner and estimated contextual (i.e., geographic) variation in brushing behavior at different times of the day. METHODS: We constructed a conceptual framework for toothbrushing by reviewing health behavior models. The main data source was the 2017 Community Health Survey. We performed a four-level random intercept logistic regression to predict toothbrushing behavior. (individual, household, Gi/Gun/Gu, and Si/Do). RESULTS: Individuals under 30 years of age had higher likelihood of brushing after lunch, while brushing after dinner was higher among those aged 40-79 years. People engaged in service/sales, agriculture/fishing/labor/mechanics, as well as student/housewife/unemployed were 0.60, 0.41, and 0.49 times less likely to brush their teeth after lunch, respectively, compared to those working in the office, but the gap narrowed to 0.97, 0.96, 0.94 for brushing after dinner. We also found significant area-level variations in the timing of brushing. CONCLUSIONS: Different patterns in association with various factors at individual-, household- and Si/Gun/Gu-levels with toothbrushing after lunch versus toothbrushing after dinner suggests a need for tailored interventions to improve toothbrushing behavior depending on the time of day.

Influence of job autonomy on job crafting of dental hygienists.

OBJECTIVES: Job autonomy focuses on the job performance and tasks of health providers with a national licence in South Korea, which affects job crafting, to develop job competency. This study was conducted to identify the influence of job autonomy on job crafting of dental hygienists. METHODS: This cross-sectional study included 411 dental hygienists extracted through convenience sampling from a pool of 35,000 clinical dental hygienists in South Korea. Measuring tool are Korean version of the Job Crafting Questionnaire (JCQ-K) and job autonomy questionnaire (JAQ). To investigate the level of job autonomy and crafting of dental hygienists based on their general characteristics, t-tests and one-way ANOVAs were performed. Pearson correlation was performed to determine the linear correlation between autonomy and crafting. To determine whether job autonomy affects job crafting, an adjusted regression analysis was conducted using general characteristics as control variables. RESULTS: High job autonomy and job crafting were associated with increases in participant age with job experience as a senior staff, education level, and work environment, such as dental office or hospital. A significant positive correlation was observed (r = 0.64) between job autonomy and job crafting. Job autonomy (ß = 0.58) and dental/medical hospital in university (ß = 0.13) had a significant relationship with dental hygienists' job crafting. CONCLUSIONS: Job autonomy could positively influence the job crafting of dental hygienists in South Korea. Our findings suggest that job latitude should be redesigned to promote task competency and social responsibility with a health outcome perspective for the population as well as the dental hygiene profession.

Did Expanded Dental Insurance Improve Chewing Ability in the Older Korean Population? Results of an Interrupted Time-series Analysis.

BACKGROUND: In 2012, the Korean National Health Insurance extended its coverage to include denture services for older adults. We examined whether the new policy resulted in improved chewing ability in the eligible population. METHODS: We used interrupted time-series (ITS) analysis, a quasi-experimental design, to analyze the effect of the policy. We used data from the Korea National Health and Nutrition Examination Survey conducted from 2007 to 2016-2018. The study population consisted of two groups: the treatment group, aged 65 years or older and eligible for the dental insurance benefit; and the control group, those younger than 65 years and ineligible. The main evaluated outcome was self-reported chewing difficulty. RESULTS: The ITS analysis showed that chewing difficulty decreased annually by 0.93% (95% CI, -1.30 to -0.55%) and 0.38% (95% CI, -0.59 to -0.16%) after the policy extension in the older than 65 and younger than 65 groups, respectively. However, we could not conclude that the insurance extension affected chewing difficulty because there was a decrease in the control group as well. CONCLUSION: Chewing ability improved in both older and younger adults regardless of dental insurance coverage for older adults. Other exogenous factors probably led to the improvements in chewing ability as well as dental insurance benefits.

Sequential Analysis of Viral Load in a Neonate and Her Mother Infected With Severe Acute Respiratory Syndrome Coronavirus 2.

We report changes in viral load over time in a 27-day-old neonate with coronavirus disease 2019 who presented with fever, cough, and vomiting. Severe acute respiratory syndrome coronavirus 2 RNA was detected in the nasopharynx, oropharynx, stool, saliva, plasma, and urine. The highest viral RNA copies in nasopharynx decreased over time while viral load in stool remained high.

Viral RNA Load in Mildly Symptomatic and Asymptomatic Children with COVID-19, Seoul, South Korea.

Along with positive SARS-CoV-2 RNA in nasopharyngeal swabs, viral RNA was detectable at high concentration for >3 weeks in fecal samples from 12 mildly symptomatic and asymptomatic children with COVID-19 in Seoul, South Korea. Saliva also tested positive during the early phase of infection. If proven infectious, feces and saliva could serve as transmission sources.

Did the Expansion of Insurance Coverage for Oral Health Reduce Self-reported Oral Health Inequalities in Korea? Results of Repeated Cross-Sectional Analysis, 2007-2015.

BACKGROUND: In 2009, the South Korean government expanded universal health insurance to include oral health services. In the present study, we sought to examine whether improved access resulted in a reduction in income-based self-reported oral health inequalities. METHODS: We analyzed repeated cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES) waves IV through VI (2007-2015). We analyzed self-reported oral health status among 68,431 subjects. Changes in oral health inequalities across four income levels (low, middle-low, middle-high, and high) were assessed with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: The average oral health status of children and adolescents improved the most over the observation period. The absolute magnitude of oral health inequalities (measured by the SII) improved for most groups, with the notable exception of young male adults. By contrast, the ratio of poor oral health between high- and low-income groups (measured by the RII) changed little over time, indicating that relative inequalities remained resistant to change. CONCLUSIONS: The expansion of dental health insurance may not be sufficient to move the needle on self-reported oral health inequalities among adults.

Development of an Oral and Maxillofacial Frailty Index: A preliminary study.

OBJECTIVE: The purpose of this study is to develop an index to measure oral and maxillofacial frailty in older adults as an acceptable screening tool. METHODS: Three hundred adults (aged ≥ 50 years) participated in this study by telephone interview. Ten candidate items for the Oral and Maxillofacial Frailty Index (OMFI) and 20 matched detailed items for oral and maxillofacial functions were asked. Information about sociodemographic and oral health-related variables was also obtained. The test-retest reliability of the 10 candidate items was determined. Correlations of the 10 candidate items with the 20 detailed items or sociodemographic and oral health-related variables were analysed to test the validity of the candidate items. To suggest optimal items for the OMFI, five different models with different numbers of items were constructed and evaluated based on their associations with main variables. RESULTS: The overall internal consistency of the 10 candidate items was .704, and the Cronbach's alpha value of each item was .23-.55. The test-retest reliability was excellent. There were significant correlations between the 10 candidate and 20 matched detailed items. The score of the 10 candidate items was significantly different according to gender, education level and oral health-related variables. The final five items for the OMFI were difficulties in chewing, the necessity of water when eating dry food, difficulties in jaw or tongue movements, difficulties in speaking or pronunciation and difficulties in facial expression. CONCLUSIONS: The five items could be used as a screening tool for evaluating oral and maxillofacial frailty in older adults.

Effect of an oral healthcare program on gingival health status in rural areas of South Korea.

INTRODUCTION: The purpose of this study was to analyze the effects of an oral health care program administered at rural public health subcenters on oral hygiene status and bleeding on probing (BOP) scores among Korean rural residents older than 40 years. METHODS: Residents older than 40 years living in two rural areas were allocated randomly by order of visit into an intervention group (n=23) and control group (n=23). Changes in plaque and BOP score were analyzed between the groups using repeated-measures ANOVA. Hierarchical multiple regression analysis was conducted to identify factors affecting changes in BOP score. RESULTS: The BoP score decreased by 22.87 in the intervention group and 0.27 in the control group between baseline and the eighth week (p<0.001). Multiple regression analysis showed that the change in BoP score (ΔBoP score) increased significantly with an increase in the reduction of the plaque (PHP) index (ΔPHP index) (t=-2.174, p<0.05) and increased significantly more in the intervention group than in the control group (t=2.143, p<0.05). CONCLUSIONS: Professional care and continuous oral health education for 8 weeks prior to scaling among adults older than 40 years living in rural environments resulted in a change in oral health behaviors and a substantial reduction in gingival bleeding.

p62/sequestosome-1 as a severity-reflecting plasma biomarker in Charcot-Marie-Tooth disease type 1A.

Autophagy is a self-degradation system for recycling to maintain homeostasis. p62/sequestosome-1 (p62) is an autophagy receptor that accumulates in neuroglia in neurodegenerative diseases. The objective of this study was to determine the elevation of plasma p62 protein levels in patients with Charcot-Marie-Tooth disease 1A (CMT1A) for its clinical usefulness to assess disease severity. We collected blood samples from 69 CMT1A patients and 59 healthy controls. Plasma concentrations of p62 were analyzed by ELISA, and we compared them with Charcot-Marie-Tooth neuropathy score version 2 (CMTNSv2). A mouse CMT1A model (C22) was employed to determine the source and mechanism of plasma p62 elevation. Plasma p62 was detected in healthy controls with median value of 1978 pg/ml, and the levels were significantly higher in CMT1A (2465 pg/ml, p < 0.001). The elevated plasma p62 levels were correlated with CMTNSv2 (r = 0.621, p < 0.0001), motor nerve conduction velocity (r = - 0.490, p < 0.0001) and disease duration (r = 0.364, p < 0.01). In C22 model, increased p62 expression was observed not only in pathologic Schwann cells but also in plasma. Our findings indicate that plasma p62 measurement could be a valuable tool for evaluating CMT1A severity and Schwann cell pathology.

Tailored Surgical Access to the Cavernous Sinus and Parasellar Region: Assessment of Cavernous Sinus Entry Corridors and the Periclinoid and Pericavernous Surgical Maneuvers.

BACKGROUND: Lesions involving the cavernous sinus (CS) represent some of the most challenging pathologies of the skull base owing to the dense traversing and surrounding neurovasculature. Extradural exposure and preparation of this region, whether as initial preparation for a combined intra-extradural approach or as the main avenue of surgical exposure, can enlarge surgical corridors and minimize the need for brain retraction in this very confined space. We provide a detailed assessment of the entry corridors to the CS that are available within each approach, the surgical exposure and freedom provided by each of these corridors, and demonstrate how extradural and intradural preparation of these corridors can be used to widen the available working space and facilitate surgery. METHODS: Pterional, frontotemporal-orbital, frontotemporal-orbitozygomatic, frontotemporal-zygomatic, perilabyrinthine transtentorial, and endoscopic transnasal transsphenoidal approaches were performed on cadaveric heads to access the perisellar and CS regions. Periclinoid maneuvers (extradural cutting of the meningo-orbital band, anterior clinoidectomy, unroofing of the optic canal, opening of the superior orbital fissure, displacement of the extra-annular structures, opening of the annulus of Zinn, and interdural dissection), pericavernous maneuvers (intradural cutting of the distal dural ring, mobilization of the supraclinoid internal carotid artery, opening of the oculomotor porus, and mobilization of cranial nerve (CN) III), peritrigeminal extensions (extradural mobilization of CN V2 [maxillary] and/or V3 [mandibular]), and other surgical maneuvers were performed and evaluated. The CS was divided into 8 anatomical compartments and 9 entry corridors were described, and exposure and freedom were assessed accordingly. RESULTS: Intradurally, the standard unextended pterional, frontotemporal-orbital, and frontotemporal orbitozygomatic transsylvian approaches provided access solely to the parasellar entry corridor into the superior wall of the CS. Expanding these approaches with extradural periclinoid maneuvers allowed for subsequent application of the intradural pericavernous maneuvers and enlargement of the parasellar corridor and exposure of the carotid cave. Extradurally, the frontotemporal-orbital approach could be expanded via application of periclinoid maneuvers, which provided access to the anterior portions of the main lateral wall entry corridors. The frontotemporal-orbitozygomatic approach could also be expanded with periclinoid maneuvers to provide extradural access to all 6 lateral wall entry corridors. The extradural frontotemporal-zygomatic approach only provided exposure following interdural dissection, which allowed for access to the inferolateral entry corridors into the lateral wall. Extradural peritrigeminal extension in the frontotemporal-orbitozygomatic and frontotemporal-zygomatic approaches allows for enlargement of the supramaxillary and pre- and postmandibular corridors. The perilabyrinthine approach to the posterior wall was enlarged with opening of Dorello's canal and the endoscopic transnasal transsphenoidal approach was enlarged with opening of the optic canal. CONCLUSIONS: Targeted extradural preparation optimizes exposure and significantly improves access to deep-seated targets by enhancing surgical maneuverability through the unlocking of neurovascular structures and widening of surgical corridors without the need for additional brain retraction.

Did expansion of insurance coverage for major diseases in Korea induce a positive spillover effect on dental service utilization?

Although people with serious major diseases are disproportionately likely to have poor oral health, they are also more likely to defer treatment for oral health conditions due to financial constraints. The South Korean government introduced a comprehensive benefit expansion policy covering four major disease categories in 2013: cancer, cardiac diseases, cerebrovascular diseases, and rare diseases. Meanwhile, a policy expanding benefits for dental prosthetic services for the elderly was also introduced during the same period. Using nationally representative Korean Health Panel data from 2012 to 2017, we performed a difference-in-difference (DID) analysis to examine the positive spillover effect of insurance expansion for the four major disease categories on encouraging dental service utilization (frequency of dental visits and dental out-of-pocket payments) or decreasing unmet dental needs. Additionally, a triple-difference (TD) analysis was performed to examine whether the effect of coverage expansion of dental prosthetic services on dental service utilization was larger among the beneficiaries of the expansion for the four major disease categories. Benefit expansion for the four major disease categories did not significantly affect dental service utilization among the beneficiaries (DID model) during all study years and slightly increased unmet dental needs in 2014 and 2015. However, the effect of expanded coverage for dental prosthetic services on encouraging dental service utilization was larger (TD model) among the beneficiaries of the policy for the four major disease categories than among non-beneficiaries when we defined the beneficiaries as individuals with two or more household members who had one of the four major diseases. Our results suggest a need to provide more intense coverage for those with comorbidities by embracing the concept of proportionate universalism in the coverage of dental services.

Insurance coverage expansion and inequalities in unmet oral healthcare needs in Korea: Repeated cross-sectional analysis, 2007-2015.

OBJECTIVES: This study aimed to evaluate whether Korea's 2012 health insurance expansion of adult dental care coverage reduced income-based oral health inequalities. METHODS: This study analysed nationally representative repeated cross-sectional data from waves IV to VI (2007-2015) of the Korean National Health and Nutrition Examination Survey. The main outcome variable is unmet dental needs due to cost, and the independent variable is household income. Further, the slope index of inequality (SII) and the relative index of inequality (RII) were calculated. Calculations were adjusted for income and stratified by age group, gender and survey period. Data from the three waves were pooled to estimate the SII and RII trend coefficients between survey years. These were tested using two-way interaction terms for each age group and gender. RESULTS: Some changes in income-based inequality trends were identified. Relative and absolute inequalities in unmet needs (indicated by the RII and SII) decreased over time for most age groups. However, this trend was not observed for older women. CONCLUSIONS: Income-based inequalities in unmet dental needs persisted among older women in Korea despite the insurance expansion. By contrast, after the 2012 insurance expansion, the absolute and relative inequality in unmet dental needs decreased for young and middle-aged as well as older adults.

Did Expanded Dental Insurance Reduce Out-of-Pocket Expenditures on Dental Care among Older Adults in Korea? Interrupted Time-Series Analysis.

The Korean National Health Insurance extended its coverage to reduce the economic burden of receiving dentures and implants for older adults in 2012 and 2014, respectively. We examined whether the new policy resulted in reduced out-of-pocket dental care expenditure in the eligible population, specifically focusing on low-income adults. We used interrupted time-series analysis (ITSA), a quasi-experimental design, to identify the effects of the policy among persons aged 65 or older. Data were extracted from the Korea Health Panel Survey (KHP; 2008-2017). The main outcome was out-of-pocket expenditures on dental care. The ITSA showed that expenditures decreased annually by 4.5% (RR: 0.96, 95% CI: 0.95-0.96) between 2012 and 2014. However, expenditure increased by 7.8% (RR: 1.08, 95% CI: 1.07-1.08) after 2014. Dental insurance coverage did not contribute to reducing the out-of-pocket expenses for dentures among low-income adults, while coverage of dental implants led to an increase in dental expenditure.

Trends in Self-Rated Poor Oral Health Among all Age Populations in Korea from 2007 to 2015: Monitoring Expansion of Dental Insurance.

OBJECTIVES: This study explored trends in self-rated poor oral health (SRPOH) from 2007 to 2015 among all age groups to monitor changes after the expansion of dental insurance. METHODS: Repeated cross-sectional data from 2007 to 2015 Korea National Health and Nutrition Examination Surveys were collected and analysed. The respondents (n = 20,199) were categorised into four age groups: 0-19, 20-44, 45-64, and ≥65 years. The outcome variable was SRPOH, with independent variables being socioeconomic factors, sex, household income, and education. The age-sex standardised prevalence rate was calculated to determine trends, and complex samples logistic regression analysis was performed to confirm the factors affecting SRPOH. RESULTS: Self-rated poor oral health prevalence decreased significantly from 2007 to 2009 (25%) to 2013 to 2015 (14%) in the age groups of 0-19 and 20-44 years (P < 0.05), whereas the SRPOH prevalence in the age groups of 45-64 and ≥65 years did not undergo any significant changes. Although the prevalence decreased by 6% among older adults, over 40% older women still experienced SRPOH. A sex gap increased with age but did not change over time. SRPOH was strongly associated with sex, income, and education across all age groups; the association did not notably change from 2007 to 2015. CONCLUSIONS: Self-rated poor oral health improved among younger people in Korea. The gender gap in the prevalence increased with age and persisted over time. However, income was the strongest determinant of SRPOH among all age groups, regardless of dental insurance expansion. Further studies should aim to draw causal inferences to explore the policy impact of dental insurance benefits.

Impact of Long Working Hours and Shift Work on Perceived Unmet Dental Need: A Panel Study.

This study investigates whether workers with long working hours as well as shift workers perceive higher unmet dental care needs, and whether there is a gender difference in the associations. We used the Korea Health Panel (2009, 2011-2014) involving 20,451 person-wave observations from 5567 individuals. Perceived unmet dental care needs was defined when the participants reported that they perceived a need for dental treatment or check-up but had failed to receive dental care services during the past year. Fixed effects logit models were applied to examine how changes in weekly working hours or shift work status were linked to changes in perceived unmet dental needs within each individual. Among participants, 15.9-24.7% reported perceived unmet dental needs and the most common reason was time scarcity. We found that long working hours (>52 h/week) was significantly associated with perceived unmet dental needs due to time scarcity in both men (OR = 1.42, 95% CI 1.13-1.78) and women (OR = 1.35, 95% CI 1.03-1.79) compared workers working 40-52 h per week. Shift work was also a significant risk factor, but only in women (OR = 1.57, 95% CI 1.06-2.32). These findings provide evidence for labor policies to reduce working hours in order to improve access to dental care services.

Did expanded access to denture services improve chewing ability in the Korean older population? Results of a regression discontinuity analysis.

The Korean National Health Insurance expanded the dental insurance in 2012 to cover denture services for older adults. We analyzed whether the new policy improved of chewing ability in the eligible population. We used regression discontinuity (RD), a quasi-experimental design, to analyze the effects of the expanded dental insurance. We analyzed data from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2015. The study population consisted of two groups: the treatment group, aged 65 and above who were eligible; and the control group, under 65 years of age who were not eligible for the dental insurance benefit. The main outcome evaluated was self-reported chewing difficulty. The RD analysis showed that in 2015, the chewing difficulty in aged above 65 was 2.2% lower than in those aged under 65. However, the difference was not statistically significant (P = 0.76). The results from the falsification testing of predetermined covariates, placebo cut-offs, and bandwidths validated our main conclusion. The expansion of dental insurance benefits to include dentures for the older adults did not improve the chewing ability in the eligible population. Future studies should evaluate long-term outcomes of oral health as well as the social impacts on the elderly.

Dental hygienist job autonomy depends on the period of dental hygiene education.

CONTEXT: Independent dental hygiene practice is critical in regions with low accessibility to dental services, as well as for preventing and managing oral diseases among children and the elderly from low-income families, as these individuals are highly vulnerable to oral diseases. AIMS: We investigated whether the job autonomy of dental hygienists has been maintained, in accordance with the guidelines of the International Federation of Dental Hygienists (IFDH). SETTINGS AND DESIGN: This study comprised a cross-sectional literature review. SUBJECTS AND METHODS: We reviewed national reports and articles published in 23 countries selected for analysis to determine the degree of dental hygienist job autonomy, based on the extent of dental hygiene education. We divided the countries into two groups, based on the historical length of dental hygienist education. STATISTICAL ANALYSIS USED: We classified education as direct access, indirect supervision, and direct supervision. Two researchers reviewed and revised the classification results to ensure reliability. The Kappa value was 0.96 points. Statistical analysis was performed by PASW statistics 23.0 program (SPSS Inc., Chicago, IL, USA.). RESULTS: Countries with >40 years of educating dental hygienists exhibited more independent dental hygienist practices than those with less than 40 years of educating dental hygienists. CONCLUSIONS: Countries with >40 years of experience in educating dental hygienists largely guarantee independent dental hygiene practice for dental hygienists, in accordance with IFDH guidelines. The society's need for dental hygienists is fulfilled and professional competency is maintained in these contexts; thus, it should be required for dental hygienists to maintain independent dental hygiene practices.

Influence of dental insurance coverage on access to preventive periodontal care in middle-aged and elderly populations: analysis of representative Korean Community Health Survey Data (2011-2015).

OBJECTIVES: This study aimed to explore the influence of dental insurance coverage on access to preventive periodontal care. Data were extracted from the 2011, 2013 and 2015 Korean Community Health Surveys conducted by the Korea Centers for Disease Control and Prevention. MATERIALS AND METHODS: This study was designed as a 5-year time series analysis using secondary data. Trends in the utilisation rate of dental scaling services before and after the introduction of insurance coverage for dental scaling were evaluated, and the influence of dental insurance coverage on access to preventive periodontal care was assessed. RESULTS: In the 4 years after 2011, the utilisation rate of scaling services increased by 12.3%. The increase in the utilisation rate from 2011 to 2015 was greater for participants ≥ 65 years old and 45-64 years old compared with those who were 19-34 or 35-44 years old. The odds ratios (ORs) for using scaling in 2011, 2013 and 2015 were 0.9, 1.1 and 1.5, respectively, for participants with healthy gingiva. For elderly participants with gingival bleeding, the utilisation rate of scaling services increased after 2015 with ORs of 0.8, 0.9 and 1.2 for 2011, 2013 and 2015, respectively. CONCLUSIONS: Insurance coverage for dental scaling positively influenced access to preventive care for periodontal disease in middle-aged and elderly individuals. In the future, the long-term contributions of dental insurance coverage to the prevalence of periodontal disease and oral health disparities should be evaluated.