Factors associated with the use of oral health care services among seniors in Canada.

Background: This study explores the link between dental insurance, income, and oral health care access among seniors (aged 65 and over) in Canada. It contributes to the understanding of oral health care among seniors before the implementation of the Canadian Dental Care Plan. Data and methods: This study uses data from the 2019/2020 Canadian Health Survey on Seniors (n=41,635) to report descriptive statistics and logistic regression model results and examine factors associated with seniors living in the community and access to oral health care services. Results: At the time of the survey (2019/2020), 72.5% of seniors in Canada reported having had a dental visit in the past 12 months, with 83.0% of insured and 65.3% of uninsured seniors reporting visits. Seniors reporting excellent or very good oral health had a higher prevalence of visits (79.2%) compared with those with good, fair, or poor oral health (62.3%). Among seniors who had not visited a dental professional in three years, 56.3% deemed it unnecessary, and 30.8% identified cost as the major barrier. After sociodemographic characteristics were controlled for, insured seniors were more likely to have had a dental visit in the past 12 months (adjusted odds ratio [OR]: 2.27; 95% confidence interval [CI]: 2.03 to 2.54) and were less likely to avoid dental visits because of cost (OR: 0.18; 95% CI: 0.12 to 0.28) compared with their uninsured counterparts. Interpretation: This study underscores the role of dental insurance in seniors' oral health care access. While insurance is associated with seniors' access to oral health care services, the study also emphasizes the need to consider social determinants of oral health such as income, gender, age, level of education, and place of residence when assessing oral health care access for seniors.

Use of oral health care services by family caregivers and care recipients: the LENTO intervention.

OBJECTIVE: We aimed to evaluate the impact of an individually tailored preventive oral health intervention on the use of oral health care services by older family caregivers (FCs) and their care recipients (CRs). MATERIAL AND METHODS: A randomized controlled six and 12-month oral health intervention study included FCs and CRs aged ≥65 years living in Eastern Finland. The participants were randomly assigned to an intervention (FCs n = 53, CRs n = 47) and a control (FCs n = 39, CRs n = 35) group. Individually tailored oral health interventions for the FCs provided by a dental hygienist focused on oral hygiene and self-care. Generalized estimating equations were used to analyze the impact of intervention on the change in the use of oral health care services. RESULTS: The intervention had no significant effect on the use of oral health care services by the FCs or their CRs. Traditional factors such as female gender, a higher number of teeth, toothache, no dental fear, and higher morbidity were significantly (p < 0.05) associated with an increased use of oral health care services in the FCs, but not among the CRs. CONCLUSIONS: Individually tailored preventive oral health intervention showed no effect on the use of oral health care services. To promote oral health among the elderly, specific interventions focusing on use of oral health care services are needed. TRIAL REGISTRATION: clinicaltrials.gov/study/NCT04003493.

Use of oral health care services among older home care clients in the context of an intervention study.

BACKGROUND: An increasing number of care-dependent older people living at home need external support to receive regular dental care. OBJECTIVES: To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition. MATERIALS AND METHODS: This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up. RESULTS: At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use. CONCLUSIONS: In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

Provision of oral healthcare services in WHO-EMR countries: a scoping review.

Global neglect of oral healthcare services (OHCS) provision, mainly in Low- and Middle-Income Countries, exacerbates the deterioration of health systems and increases global health inequality.ObjectivesThe objective is to explore the profiles of available oral healthcare services in the WHO Eastern Mediterranean Region (EMR) countries.MethodsA systematic literature search was conducted of grey literature and databases (PubMed, Medline, Embase, and the Cochrane Library). Peer-reviewed articles that reviewed and/or evaluated OHCS in WHO-EMR countries were identified. No time or language limitations were applied. Two independent reviewers conducted the screening and data extraction. A third reviewer arbitrated disagreement. The evaluation of the OHCS provision followed the WHO framework for health system performance assessment. The extraction included socio-demographic characteristics of the studied population, OHCS profile, responsiveness, and health insurance coverage.ResultsOne hundred and thirty-seven studies were identified. The studies that met the inclusion criteria were fifteen published between 1987 and 2016. In addition, two reports were published in 2022. The included studies were conducted in Pakistan, Saudi Arabia, Iran, Libya, Egypt, Oman, Syria, Jourdan, Kuwait, and Tunisia. Generally, Ministries of Health are the main providers of OHCS. The provision for national dental care prevention programmes was highly limited. Furthermore, most of these Ministries of Health have struggled to meet their local populations' dental needs due to limited finances and resources for OHCS.ConclusionsOral and dental diseases are highly prevalent in the WHO-EMR region and the governments of the region face many challenges to meeting the OHCS needs of the population. Therefore, further studies to assess and re-design the OHCS in these countries to adapt dental care prevention into national health programmes are crucial.

Impact of health insurance on the use of oral health services in the Peruvian population 2015-2019.

BACKGROUND: The high treatment cost of oral diseases is a barrier for accessing oral health services (OHS), particularly in low-income countries. Therefore, this study aimed to evaluate the impact of health insurance on the use of OHS in the Peruvian population from 2015 to 2019. METHODS: We conducted a prospective, longitudinal study of secondary data using the National Household Survey (ENAHO) 2015-2019 panel databases, which collected information from the same participants during each of the five years. The dependent variable was the use of OHS in the three months prior to the survey (yes/no). The independent variable was health insurance affiliation (four years or less/all five years). Both were measured by survey questions. Generalized estimating equation (GEE) Poisson regression models with robust standard errors were used to estimate the relative risk (RR) associated with use of OHS. RESULTS: We included 4064 individuals distributed in 1847 households, who responded to the survey during each of the five years. The adjusted GEE model showed that those who had health insurance during all five years without interruption were more likely to attend OHS than those who had insurance for four years or less (adjusted relative risk [aRR]: 1.30; 95%CI: 1.13-1.50). In addition, we carried out a sensitivity analysis by recategorizing the independent variable into three categories (never/some years/ all five years), which also showed (aRR: 1.45; 95%CI: 1.11-1.89) that participants with health insurance during all five years were more likely to have used OHS than those who never had insurance. CONCLUSION: Therefore, in the Peruvian context, health insurance affiliation was associated with greater use of OHS. The panel data used derives from a subsample of consecutive nationally representative samples, which may have led to a loss of representativeness. Furthermore, the data was collected between 2015 and 2019, prior to the onset of the COVID-19 pandemic, and insurance conditions may have changed.

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.

Utilisation of dental services by Brazilian adults in rural and urban areas: a multi-group structural equation analysis using the Andersen behavioural model.

BACKGROUND: The utilisation of health services is determined by complex interactions. In this context, rural populations face greater barriers in accessing dental services than do urban populations, and they generally have poorer oral health status. The evaluation of the determinants of health services utilisation is important to support planning and management of dental services. The aim of this study was to evaluate the predictors of dental services utilisation of Brazilian adults living in rural and urban areas. METHODS: Data from 60,202 adults aged 18 years or older who took part in the Brazilian National Health Survey carried out in 2013 were analysed. Predisposing (age, sex, education, social networks), enabling financing (income, durable goods and household's crowding), enabling organisation (health insurance, registration in primary health care [PHC]) and need variables (eating difficulties, self-perceived tooth loss and self-perceived oral health) were selected based upon the Andersen behavioural model. Multi-group structural equation modeling assessed the direct and indirect associations of independent variables with non-utilisation of dental services and the interval since the last dental visit for individuals living in rural and urban areas. RESULTS: Adults living in urban areas were more likely to use dental services than those living in rural areas. Lower enabling financing, lower perceived dental needs and lack of PHC registration were directly associated with lower utilisation of dental services (non-utilisation, ß = - 0.36, ß = - 0.16, ß = - 0.03, respectively; and interval since last dental visit, ß = 1.25, ß = 0.82, ß = - 0.12, respectively). The enabling financing (non-utilisation, ßrural = - 0.02 [95%CI: - 0.03 to - 0.02], ßurban = 0.00 [95%CI: - 0.01 to 0.00]) and PHC registration (non-utilisation, ßrural = - 0.03 [95%CI: - 0.04 to - 0.02], ßurban = - 0.01 [95%CI, - 0.01 to - 0.01]) non-standardised total effects were stronger in rural areas. Enabling organisation (ß = 0.16) and social network (ß = - 2.59) latent variables showed a direct effect on the interval since last dental visit in urban areas. Education and social networks influenced utilisation of dental services through different pathways. Males showed less use of dental services in both urban and rural areas (non-utilisation, ßrural = - 0.07, ßurban = - 0.04; interval since last dental visit, ßrural = - 0.07, ßurban = - 0.07) and older adults have used dental services longer than younger ones, mainly in rural areas (ßrural = 0.26, ßurban = 0.17). CONCLUSION: Dental services utilisation was lower in rural areas in Brazil. The theoretical model was supported by empirical data and showed different relationships between the predictors in the two geographical contexts. In rural areas, financial aspects, education, primary care availability, sex and age were relevant factors for the utilisation of services.

Systematic review of the tools of oral and dental health literacy: assessment of conceptual dimensions and psychometric properties.

BACKGROUND: This article aims to provide a description of conceptual dimensions and psychometric properties of the tools of oral and dental health literacy. METHODS: Two authors in this study conducted electronic searches in the Medline (via PubMed), and Embase databases to find relevant articles from 1990 to present day. Evaluation of the tools was carried out in two parts; general evaluation of the tools using skills introduced by Sørensen et al., and qualitative assessment of psychometric properties using COSMIN checklist. RESULTS: After reviewing 1839 articles on oral and dental health literacy and evaluating 33 full text articles for eligibility, 21 articles entered the study. The sample size varied from 20 to 1405 subjects and the items of each tool ranged from 11 to 99 items. Of the 21 tools examined, 16 tools were evaluated for word recognition. For the studies examined, the evaluation of COSMIN scores was often fair or good. Of the 21 tools examined, 9 tools at least in one dimension were in the category of "poor", 19 tools were in the category of "fair", 20 tools were in the category of "good", and 4 tools were in the category of "excellent" in at least one dimension. CONCLUSION: The findings of this study showed that some aspects of oral and dental health literacy are being ignored in the existing tools. Therefore, the authors of present study emphasize on the necessity to design and develop a comprehensive tool and take into account two characteristics of simplicity and briefness for international use.

Adults' dental treatment in 2001-2013 in Finnish public dental service.

BACKGROUND: All adults over 17 years of age have access to the Public Dental Service after the Finnish Dental Care Reform in 2001-2002. This study aimed to survey the treatment needs and treatment measures provided for adult patients and changes in these during the period 2001-2013. METHODS: Sing each person's unique identifier, demographic data on dental visits during the period 2001-2013 were collected from municipal databases in five PDS-units covering 320,000 inhabitants. The numbers of visitors, those in need of basic periodontal or caries treatment (CPI > 2 and D + d > 0) were calculated for three age groups. Treatment provided was also calculated in 13 treatment categories. Trend analyses were performed to study changes during the study period. RESULTS: Restorative treatments (968,772; 23.6%), examinations (658,394; 16.1%), radiographs taken (529,875; 12.9%) anaesthesia used (521,169; 12.7%) and emergency treatments (348,229; 8.5%) made up 73.8% of all treatment measures during the entire study period. Periodontal treatment (7.8%) and caries prevention (3.9%) made up a small part of the care provided and prosthetics and treatment of TMJ disorders were extremely uncommon (fewer than 1%). Treatments related to caries (restorative treatment, examinations, endodontics, emergencies, anaesthesia and radiographs) made up 60.4% of the dental personnel's treatment time. During the study period, statistically significant increasing trends were found for radiographs (p < 0.001***), anaesthesia (p = 0.003**) and total number of treatments (p = 0.009**). There was a slight decreasing trend in treatment need among the youngest adults (18-39 years; p = 0.033*). CONCLUSION: Compared with the results of national epidemiological studies, insufficient periodontal treatment is provided and prosthetic treatment is almost totally neglected in the PDS. Rather, adults' dental treatment concentrates on treatment of caries. The unmet needs may be due to tradition, inadequate treatment processes or a lack of resources or failed salary incentives.

Prevalence of dental caries in deciduous teeth and oral health related quality of life among preschool children aged 4-6 years in Kisarawe, Tanzania.

BACKGROUND: Preschool years are a critical period in the development of a healthy child. The consequences of poor oral health in preschool children reach beyond dental problems, with oral health-related quality of life (OHRQoL) being associated with overall systematic health as well as one's quality of life. The purpose of this study was to assess the prevalence of dental caries and its impacts on the OHRQoL in a sample of preschool children in Kisarawe. METHODS: A cross-sectional based study was conducted in 2017. A total of 1106 preschool children completed a face-to-face interview, using a translated Kiswahili version of the Michigan Oral Health-related Quality of Life Scale (MOHRQoL) -Child Version (2003), and underwent clinical oral examination using WHO (1997) criteria. RESULTS: The decayed component was the most prevalent (dft = 2.08) and the Significant Caries Index (SiC) was 5.54 double of the (dft), showing polarization of dental caries in the studied population. After adjusting for appropriate covariates, preschool children of age 5 and 6 years old were more likely to have decayed tooth [Adjusted OR = 3.02, (95% CI =2.01-4.54)] and [Adjusted OR = 2.23, (95% CI = 1.55-3.20)] respectively. Preschool children without visible plaque on the buccal surface of upper anterior teeth were less likely to have decayed teeth [Adjusted OR = 0.21, (95% CI = 0.09-0.45)]. Regarding measurements of oral health-related quality of life using the MOHRQoL, only preschool children who reported on 'do your teeth hurt you now?' and 'do kids make fun of your teeth?' were more likely to have a decayed tooth [Adjusted OR = 1.74, (95% CI = 1.12-2.71)] and [Adjusted OR = 1.87, (95% CI = 1.11-3.15)], respectively. CONCLUSION: Findings from this study suggest that dental caries affects a significant portion of preschool children and, was associated with poor oral hygiene. The overall impacts of dental caries prevalence to OHRQoL were low in this sample of preschool children. Children having caries (independent variable) were shown to report more frequently that 'do your teeth hurt you now?' and 'do kids make fun of your teeth?' were more likely to have a decayed tooth among preschool children in Kisarawe, Tanzania.

Yarning about oral health: perceptions of urban Australian Aboriginal and Torres Strait Islander women.

BACKGROUND: Many factors influence how a person experiences oral health and how such experiences may facilitate supportive oral health behaviours. Women in particular face different challenges due to their environment, responsibilities and physiological differences to men. Within Australia, Aboriginal and Torres Strait Islander women are reported to have poorer oral health and are faced with additional barriers to supporting their oral health compared with non-Indigenous women. The objective of this paper is to report the experiences and perceptions of oral health from the perspective of urban, Aboriginal and Torres Strait Islander women. METHODS: The present data derive from a descriptive study that used yarning circles and face-to-face interviews with women who were mothers/carers of urban, Aboriginal and/or Torres Strait Islander children. This was a qualitative study to investigate the impact of child oral health on families. Participants used the opportunity to share their own personal experiences of oral health as women, thus providing data for the present analyses. Information collected was transcribed and analysed thematically. RESULTS: Twenty women shared their personal narratives on the topic of oral health which were reflective of different time points in their life: growing up, as an adult and as a mother/carer. Although women are trying to support their oral health across their life-course, they face a number of barriers, including a lack of information and the costs of accessing dental care. The teenage years and pregnancy were reported as important time periods for oral health support. CONCLUSIONS: To improve the oral health of Indigenous Australian women, policymakers must consider the barriers reported by women and critically review current oral health information and services. Current oral health services are financially out of reach for Indigenous Australian women and there is not sufficient or appropriate, oral information across the life-course.

Utilization of dental services among low and middle income pregnant, post-partum and six-month post-partum women.

BACKGROUND: This study aims to explore the difference in the utilization pattern of dental services among pregnant, post-partum and six-month post-partum women. METHODS: This cross-sectional questionnaire survey was performed at two maternity and child care hospitals in India that primarily cater to middle and low income communities. Data were collected from 3 groups: 1) pregnant women in their first trimester; 2) post-partum women (< 48 h after delivery); and 3) six-month post-partum women. The primary outcome of interest was dental service utilization during pregnancy. Self-perceived oral health (SPOH) was calculated based on the four global dimensions- knowledge, function, quality of life and social. Multiple logistic regression analysis was carried out to assess the effect of each independent variable after adjustment for the effect of all other variables in the model. RESULTS: Responses of 450 (150 pregnant, 150 post-partum and 150 six-month post-partum) women were analyzed (response rate = 72%). Significant differences in the dental attendance pattern was observed between the study groups (p < 0.01). Dental attendance among pregnant and six-month post-partum women were 60 and 75%, respectively, however, only about 15% of the post-partum women reported to have sought dental care within the 6 months prior to the study. Post-partum women had the highest SPOH scores, indicating poor self-perceived oral health, followed by pregnant and then six-month post-partum women, which was statistically significant (p < 0.05). A significantly higher percentage of post-partum women reported to have poor oral and general health, as compared to both, pregnant and six-month post-partum women (p < 0.01). Higher percentage of women reporting 'good' oral and general health had sought dental care compared with others (p < 0.01). After adjusting for all the other variables in the model, women with lower levels of education (ORa = 1.42; 95% CI: 1.01-2.00), women with poor self-perceived oral health (ORa = 1.08; 95% CI: 1.02-1.14) and post-partum women (ORa = 0.15; 95% CI: 0.09-0.24) were found to be less likely to seek regular dental care. CONCLUSION: Pattern of dental service utilization among women in this population varied according to their pregnancy status, level of education and self-perceived oral health.

Utilization of dental services and associated factors among preschool children in China.

BACKGROUND: This study sought to evaluate dental utilization among 3-,4-, and 5-year-old children in China and to use Andersen's behavioural model to explore influencing factors, thereby providing a reference for future policy making. METHODS: This study is a cross-sectional study. Data of 40,305 children aged 3-5 years were extracted from the Fourth National Oral Health Survey, which was performed from August 2015 to December 2016. Patient data were collected using a questionnaire, which was answered by the child's parents, and clinical data were collected during a clinical examination. Stratification and survey weighting were incorporated into the complex survey design. Descriptive statistics, bivariate correlations and hierarchical logistic regression results were then analysed to find the factors associated with oral health service utilization. RESULTS: The oral health service utilization prevalence during the prior 12 months were 9.5% (95%CI: 8.1-11.1%) among 3-year-old children, 12.1% (95%CI: 10.8-13.5%) among 4-year-old children, and 17.5% (95%CI: 15.6-19.4%) among 5-year-old children. "No dental diseases" (71.3%) and "dental disease was not severe" (12.4%) were the principal reasons why children had not attended a dental visit in the past 12 months. The children whose parents had a bachelor's degree or higher (OR: 2.29, 95%CI: 1.97-2.67, p < 0.001), a better oral health attitude ranging from 5 to 8(OR: 1.64, 95%CI: 1.43-1.89, p < 0.001), annual per capital income more than 25,000 CNY (OR: 1.40, 95%CI: 1.18-1.65, p < 0.001),think their child have worse or bad oral health (OR: 3.54, 95%CI: 2.84-4.40, p < 0.001), and children who often have toothaches (OR: 9.72, 95%CI: 7.81-12.09, p < 0.001) were more likely to go to the dentist in the past year. CONCLUSION: The prevalence of dental service utilization was relatively low among preschool children. It is necessary to strengthen oral health education for parents and children, thereby improving oral health knowledge as well as attitude, and promoting dental utilization.

Rural-urban disparities in the distribution of dental caries among children in south-eastern Louisiana: a cross-sectional study.

INTRODUCTION: The purpose of this cross-sectional study was to assess the prevalence of dental caries among elementary school-aged children in rural compared to urban communities within south-eastern Louisiana that have participated in a school-based dental screening and sealant program. METHODS: The authors utilized de-identified Sealant Efficiency Assessment for Locals and States screening data for 2007-2014 provided by The Health Enrichment Network oral health program. The screening was conducted throughout 46 elementary schools in Louisiana. Screening forms recorded decayed, missing, and filled permanent teeth (DMFT). Descriptive statistics including demographic characteristics and oral health conditions were calculated. Univariate and multivariable logistic regression analyses were performed to assess the burden of caries in schools. RESULTS: Of 963 children screened, 32% had dental caries. There was an increased risk of having any DMFT among children who attended rural schools as compared to those who attended urban schools (prevalence odds ratio (POR)=2.17, 95% confidence interval (CI)=1.61-2.93). This study found that non-Hispanic black children had reduced odds of DMFT as compared to the children from other reported ethnicities (POR=0.695, 95%CI=0.503-0.960). CONCLUSION: A higher prevalence of dental caries was found in rural compared to urban communities. Further research is needed to assess the extent of geographic differences to improve oral health outcomes.

Success of Two Caries Risk Assessment Tools in Children: A Pilot Study With a 3-Year Follow-Up.

Caries risk is defined as the dental caries probability under the individual bacteriological environment, dietary habits, and environmental factors. Assessment of caries risk plays a major role in the prevention of dental caries. The aim of this study was to compare the effectiveness of two different caries risk assessment methods on caries-free preschool children. A sample of 90 caries-free 4- to 6-year-old children were selected from 400 preschool children. The selection was limited to children who had no dental caries, visible plaque, and systemic disease. American Academy of Pediatric Dentistry's Caries Risk Assessment Tool (CAT) and Clinpro Cario L-Pop (CCLP; 3M ESPE, Germany) were used to categorize children into caries risk groups. Children were classified as being in high-, medium-, or low-risk groups by two methods. Determining risk factors according to CAT were examined. The compliance among the two methods was evaluated. Sixty-eight children were reevaluated intraorally after 3 years. The compliance between CAT and CCLP was sought using Kappa test. Statistical evaluation revealed moderate compliance among methods at baseline. The three most determinant factors in the high-risk group according to CAT were no topical fluoride exposure, no use of dental services, and active caries in mother. CAT is found statistically more successful than CCLP in predicting caries risk 3 years later. Caries risk assessment is effective to predict future caries and can be helpful for the clinician to choose the right tailor-made caries prevention plans.

Social Connectedness Factors that Facilitate Use of Healthcare Services: Comparison of Transgender and Gender Nonconforming and Cisgender Adolescents.

OBJECTIVE: To compare social connectedness factors that facilitate use of primary, dental, and mental healthcare services among transgender and gender nonconforming (TGNC) and cisgender adolescents. METHODS: Data from the cross-sectional 2016 Minnesota Student Survey were used to examine protective social connectedness factors associated with use of different healthcare services among matched samples of 1916 TGNC and 1916 cisgender youth. Stratified, logistic regression analyses were used to examine background characteristics and social connectedness factors (parent connectedness, connections to other nonparental adults, teacher-student relationships, and friend connections) associated with use of each healthcare service within the last year. RESULTS: For TGNC youth, but not for cisgender youth, higher levels of parent connectedness were associated with receipt of primary (OR, 2.26; 95% CI, 1.40-3.66) and dental (OR, 3.01; 95% CI, 1.78-5.08) care services, and lower levels of connectedness to nonparental adults was associated with receipt of mental healthcare (OR, 0.55; 95% CI, 0.33-0.93). Among cisgender youth, no protective factors were significantly associated with receipt of primary care services, higher levels of friend connections were associated with receipt of dental services (OR, 1.85; 95% CI, 1.10-3.09), and lower levels of parent connectedness were associated with receipt of mental healthcare (OR, 0.20; 95% CI, 0.10-0.40). CONCLUSIONS: To promote the health of TGNC youth, clinicians should understand the distinct factors associated with obtaining healthcare among this population such as the need for tailored efforts focused on strengthening connectedness between TGNC youth and their parents to facilitate receipt of needed care.

Factors affecting dental service utilisation among older Singaporeans eligible for subsidized dental care - a qualitative study.

BACKGROUND: The World Health Organization has highlighted the paucity of research into the oral health needs of older adults. In Singapore, until recently, publically funded/subsidized oral health care for adults has been limited to basic primary care at government-funded polyclinics. Access to a more comprehensive range of subsidized care in the private sector was widened through the government-funded Community Health Assistance Scheme (CHAS) in 2012 and Pioneer Generation (PG) scheme in 2015. Little is known about the attitude to dental service utilization among older adults in Singapore since then. METHODS: We conducted semi-structured individual interviews with 25 participants above 65 years of age who were eligible for subsidized dental care plans. Participants were recruited from a public teaching hospital and a public primary care clinic in Singapore. The duration of each interview was 15-30 min. Interviews were transcribed verbatim and the transcripts were analyzed thematically using a phenomenological approach. RESULTS: Pertinent themes emerged related to four major areas: (a) general awareness towards oral health, (b) life course perspective of oral health, (c) barriers to visit the dentist, (d) shaping dental service utilisation behaviours through provision of financial subsidies for dental care. Most participants perceived a strong relationship between oral health and systemic health. However, there were erroneous traditional beliefs such as oral health is not part of physical health and edentulous participants did not need to visit a dentist. Fear, anxiety, previous negative experience and lack of knowledge were barriers to visiting the dentist. Trust and convenience were considerations for patients when deciding whether to switch from public to private dental services where CHAS/PG were only available. CONCLUSION: Our study provided important insights regarding oral health perceptions and beliefs of older people residing in the community which may affect their dental service utilization. This further highlights the importance of understanding the concerns of this group when implementing healthcare policies for elderly in Singapore. The findings of our study will serve as a baseline for future studies in Singapore and inform studies in other countries that implement targeted schemes for older adults.

A crossectional investigation of the relationship between complementary health insurance and frequency of dental visits in 15 to 64 years old of Tehran population, Iran, a secondary data analysis (urban HEART-2).

BACKGROUND: This study aimed to investigate the relationship between complementary health insurance and frequency of dental visits. METHODS: The present study was performed using the Urban Health Equity Assessment and Response Tool (Urban HEART). A cross-sectional study was conducted in Tehran (Iran) to assess inequalities in health status among different socioeconomic and ethnic groups, genders, geographical areas, and social determinants of health. Out of 20,320 records retrieved from the original study with dental information, 17,252 had both dental insurance and dental visit information. Complementary health insurance as the main independent variable had three categories (i.e., basic insurance, with complementary medical coverage, and with dental coverage). The frequency of dental visits during the last year as a dependent variable had also three categories (i.e., no visit, one, and two, or more dental visits in the last year). In this study, in addition to investigating the relationship between complementary health insurance and frequency of dental visits, potential covariates that may affect the mentioned relationship were evaluated in the regression model. Statistical analyses included simple and multiple multinomial logistic regression considering the sampling method and sampling weights. RESULTS: The meanage of 17,252 participants (Tehran citizens) was 39.36 years; 49.4%were women, 86.0%hadonly basicinsurance, 7.2% had complementary medical insurance, and 6.8% had complementary dental insurance. Of all subjects, 43.8% reported no dental visit, 26.1% reported one, and 30.1% reportedtwoor more dental visits during the lastyear. The frequency of dental visits was lower in people who had basic insurance than others such that that odds ratio (OR) was 0.73 (p-value < 0.001) for one visit and 0.68 (p-value< 0.001) for two or more visits in the last year. The frequency of dental visits was also positively associated with dental brushing, toothpaste use, high educational level, being married, having more than 20 teeth, and having dental pain. CONCLUSION: Having dental insurance increases the frequency of dental visits but the association between dental insurance and dental visits was independently influenced by other predictors.

Medical Provider Promotion of Oral Health and Women's Receipt of Dental Care During Pregnancy.

Objectives Dental care during pregnancy is important. We examined whether promotion of oral health by medical providers during pregnancy and pregnant women's receipt of dental care improved between 2009 and 2012 in California. Methods We used population-based postpartum survey data collected during 2009 (n = 3105) and 2012 (n = 6810) to compare the prevalence of women's reports that, during pregnancy, (a) their medical providers discussed oral health and/or suggested they see a dentist, and (b) they received dental care. Results Between 2009 and 2012, the proportion of women reporting that their medical providers talked about oral health or referred them to a dentist increased significantly overall (from 36 to 42%, and 21-26%, respectively, p < 0.001). The proportion of women with a dental visit during pregnancy also increased, from 38% in 2009 to 42% in 2012 (p < 0.005). The improvements were largely among women of lower income and education levels, those covered by Medi-Cal, and Latinas. Women whose medical providers promoted oral health care were approximately two times more likely to report having had a dental visit during pregnancy, even after adjusting for several potential confounders. Conclusions for Practice Characteristics of women reporting that their medical providers promoted, and that they received, dental care during pregnancy in 2012 suggests that the increases in promotion and use of oral health care were largely concentrated among Medi-Cal recipients. Further improvement is needed for all populations of pregnant women. Both public and private providers need to incorporate promotion of and referral for dental care into routine prenatal care protocols.

Recall intervals in children are individualized and extended.

Objective: The aim of this study was to follow attendance patterns longitudinally by exploring length of intervals between routine dental examinations in children at the ages of 5 and 12 years, and study associations between length of recall intervals and caries prevalence, controlled for gender, parent's background and parent's education. Materials and methods: The study included 2960 children in one Norwegian county monitored from 5 to 12 years of age. Data were collected at clinical examinations, from dental records and by parental questionnaires. Length of recall intervals was dichotomized into short (shorter than 18 months) and long (18 months and longer). Data were analysed and tested using Chi-square statistics, correlation coefficient and multivariate regression. The study was ethically approved. Results: Recall intervals were individualized and varied from 4 to 30 months. The most frequent used recall intervals were 12, 18, 20 and 24 months. A majority of children at both ages were given long recall intervals. Multivariate logistic regression showed that the probability of having short interval was higher in children having caries experience than in caries-free children at both 5 years (OR 12.6 CI 9.9-16.0) and 12 years (OR 2.7 CI 2.3-3.1). At 5 years of age, length of recall intervals was associated with parents' background (OR 1.8 CI 1.4-2.4) and parents' education (OR 1.3 CI 1.0-1.5). Conclusions: The results showed that routine intervals were individualized and extended, indicating that more resources were spent on children with the highest need of dental care, aiming at reducing health inequalities.