Dental utilization among Hispanic adults in agricultural worker families in California's Central Valley.

OBJECTIVE: To examine past-year dental visits among underserved, Hispanic farm-worker families using the Andersen Behavioral Model of Health Services Utilization, which posits that predisposing, enabling, and need factors influence care-seeking behavior. METHODS: Oral health survey and clinical data were collected in 2006-2007 from families in Mendota, California (Fresno County) as part of a larger, population-based study. Generalized estimating equation logit regression assessed effects of factors on having a dental visit among adults (N = 326). Predisposing variables included sociodemographic characteristics, days worked in agriculture, self-rated health status, and dental beliefs. Enabling factors included resources to obtain services (dental insurance, income, acculturation level, regular dental care source). Need measures included perceived need for care and reported symptoms, along with clinically determined untreated caries and bleeding on probing. RESULTS: Only 34% of adults had a past-year dental visit, despite 44% reporting a regular dental care source. Most (66%) lacked dental insurance, and nearly half (46%) had untreated caries. Most (86%) perceived having current needs, and on average, reported a mean of 4.2 dental symptoms (of 12 queried). Regression analyses indicated those with more symptoms were less likely to have a past-year dental visit. Those who would ask a dentist for advice and had a regular dental care source were more likely to have a past-year dental visit. CONCLUSIONS: The final model included predisposing, enabling, and need factors. Despite low utilization and prevalent symptoms, having a regular source of care helps break this pattern and should be facilitated.

Oral health status of San Francisco public school kindergarteners 2000-2005.

OBJECTIVES: To determine the prevalence of dental caries and oral health disparities in San Francisco kindergarten public school children from 2000-2005. METHODS: The San Francisco Department of Public Health in partnership with the San Francisco Dental Society and assistance from the National Dental Association, has been conducting annual dental screenings of kindergarten children enrolled in the San Francisco Unified School District since 2000. Outcomes assessed from this series of cross-sectional screenings included prevalence of caries experience, untreated caries, treatment needs, and caries severity by child's sex, race/ethnicity, residential zip code, and a proxy for socioeconomic status. RESULTS: Of 76 eligible schools, 62-72 participated, and 86-92% of enrolled children (n=3,354-3,527) were screened yearly. Although there was a small, significant decrease over the time period, in 2005, 50.1% of children had caries experience; 28.8% had untreated caries and 7.6% had urgent treatment needs. Each year caries prevalence was greatest for Asian children, those attending schools with > 50% children eligible for the free or reduced-price meal program, and children living in zip codes in and around Chinatown and San Francisco's southern border. CONCLUSIONS: Despite signs of improvement, caries remains a public health problem especially in Asian and Hispanic children, and children living in certain sections of San Francisco.

Salivary fluoride levels following application of fluoride varnish or fluoride rinse.

OBJECTIVES: This study examined the concentration of fluoride in whole saliva over time following the application of a fluoride varnish or a single rinse with a fluoride solution. METHODS: A two-period, two-treatment randomized cross-over experimental trial with a 2-week washout period was used with 16 adult subjects. In the first period, eight subjects rinsed once with a 0.05% NaF solution and 8 subjects had 5.0% NaF varnish applied to facial and lingual surfaces of 20 teeth. Stimulated whole saliva was collected at baseline, 5 and 15 min, 1, 2, 4, 8, 12, 24, 32, 48, 56, 72, 80, 96, 104 h. After the washout period each subject was switched to the other treatment and saliva was collected at the same intervals. Salivary fluoride content was measured with the micro-diffusion method. RESULTS: The NaF levels peaked at 5 min after application for both varnish (mean +/- SE 24.5 +/- 5.0 ppm) and rinse (3.2 +/- 0.8 ppm). Mean NaF levels returned to baseline, on average, within 2 h for the rinse and within 24 h for the varnish. The maximum fluoride levels were significantly greater (P < 0.01) with the varnish than with the rinse and remained above baseline levels for a longer duration. CONCLUSIONS: Salivary fluoride levels with the rinse returned to baseline, on average, in 2 h while they remained elevated for, on average, 24 h with the varnish. Salivary fluoride levels from the varnish were found to be comparable with those in previous studies for 1.1% neutral NaF.

Dental utilization by children in Hispanic agricultural worker families in California.

BACKGROUND: Agricultural worker families encounter multiple barriers to accessing all needed dental care. This study investigated predisposing, enabling, and need factors associated with children's past year dental utilization among Hispanic agricultural worker families in central California. METHODS: Oral health survey and clinical data were collected from families participating in a larger, population-based study in 2006-7. Generalized estimating equation logit regression assessed effects on a dental visit among children aged 0-17 (n=405). Analyses adjusted for clustering of children in the same household. Predisposing (sociodemographics), enabling (child's dental insurance, usual source of dental care, caregiver past year dental visit, acculturation level, income and education), and need (caregiver's oral health rating, perception of cavities, and clinically-determined treatment urgency) factors were examined. RESULTS: Half (51%) the children had a past year dental visit, while 23% had never been to a dentist. In the final model, children were less likely to have a past year dental visit if they were foreign-born, male, had caregivers that thought they had cavities or were unsure, and if the dentist recommended treatment 'at earliest convenience'. Children aged 6-12, with a regular dental care source, and whose caregivers had a recent dentist visit were more likely to have a past year dental visit. CONCLUSIONS: Children were more likely to have a past year dental visit if they had a usual source of dental care (OR =4.78, CI=2.51-9.08), and if the caregiver had a past year dental visit (OR=1.88, CI=1.04-3.38). Emphasis should be placed on these two modifiable factors to increase children's dental utilization.