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1.
PLoS One ; 19(7): e0306403, 2024.
Article in English | MEDLINE | ID: mdl-38968302

ABSTRACT

The aims of this study were to investigate the relationship between self-reported preventive and curative orientations of general dental practitioners (GDPs) and the oral healthcare services (OHS) they provided to patients under 18-years-old. And in addition, to determine which patient, GDP, and dental practice characteristics predicted the provision of preventive and curative care. GDPs in the Netherlands using dental software program Exquise (>2,000) were invited to participate in this study voluntarily. Participants completed a web-based questionnaire on characteristics of themselves, their dental practices, and on 20 hypothetical clinical situations concerning caries management. Based on their responses GDPS were classified for their preventive orientation, and their curative orientation. Data on the OHS provided to their young patients over the period 2013-2017 were automatically extracted from the patient files. Based on the annual frequency of provided care to regular patients over a period of 4 or 5 years, this was converted into 3 longitudinal care patterns regarding prevention and 3 longitudinal care patterns regarding curative care. Multinomial logistic regression analyses were conducted with a multilevel approach to correct for dental practices. The 37 participating GDPs provided data for 16,229 young patients. There was not a significant relationship between self-reported preventive orientations and preventive care patterns. The self-reported middle curative orientation was a predictor of the care pattern 'curative treatment(s) in 1 year' (OR 1.23 compared to nu curative treatments; 95% CI 1.02-1.48). The self-reported high curative orientation was a predictor of 'curative treatments in several years' (OR 1.90; 95% CI 1.27-2.85). Common characteristics predicting (p<0.05) both regular preventive care and curative treatments in several years were patient related: age 4-9 and 10-12, low-income neighborhood, 5 years included in study. GDP and dental practice related predictors were: the GDP could fulfill the care demand by working overtime, small dental practice (≤2,000 patients), and practice policy on the provision of care to young patients. This showed that the variation in provided care was partly supplier-driven instead of patient-centered.


Subject(s)
Self Report , Humans , Netherlands , Female , Male , Adolescent , Dentists , Child , Surveys and Questionnaires , Practice Patterns, Dentists'/statistics & numerical data , Child, Preschool , Dental Caries/prevention & control , Dental Caries/therapy , Dental Health Services/statistics & numerical data , Dental Care/statistics & numerical data , Preventive Dentistry
2.
BMC Oral Health ; 24(1): 705, 2024 Jun 18.
Article in English | MEDLINE | ID: mdl-38890617

ABSTRACT

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.


Subject(s)
Dental Health Services , World Health Organization , Humans , Dental Health Services/statistics & numerical data , Middle East , Health Services Accessibility , Mediterranean Region , Oral Health , Developing Countries , Dental Care/statistics & numerical data
3.
Health Rep ; 35(6): 16-28, 2024 Jun 19.
Article in English | MEDLINE | ID: mdl-38896417

ABSTRACT

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.


Subject(s)
Health Services Accessibility , Insurance, Dental , Oral Health , Humans , Aged , Female , Male , Canada , Health Services Accessibility/statistics & numerical data , Insurance, Dental/statistics & numerical data , Aged, 80 and over , Dental Health Services/statistics & numerical data , Health Surveys , Income
4.
BMC Oral Health ; 24(1): 684, 2024 Jun 12.
Article in English | MEDLINE | ID: mdl-38867214

ABSTRACT

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.


Subject(s)
Insurance, Health , Humans , Peru , Female , Male , Prospective Studies , Adult , Middle Aged , Insurance, Health/statistics & numerical data , Longitudinal Studies , Adolescent , Young Adult , Dental Health Services/statistics & numerical data , Dental Health Services/economics , Child , Health Services Accessibility/statistics & numerical data , Aged , COVID-19/epidemiology , Child, Preschool , Infant
5.
Acta Odontol Scand ; 83: 317-326, 2024 May 22.
Article in English | MEDLINE | ID: mdl-38775632

ABSTRACT

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.


Subject(s)
Caregivers , Humans , Male , Female , Aged , Finland , Oral Health , Aged, 80 and over , Dental Health Services/statistics & numerical data
6.
Article in English | MEDLINE | ID: mdl-38791770

ABSTRACT

This study sought to carry out a systematic and preliminary evaluation of the policies on access to public dental services for people with ASD in a Brazilian city. The study, conducted between November/2019 and February/2020, was developed through document analysis, the design of the theoretical logical model of the policies, and seven semi-structured interviews with key informants. The sample was intentionally selected. We also considered the answers to 108 questionnaires from a pilot study on the access of people with ASD to dental services applied to caregivers, dentists, and non-dental professionals. No refusals were recorded. The availability study showed that the policies' objectives were not being achieved in terms of care network organization: there were no institutional flows, personal contacts were used between professionals to guarantee access to secondary attention, there was no specific training for the dentists about ASD, and the oral health care network was unknown to non-dentist professionals and caregivers. Most people with ASD have visited the dentist at least once in their lives, but a large percentage of those within this study did not do so in the last year. This study identified difficulties in implementing policies and suggested possible strategies for overcoming them as dimensions and subdimensions for evaluation.


Subject(s)
Autism Spectrum Disorder , Health Services Accessibility , Brazil , Humans , Autism Spectrum Disorder/therapy , Health Services Accessibility/statistics & numerical data , Male , Health Policy , Female , Adult , Dental Health Services/statistics & numerical data , Dental Care/statistics & numerical data
7.
Soc Sci Med ; 348: 116801, 2024 May.
Article in English | MEDLINE | ID: mdl-38564957

ABSTRACT

Devolution and decentralisation policies involving health and other government sectors have been promoted with a view to improve efficiency and equity in local service provision. Evaluations of these reforms have focused on specific health or care measures, but little is known about their full impact on local health systems. We evaluated the impact of devolution in Greater Manchester (England) on multiple outcomes using a whole system approach. We estimated the impact of devolution until February 2020 on 98 measures of health system performance, using the generalised synthetic control method and adjusting for multiple hypothesis testing. We selected measures from existing monitoring frameworks to populate the WHO Health System Performance Assessment framework. The included measures captured information on health system functions, intermediatory objectives, final goals, and social determinants of health. We identified which indicators were targeted in response to devolution from an analysis of 170 health policy intervention documents. Life expectancy (0.233 years, S.E. 0.012) and healthy life expectancy (0.603 years, S.E. 0.391) increased more in GM than in the estimated synthetic control group following devolution. These increases were driven by improvements in public health, primary care, hospital, and adult social care services as well as factors associated with social determinants of health, including a reduction in alcohol-related admissions (-110.1 admission per 100,000, S.E. 9.07). In contrast, the impact on outpatient, mental health, maternity, and dental services was mixed. Devolution was associated with improved population health, driven by improvements in health services and wider social determinants of health. These changes occurred despite limited devolved powers over health service resources suggesting that other mechanisms played an important role, including the allocation of sustainability and transformation funding and the alignment of decision-making across health, social care, and wider public services in the region.


Subject(s)
Goals , Organizational Case Studies , Outcome Assessment, Health Care , England/epidemiology , State Medicine/organization & administration , State Medicine/trends , Organizational Case Studies/statistics & numerical data , Public Health/standards , Public Health/statistics & numerical data , Social Determinants of Health/statistics & numerical data , Outpatients/statistics & numerical data , Maternal Health Services/statistics & numerical data , Dental Health Services/statistics & numerical data , Age Distribution , Primary Health Care/statistics & numerical data , Emergency Medicine/statistics & numerical data , Inpatients/statistics & numerical data , Social Support/statistics & numerical data , Mental Health Services/statistics & numerical data , Patient Care/statistics & numerical data , Humans , Male , Female , Adult , Adolescent , Young Adult , Middle Aged , Aged
8.
J Public Health Dent ; 84(2): 136-146, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38506129

ABSTRACT

OBJECTIVES: This study aimed to assess the association between affordability in terms of difficulty paying dental bills in Australian dollars and dental service use in the presence of sociodemographic confounders, and to assess the role of dental anxiety and satisfaction with dental professionals as mediators. The second aim was to investigate how dental anxiety and satisfaction with dental professionals modify the association between affordability and use of dental services in Australian adults. METHODS: Longitudinal data from the Australian National Study of Adult Oral Health (2004-06 and 2017-18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals. RESULTS: The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway. CONCLUSIONS: Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship.


Subject(s)
Dental Anxiety , Humans , Australia , Longitudinal Studies , Dental Anxiety/epidemiology , Dental Anxiety/psychology , Male , Female , Adult , Middle Aged , Patient Satisfaction , Dental Care/statistics & numerical data , Dental Care/economics , Dental Health Services/statistics & numerical data , Dental Health Services/economics , Aged
9.
Scand J Caring Sci ; 38(2): 426-437, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38389124

ABSTRACT

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.


Subject(s)
Home Care Services , Humans , Home Care Services/statistics & numerical data , Aged , Female , Male , Aged, 80 and over , Oral Health , Dental Health Services/statistics & numerical data
10.
Int Dent J ; 74(3): 473-481, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38225185

ABSTRACT

OBJECTIVES: The aim of this work was to analyse inequalities in oral health services utilisation (OHSU) in older Peruvian adults through comparative analysis of the years 2019 and 2021. METHODS: We conducted a secondary analysis of data from the 2019 and 2021 Demographic and Health Survey (ENDES). The outcome variable was OHSU by older Peruvian adults in the past year. We used Poisson generalised linear models adjusted for age and sex to assess changes in OHSU by sociodemographic characteristics. The Erreygers concentration index was used to describe the socioeconomic inequalities in OHSU. The contribution of each variable to inequalities was estimated by a decomposition analysis. RESULTS: In 2021, OHSU probability amongst older Peruvian adults decreased by 37% compared to 2019. The decline was greatest in those aged 80 or older (51%), the lowest wealth quintile (47%), those with functional limitations (53%), and those whose native language is Quechua or other indigenous languages (47%). Surprisingly, we observed a reduction in OHSU inequalities (difference: -0.1074; P = .003) during the COVID-19 pandemic, particularly amongst rural residents (difference: -0.0771; P = .030), the lowest wealth quintile (difference: -0.0764; P = .020), and those with functional limitations (difference: -0.3665; P < .001). Poverty accounted for 73% of the inequality in 2021. CONCLUSIONS: The probability of OHSU has significantly decreased likely due to the COVID-19 pandemic. Paradoxically, we observed a reduction in OHSU inequalities during the pandemic, despite the known socioeconomic impact. However, further research is required to gain deeper understanding of this phenomenon.


Subject(s)
COVID-19 , Dental Health Services , Humans , Peru , COVID-19/epidemiology , Male , Female , Aged , Aged, 80 and over , Dental Health Services/statistics & numerical data , Middle Aged , Socioeconomic Factors , Healthcare Disparities/statistics & numerical data , Pandemics , Patient Acceptance of Health Care/statistics & numerical data
11.
J Occup Health ; 65(1): e12415, 2023.
Article in English | MEDLINE | ID: mdl-37354491

ABSTRACT

OBJECTIVES: Dental check-ups at the workplace provide the opportunity for early detection of dental diseases. Dental check-ups during working hours could reduce the number of days of absence from work due to visits to dental clinics outside the workplace. Although health check-ups are provided to workers in Japan, dental check-ups is not mandatory. This study aimed to determine the association between the place of dental check-ups and absenteeism due to visits to the dental clinic. METHODS: This cross-sectional study used data from an online self-reported worker survey conducted for 2 weeks in March 2017. We applied linear regression analysis with robust variance to determine the association between the place of dental check-ups and absenteeism due to dental clinic visits while adjusting for sociodemographic, health, and oral health covariates. RESULTS: The average age of the 3930 participants was 43.3 ± 11.7 years, and 52.3% were male. The number of days of absenteeism due to dental clinic visits in the past year for those who received check-ups only at the dental clinic and at the workplace were 0.57 ± 2.67 days and 0.21 ± 1.20 days, respectively. After adjusting for covariates, it was found that those who received dental check-ups at the workplace had 0.35 (95% CI, 0.12-0.58) fewer days of absence than those who received dental check-ups at the dental clinic. CONCLUSION: Workers who received dental check-ups at the workplace were associated with fewer days of absence due to dental visits than those who received at the dental clinic.


Subject(s)
Absenteeism , Ambulatory Care , Dental Health Services , East Asian People , Workplace , Adult , Female , Humans , Male , Middle Aged , Cross-Sectional Studies , Surveys and Questionnaires , Workplace/statistics & numerical data , Dental Health Services/organization & administration , Dental Health Services/statistics & numerical data , Ambulatory Care/statistics & numerical data , Dental Care/methods , Dental Care/statistics & numerical data
12.
Epidemiol. serv. saúde ; 32(1): e2022183, 2023. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1421408

ABSTRACT

Objective: to analyze the difference in the number of primary teeth dental procedures performed within the Brazilian National Health System (SUS) in the state of Rio Grande do Sul, before and during the COVID-19 pandemic. Methods: this was a descriptive ecological study, using secondary data from the SUS Outpatient Information System (SIA-SUS), from 2018 to 2021, in the state and in its seven health macro-regions; we calculated the relative and absolute frequencies and the percentage difference of the dental procedures performed. Results: 94,443 and 36,151 dental procedures were recorded before and during the pandemic, respectively, corresponding to a 61.7% reduction; relevant percentage reductions were found in restorative procedures, which reached 20% in the southern region of the state; an increase in the percentage of exodontic and endodontic procedures was found. Conclusion: the results suggest that the COVID-19 pandemic had negative repercussions on the performance of primary teeth dental procedures in Rio Grande do Sul.


Objetivo: analizar la diferencia en el número de procedimientos odontológicos en dentición temporal realizados en el Sistema Único de Salud del estado de Rio Grande do Sul, antes y durante la pandemia de COVID-19. Métodos: estudio ecológico descriptivo, utilizando datos secundarios del Sistema de Información Ambulatorio del SUS (SIA-SUS), de 2018 a 2021, en el estado y en las siete macrorregiones de salud. Se calcularon las frecuencias relativas, absolutas y la diferencia porcentual de los procedimientos odontológicos realizados. Resultados: se registraron 94.443 y 36.151 procedimientos odontológicos antes y durante la pandemia, respectivamente, lo que corresponde a una reducción del 61,7%. Se observaron reducciones porcentuales relevantes en los procedimientos restaurativos, que alcanzaron 20 puntos porcentuales en la región sur del estado. Se observó un aumento en el porcentaje de procedimientos de exodoncia y endodoncia. Conclusión: los resultados sugieren que la pandemia de COVID-19 tuvo repercusiones negativas en la realización de procedimientos odontológicos en dentición temporal en el estado.


Objetivo: analisar a diferença no número de procedimentos odontológicos na dentição decídua, realizados pelo Sistema Único de Saúde (SUS) no estado do Rio Grande do Sul, Brasil, antes e durante a pandemia de covid-19. Métodos: estudo ecológico descritivo, utilizando-se dados secundários do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), de 2018 a 2021, no estado e em suas sete macrorregiões de saúde; foram calculadas as frequências relativas e absolutas, e a diferença percentual dos procedimentos odontológicos realizados. Resultados: foram registrados 94.443 e 36.151 procedimentos odontológicos antes e durante a pandemia, respectivamente, correspondendo a uma redução de 61,7%; reduções percentuais relevantes foram observadas nos procedimentos restauradores, atingindo 20 pontos percentuais na região Sul do estado; observou-se aumento no percentual de procedimentos exodônticos e endodônticos. Conclusão: os resultados sugerem que a pandemia de covid-19 teve repercussões negativas sobre a realização dos procedimentos odontológicos na dentição decídua, no estado.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Dental Care/statistics & numerical data , Pediatric Dentistry , COVID-19/epidemiology , Tooth, Deciduous , Unified Health System , Brazil , Pediatric Dentistry/statistics & numerical data , Dental Health Services/statistics & numerical data
13.
Rev. Ciênc. Plur ; 8(3): 26784, out. 2022. ilus, tab
Article in Portuguese | LILACS, BBO - Dentistry | ID: biblio-1399474

ABSTRACT

Introdução:Uma ampla gama de fatores pode contribuir para facilitar ou restringir o uso de serviços de saúde bucal pela população. A compreensão desses fatores pode contribuir para a identificação das parcelas da população com maior dificuldade de acesso e auxiliar na elaboração de políticas públicas de saúde voltadas para populações específicas de forma equânime. Objetivo:Analisar a produção científica acerca dos fatores associados ao uso de serviços odontológicos públicos no Brasil.Metodologia:Foi realizada uma revisão integrativa da literatura, com busca de artigos originais publicados entre 2011 e 2021, nas bases Medline, Lilacs, SciELO e BVS. De um total de 724 estudos, 10 artigos atenderam aos critérios de elegibilidade propostos e foram selecionados para a revisão.Resultados:entre as crianças os fatores associados ao uso de serviços odontológicos públicos foram: condição socioeconômica, raça, escolaridade da mãe e necessidade de tratamento. Nos adultos: gênero, raça, renda, nível de escolaridade, histórico de dor de dente, cárie, avaliação do tratamento recebido como regular, autopercepção de saúde bucal e de necessidade de tratamento. E entre idosos: raça, renda, nível de escolaridade, uso de serviços para fins curativos, uso de prótese e autopercepção da saúde bucal. Conclusões:Sugerem-se estudos longitudinais para elucidação de relações de causalidade e estudos com a população adolescente. São necessárias mudanças na assistência odontológica no país, de forma a superar a perspectiva focalizada de um SUS para pobres e alcançar uma Atenção à Saúde Bucal baseada nos princípios da universalidade, integralidade e equidade (AU).


Introduction:A wide range of factors can contribute to facilitate or to limit the use of oral health services by people. The understanding of these variables can contribute to identify the segments of the population with more difficulty of access and help the development of public health policies related to specific groups of people evenly. Objective:This paper aims to analyze the scientific production about the factors associated with the public dental services in Brazil. Methodology:An integrative review about the literature in the area was conducted, in search for papers published between 2011 and 2021, in Medline, Lilacs, SciELO and BVS. From 724 studies, 10 researches fulfilled the proposed eligibility criteria and were selected to the review. Results:Among the children, the factors associated with the use of public dental services were: socioeconomic condition, race, mother ́s educational degree and the need for treatment. In the case of adults: gender, race, income, level of education, medical history of toothache and dental caries, regular evaluation of the treatment received, the self-perception of oral health and of the need of treatment. Among the elderly people: race, income, level of education, the use of services for curative purposes, the use of prosthesisand the self-perception of oral health. Conclusions:It is suggested the development of longitudinal studies in order to elucidate the relations of causality and of studies with the teenagers. Changes in dental assistance in the country are necessary, in order to overcome the perspective of a SUS to poor people and to reach a Primary Dental Healthcare based in the principles of universality, integrality and equity (AU).


Introducción: Una amplia gama de factores puede contribuir a facilitar o restringir el uso de los servicios de salud bucal por parte de la población. La comprensión de estos factores puede contribuir a la identificación de las partes de la población con mayor dificultad de acceso y ayudar en la elaboración de políticas públicas de salud dirigidas a poblaciones específicas de manera equitativa. Objetivo: Analizar la producción científica sobre factores asociados al uso de los servicios públicos odontológicos en Brasil. Metodología: Se realizó una revisión integrativa de la literatura, buscando artículos originales publicados entre 2011 y 2021, en las bases de datos Medline, Lilacs, SciELO y BVS. De un total de 724 estudios, 10 artículos cumplieron con los criterios de elegibilidad propuestos y fueron seleccionados para revisión. Resultados: Entre los niños, los factores asociados al uso de los servicios odontológicos públicos fueron: nivel socioeconómico, raza, nivel de escolaridad de la madrey necesidad de tratamiento. En adultos: género, raza, ingresos, nivel de escolaridad, antecedentes de dolor de dientes, caries, evaluación del tratamiento recibido como habitual, autopercepción de la salud bucal y de necesidad de tratamiento. Y entre los adultos mayores: raza, ingresos, nivel de escolaridad, uso de servicios con fines curativos, uso de prótesis y autopercepción de la salud bucal. Conclusiones: Se sugieren estudios longitudinales para aclarar las relaciones causales y estudios sobre la población adolescente. Se necesitan cambios en la atención odontológica en el país, a fin de superar la perspectiva focalizada de un SUS para los pobres y lograr una Atención de Salud Bucal basada en los principios de la universalidad, integralidad y equidad (AU).


Subject(s)
Dental Care , Dental Health Services/statistics & numerical data , Health Policy , Health Services Accessibility/statistics & numerical data , Unified Health System
14.
Int. j interdiscip. dent. (Print) ; 15(1): 20-24, abr. 2022. tab, ilus
Article in Spanish | LILACS | ID: biblio-1385243

ABSTRACT

RESUMEN: Objetivo: Sintetizar los resultados de estudios epidemiológicos sobre Traumatismo Dentoalveolar (TDA) en la población chilena. Material y métodos: Se realizó una revisión sistemática de la literatura para identificar estudios poblacionales a nivel nacional, regional, provincial y comunal, además de datos de servicios dentales de atención primaria y secundaria sobre TDA en Chile. Resultados: Se incluyeron 2 estudios con representatividad nacional y 8 realizados en centros de atención en salud. A nivel nacional, la prevalencia de TDA a los 6 años fue de un 2.57%, y a los 12 años, 4.97%. En los estudios realizados en centros de salud, el diagnóstico más prevalente en dentición primaria fueron las lesiones de tejidos de soporte y en dentición permanente, la fractura coronaria. Fue más frecuente la afectación de un solo diente, y los incisivos centrales superiores fueron los dientes más afectados. Conclusiones: Los estudios representativos de la población en Chile son escasos, realizados hace más de una década y representativos sólo de la población de 6 y 12 años, lo cual pone de manifiesto la necesidad de mayor información epidemiológica sobre el TDA en la población chilena.


ABSTRACT: Aim: To summarize the evidence on epidemiological studies about traumatic dental injuries (TDI) in Chile. Methods: A systematic literature review was carried out in two databases to identify population studies at national, regional, provincial and community levels, as well as reports from primary and secondary dental care services, regarding TDI in Chile. Results: Two studies with national representation and eight studies from primary and secondary healthcare centers were included in the analysis. National prevalence for 6-year-old children was 2.57%, and 4.97% for 12-year-old children. While the most frequent diagnosis in primary dentition was traumatic injury involving tooth-supporting tissues, the most commonly reported diagnosis in permanent dentition was crown fracture. Single tooth affection was more frequent, and the upper central incisors were the most affected teeth. Conclusions: Data on representative studies about TDIs in Chile are scarce. Few studies, carried out more than a decade ago and only on 6- and 12-year-old children are available. There is a need for further epidemiological information about TDIs in Chile.


Subject(s)
Humans , Male , Female , Oral Health , Tooth Injuries , Dental Health Services/statistics & numerical data , Chile
15.
Health Serv Res ; 57(1): 137-144, 2022 02.
Article in English | MEDLINE | ID: mdl-34327703

ABSTRACT

OBJECTIVE: To examine whether quality of dental care varies by age and over time and whether community-level characteristics explain these patterns. DATA SOURCE: Deidentified medical and dental claims from a commercial insurer from January 2015 to December 2019. STUDY DESIGN: A retrospective cohort study. The primary outcome was a composite quality score, derived from seven dental quality measures (DQMs), with higher values corresponding to better quality. Hierarchical regression models identified person- and zip code-level factors associated with the quality. DATA COLLECTION/EXTRACTION METHODS: Continuously enrolled US dental insurance beneficiaries younger than 21 years of age. PRINCIPAL FINDINGS: Quality was assessed for 4.88 million person-years covering 1.31 million persons. Overall quality slightly improved over time, mostly driven by substantial improvements among children aged 0-5 years by 0.153 points/year (95% confidence interval [CI]:0.151, 0.156). Quality was poorest and declined over time among adolescents with only 20.5% of DQMs met as compared to 42.6% among aged 0-5 years in 2019. Dental professional shortage, median household income, percentages of African Americans, unemployed, and less-educated populations at the zip code level were associated with the composite score. CONCLUSION: Quality of dental care among adolescents remains low, and place of residence influenced the quality. Increasing the supply of dentists and oral health promotion strategies targeting adolescents and low-performing localities should be explored.


Subject(s)
Dental Care/statistics & numerical data , Dental Health Services/statistics & numerical data , Insurance, Dental/statistics & numerical data , Insurance, Health/statistics & numerical data , Private Sector/statistics & numerical data , Child , Child, Preschool , Health Services Accessibility , Health Services Research , Humans , Infant , Retrospective Studies , United States
16.
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(4): 1143-1153, Oct.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1360728

ABSTRACT

Abstract Objectives: to relate the search for dental care during pregnancy to sociodemographic, gestational and dental characteristics. Methods: quantitative approach study with cross-sectional design carried out with high-risk pregnant women, from January to May 2018. Statistical analysis was performed using Pearson's chi-square association test and Fisher's exact test, followed by logistic regression analysis and odds ratio calculation. Results: the final sample was composed of 190 pregnant women and the guidance for seeking dental care was significantly related to issues related to Prenatal Dental Care, regarding safety (p = 0.025), effective search (p < 0.0001) and the Unit Basic Health Care as a place of assistance (p = 0.0018). Pregnant women who did not receive search guidance are 19.6 more likely to not seek this service (p <0.001), when they seek it without guidance, they have 6.3 more chances to seek private services (p = 0.014) and when they do not receive guidance, they are 4.5 more likely to not feel secure in relation to this assistance (p = 0.005). Conclusion: the guidance and encouragement provided by the health team is paramount in pregnant woman's decision to seek assistance, especially in the context of Primary Health Care, and is characterized as a strategic tool in reducing insecurities related to dental treatment during pregnancy.


Resumo Objetivos: relacionar a orientação de busca pelo atendimento odontológico durante a gestação com características sociodemográficas, gestacionais e odontológicas. Métodos: estudo de abordagem quantitativa com delineamento transversal realizado junto a gestantes de alto risco, no período de janeiro a maio de 2018. A análise estatística foi conduzida pelo teste de associação qui-quadrado de Pearson e teste exato de Fisher, seguida pela análise de regressão logística e cálculo da odds ratio. Resultados: a amostra final foi composta por 190 gestantes e a orientação de busca foi significativamente relacionada às questões relativas ao Pré-Natal Odontológico, quanto à segurança (p=0,025), à busca efetiva (p<0,001) e à Unidade Básica de Saúde como local da assistência (p=0,0018). Gestantes que não receberam orientação de busca apresentam 19,6 mais chances de não buscar este serviço (p<0,001), quando o buscam sem orientação dispõe de 6,3 mais chances de ser por serviços privados (p=0,014) e quando não recebem orientação têm 4,5 mais chances de não sentir segurança em relação a esta assistência (p=0,005). Conclusão: a orientação e o incentivo realizados pela equipe de saúde são primordiais na decisão da gestante em buscar pela assistência, especialmente no âmbito da Atenção Primária em Saúde, e caracteriza-se como uma ferramenta estratégica na redução de inseguranças relacionadas ao tratamento odontológico no período gestacional.


Subject(s)
Humans , Female , Pregnancy , Prenatal Care , Pregnancy, High-Risk , Dental Health Services/statistics & numerical data , Pregnant Women , Primary Health Care , Socioeconomic Factors , Oral Health , Cross-Sectional Studies
17.
PLoS One ; 16(5): e0252037, 2021.
Article in English | MEDLINE | ID: mdl-34033664

ABSTRACT

BACKGROUND: Hypertension is one of the largest contributors to the disease burden and a major economic challenge for health-care systems. Early detection of persons with high blood pressure can be achieved through screening and has the potential to reduce morbidity and mortality. We evaluate the cost-effectiveness of an opportunistic hypertension screening programme in a dental-care facility for individuals aged 40-75 in comparison to care as usual (the no-screening baseline scenario). METHODS: A cost-effectiveness analysis (CEA) was carried out from the payer and societal perspectives, and the short-term (from screening until diagnosis has been established) cost per identified case of hypertension and long-term (20 years) cost per quality-adjusted life year (QALY) were reported. Data on the short-term cost were based on a real-world screening programme in which 2025 healthy individuals were screened for hypertension. Data on the long-term cost were based on the short-term outcomes combined with modelling in a Markov cohort model. Deterministic and probabilistic sensitivity analyses were carried out to assess uncertainty. RESULTS: The short-term analysis showed an additional cost of 4,800 SEK (€470) per identified case of hypertension from the payer perspective and from the societal perspective 12,800 SEK (€1,240). The long-term analysis showed a payer cost per QALY of 2.2 million SEK (€210,000) and from the societal perspective 2.8 million SEK per QALY (€270,000). CONCLUSION: The long-term model results showed that the screening model is unlikely to be cost-effective in a country with a well-developed health-care system and a relatively low prevalence of hypertension.


Subject(s)
Blood Pressure Monitoring, Ambulatory/economics , Cost-Benefit Analysis , Dental Health Services/statistics & numerical data , Mass Screening/economics , Blood Pressure Monitoring, Ambulatory/methods , Dental Health Services/economics , Female , Humans , Male , Mass Screening/methods , Middle Aged , Models, Statistical
18.
Brasília; Fiocruz Brasília;Instituto de Saúde de São Paulo; 26 mar. 2021. 16 p.
Non-conventional in Portuguese | LILACS, Coleciona SUS, PIE | ID: biblio-1358537

ABSTRACT

Esta revisão rápida foi comissionada e subsidiada pelo Ministério da Saúde, no âmbito do projeto GEREB-010-FIO-20 e faz parte da Coleção "Rapid response for health promotion". Contexto: Conforme a Política Nacional de Saúde Bucal, as práticas de saúde bucal (SB) estão incorporadas em todos os níveis de atenção do SUS. Na atenção primária à saúde (APS), as equipes de SB trabalham alinhadas a equipes de Saúde de Família para garantir o acesso da população a ações de promoção, prevenção, tratamento e reabilitação relacionadas à saúde bucal. Pergunta: Qual a prevalência de acesso a serviços de saúde bucal na Atenção Primária à Saúde entre gestantes, conforme seu perfil socioeconômico? Métodos: Três bases da literatura eletrônica e o Google Acadêmico foram buscadas em março de 2021 para identificar estudos sobre o acesso e utilização de serviço de saúde bucal da APS entre gestantes. Utilizando atalhos de revisão rápida para simplificar o processo, foi realizada seleção e extração dos dados com posterior avaliação da qualidade. Em seguida, os resultados foram reunidos em síntese narrativa. Resultados: A busca retornou 1.168 referências únicas, que após seleção resultaram na inclusão de 8 estudos. Os estudos incluídos eram transversais ou de abordagem qualitativa, cuja condução foi considerada adequada a partir dos instrumentos de avaliação metodológica. As gestantes estudadas representavam populações das cidades de Currais Novos (RN), Dourados (MS), Rio de Janeiro (RJ), Grande Vitória (ES), São Mateus (ES), Porto Alegre (RS) e Rio Grande (RS). Um estudo avaliou todas as macrorregiões brasileiras a partir dos dados dos dois primeiros ciclos do PMAQ (2011-2014). A escolaridade foi o único indicador do perfil socioeconômico descrito para todas as populações e a maioria apresentou a realização de consulta odontológica como medida de acesso e utilização dos serviços de saúde bucal. Considerações finais: Esta revisão rápida apresenta resultados de acesso da saúde bucal em registros pontuais com contextos específicos, limitando os resultados de prevalência. Não foram registradas participações de beneficiárias do Programa Bolsa Família. É recomendado novos estudos para a realização de estimativas de prevalência e generalização para outros grupos de modo a beneficiar a população de interesse.


This rapid review was commissioned and subsidized by the Ministry of Health, within the scope of the GEREB-010-FIO-20 project and is part of the "Rapid response for health promotion" Collection. Context: According to the Brazilian National Oral Health Policy, oral health practices (OH) are incorporated into all levels of care in the SUS. In primary health care (PHC), OH teams work in line with Family Health teams to ensure the population's access to oral health promotion, prevention, treatment and rehabilitation actions. Question: What is the prevalence of access to oral health services in Primary Health Care among pregnant women, according to their socioeconomic profile? Methods: Three electronic literature databases and Google Scholar were searched in March 2021 to identify studies on the access and use of PHC oral health services among pregnant women. Using quick review shortcuts to simplify the process, data selection and extraction were performed with subsequent quality assessment. Then, the results were gathered in narrative synthesis. Results: The search returned 1,168 unique references, which after selection resulted in the inclusion of 8 studies. The included studies were cross-sectional or of a qualitative approach, whose conduction was considered adequate based on the methodological assessment instruments. The pregnant women studied represented populations from the cities of Currais Novos (RN), Dourados (MS), Rio de Janeiro (RJ), Grande Vitória (ES), São Mateus (ES), Porto Alegre (RS) and Rio Grande (RS). One study evaluated all Brazilian macro-regions using data from the first two PMAQ cycles (2011-2014). Education was the only indicator of the socioeconomic profile described for all populations, and most of them had a dental appointment as a measure of access and use of oral health services. Final considerations: This quick review presents results of access to oral health in punctual records with specific contexts, limiting the prevalence results. There were no participations of beneficiaries of the Bolsa Família Program. Further studies are recommended to carry out prevalence estimates and generalization to other groups in order to benefit the population of interest.


Subject(s)
Humans , Female , Pregnancy , Primary Health Care , Socioeconomic Factors , Dental Health Services/statistics & numerical data , Pregnant Women
19.
Health Serv Res ; 56(1): 25-35, 2021 02.
Article in English | MEDLINE | ID: mdl-32844447

ABSTRACT

OBJECTIVE: To examine the impact of commercial dental insurer and provider concentration on dentist reimbursement. DATA SOURCES: We utilized provider data from the American Dental Association, reimbursement data from IBM Watson MarketScan® Commercial Research Databases, submitted billed charges from FAIR Health® , dental insurance market concentration data from FAIR Health® , and county-level demographic and economic data from the Area Health Resources File and the Council for Community and Economic Research. STUDY DESIGN: We used the Herfindahl-Hirschman Index to separately measure commercial dental insurance concentration and dentist concentration. We studied the effect of provider and insurance concentration on dentist reimbursement. Using two-stage least squares, we accounted for potential endogeneity in dental insurer and provider concentration. PRINCIPAL FINDINGS: Across the dental procedures we examined, a 10 percent increase in dental insurance concentration is associated with a 1.95 percent (P-value = .033) reduction in gross payments to dentists. Conversely, a 10 percent increase in dentist concentration is associated with a more modest 0.71 percent (P-value = .024) increase in gross payments. A 10 percent increase in dental insurance concentration is associated with a 1.16 percentage point (P-value = .016) decline in the allowed-to-list price ratio, while a 10 percent increase in dentist concentration is associated with a 0.56 percentage point (P-value = .001) increase in the allowed-to-list price ratio. Similar patterns were found across dental procedure subcategories. CONCLUSIONS: Dental provider markets are substantially less concentrated than insurance markets, which may limit the ability of dentists to garner higher reimbursement.


Subject(s)
Dental Health Services/economics , Insurance Carriers/economics , Insurance, Dental/economics , Costs and Cost Analysis , Dental Health Services/statistics & numerical data , Economics, Dental , Humans , Insurance Carriers/statistics & numerical data , United States
20.
Epidemiol. serv. saúde ; 30(3): e2020444, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1339861

ABSTRACT

Objetivo: Investigar os fatores associados ao não acesso em saúde bucal no Brasil. Métodos: Estudo transversal, sobre dados da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, em 2014 e 2018, mediante regressão logística multivariada hierarquizada. Definiu-se como 'não acesso' quando o usuário não consegue marcar consulta com cirurgião-dentista. Resultados: Foram analisados dados de 37.262 indivíduos do segundo ciclo (2014) e 117.570 do terceiro ciclo (2018). Maior chance de não acesso ocorreu para residentes em municípios mais desiguais e com menor cobertura de saúde bucal, deslocamento para a unidade de saúde superior a 11 minutos, sexo feminino, idade entre 25 e 39 anos e renda de até 1 salário mínimo. Conclusão: O não acesso associou-se a fatores municipais, como maior desigualdade; fatores organizacionais, como menor cobertura e tempo de deslocamento até a unidade; e fatores individuais, como sexo, idade e renda.


Objetivo: Investigar los factores asociados a la falta de acceso a la salud bucal en Brasil. Métodos: Estudio transversal, con datos de la evaluación externa del Programa de Mejoramiento del Acceso y la Calidad de la Atención Primaria (2014 y 2018), mediante regresión logística multivariable jerárquica. La categoría 'sin acceso' se definió cuando el usuario no consiguió concertar una consulta con un cirujano dentista. Resultados: Analizamos datos de 37.262 (2014) y 117.570 (2018) individuos. Se encontró una mayor probabilidad de no acceso para quienes: vivían en municipios con más desigualdad y con menor cobertura de salud bucal, cuyo tiempo de viaje a la unidad era superior a 11 minutos; mujeres, entre 25 y 39 años e ingresos de hasta 1 sueldo mínimo. Conclusión: La falta de acceso se asoció con factores municipales como mayor desigualdad; factores organizacionales como menor cobertura y tiempo de viaje a la unidad; y factores individuales como sexo, edad e ingresos.


Objective: To investigate factors associated with non-access to oral health in Brazil. Methods: This was a cross-sectional study of data from external evaluations of the National Primary Care Access and Quality Improvement Program (2014 and 2018), using hierarchical multivariate logistic regression. 'Non-access' was defined as the service user not being able to make an appointment with a dentist. Results: We analyzed data on 37.262 individuals (2014 sample) and on a further 117.570 individuals (2018 sample). Greater likelihood of non-access was found for those who live in municipalities with greater inequalities and with less oral health coverage, those whose travel time to the health center is more than 11 minutes, being female, being aged between 25 and 39 years and those whose income was up to 1 minimum wage. Conclusion: Non-access was associated with municipal factors such as greater inequality; organizational factors such as less oral health coverage and travel time to the health center; and individual factors such as sex, age and income.


Subject(s)
Humans , Primary Health Care , Dental Health Services/statistics & numerical data , Social Determinants of Health , Health Inequities , Socioeconomic Factors , Brazil , Cross-Sectional Studies , Health Services Accessibility
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