Varying Manpower Alters Dental Health in a Developing Health Care System.

OBJECTIVES: This study assessed relationships between oral health care workforce and dental health in 12-year-olds in a developing health care system in Iran from 1992 to 2014 and compared these findings with the most recent corresponding findings in selected countries. METHODS: Data regarding oral health care workers from 1962 to 2014 were extracted from the comprehensive human resource data bank of the Shahid Beheshti Research Institute of Dental Sciences. Data regarding decayed, missing, and filled permanent teeth (DMFT) of 12-year-olds, extracted from official statistics, described dental health. Comparisons with other countries utilised the database of the World Health Organization. Changes in the DMFT index with fluctuations in the number of oral health care workers were investigated using exploratory data analysis methods. Associations of DMFT with the density of the oral health care workforce were evaluated using a multiple linear regression model. RESULTS: The trend in supply of dental workforce in Iran began to expand in the 1970s and, after a reduction in 2003 to 2007, reached a peak by 2014. Means of DMFT indices of 12-year-olds in Iran fluctuated between 1.50 and 2.40 from 1992 to 2014. The relationship between the dentist to population ratio and the DMFT index of 12-year-olds showed a downwards trend (r = -0.994; P < .001) until 1998 and afterwards an upwards trend (r = 0.887; P < .001). Globally, the DMFT index decreased in countries with a preventively-oriented oral health care workforce. CONCLUSIONS: Increased numbers of dentists have no significant impact on improving dental health in 12-year-olds. To promote dental health, the system providing health services should implement a preventively-oriented approach when planning for the oral health workforce.

Offspring sex ratio of Iranian dentists.

OBJECTIVE: To assess the impact of occupational factors on the sex ratio of dentists' children. METHODS: A randomly selected 501 Iranian dentists participated in a telephone interview. The participants were contacted by their mobile number to answer questions about demographic variables (gender, age, marriage status), practice-related variables (year of graduation as general or specialist dentist, years of clinical work, working hours, average number of radiographs taken in a day, and spouse's job), and questions about their children (number, gender and date of birth of each child). Kruskal-Wallis and Chi-square tests served for statistical evaluation. RESULTS: Of all participating dentists, 71 % were men, about two-thirds were 35- to 50-year olds, and 89 % were married. In total, the dentists had 768 children; about 21 % had no child. Of all the children, 54 % were boys (overall sex ratio = 1.17). The offspring sex ratio was 1.13 among male dentists, 1.50 for female dentists, and 1.44 when both parents were dentists. Higher percentages of boys were prevalent among female dentists, younger dentists, and general dental practitioners (p < 0.008). CONCLUSION: Demographic and practice-related factors showed some impact on proportions of both sexes of dentists' children in this study. However, the result needs evaluation in further studies.

Determinants of Iranian dentists' behaviour regarding infection control.

AIM: To evaluate the determinants of Iranian dentists' behaviour regarding infection control (IC). DESIGN: A cross-sectional questionnaire survey. SETTING: Iranian general dental practitioners (GDP) participating in a national dental congress. METHODS: The GDPs filled in a self-administered questionnaire containing questions regarding their attitudes towards and their behaviour on several aspects of IC. Background factors included GDP's year of birth, gender, and work-related factors. Statistical evaluation employed the Chi-square test, Cronbach alpha, and regression analysis. RESULTS: In total, 479 GDPs returned the questionnaire. Their mean age was 38.6years (SD=9.4) and 53% were men. The vast majority of the GDPs had positive attitudes towards the inquired after IC criteria with no statistical difference based on the GDP's background characteristics. Of all respondents, >70% reported that they inform the laboratory about the infection status of the sent items, disinfect impressions before sending to the laboratory, and wash patients' mouths before working with high-speed or ultrasonic devices. Adherence to all the studied IC criteria was reported by 10% of the respondents; more frequently by younger GDPs and those with fewer experience years (P<0.05). CONCLUSION: Greater emphasis on infection control programmes in dentists' education is called for especially in continuing education.

Does dental insurance make a difference in type of service received by Iranian dentate adults?

OBJECTIVES: To assess the relationship between insurance status and type of service received among dentate adults in a developing oral health care system. METHODS: A cross-sectional survey based on phone interviews in Tehran, Iran. Four trained interviewers collected data using a structured questionnaire. Of 1,531 subjects answering the phone call, 224 were <18 years; of the remaining 1,307, 221 (17%) refused to participate, and 85 (6%) were excluded as edentate or reporting no dental visit, leaving 1,001 eligible subjects in the sample. The questionnaire covered insurance status, socio-demographics, frequency of tooth brushing, dental attendance as reasons for, and time since last dental visit, and dental service received then. Data analysis included the chi-square test and logistic regression. RESULTS: Of the subjects, 71% had a dental insurance. Those with no insurance were more likely to report tooth extractions (OR=1.5) than those with an insurance coverage; for all other treatments no differences according to the insurance status appeared. Among the insured subjects, extractions were more likely for those reporting a problem-based dental visit (OR=6.0) or having a low level of education (OR=2.3). CONCLUSIONS: In Iran, with its developing oral health care system, dental insurance had only a minor impact on dental services reported.

Why do adults entitled to free or highly subsidized dental services select fully out-of-pocket-paid care?

OBJECTIVE: To investigate patients' reasons for selecting a dental clinic given their choice of free or highly-subsidized dental services. METHODS: The study was based on cross-sectional data obtained through phone interviews with adults in Tehran, Iran. The present study included those entitled to free or highly-subsidized dental services (n = 726). The data covered the patients' awareness of subsidized dental services and type of dental clinic for their most recent visit and their reasons for selecting that clinic. Awareness of subsidized dental services was dichotomized as being either aware or unaware of such subsidy. The type of clinic was dichotomized as providing either free or highly-subsidized (FHS) or fully out-of-pocket paid (FOP) services. Free format answers about the subjects' reasons for selecting a particular clinic were later sub-grouped as: convenient access, good technical aspects, good interpersonal aspects, low or reasonable fees, recommendation by a friend, and no reason. Socio-demographic status was based on background. Data analysis included the chi-square test and logistic regression model. RESULTS: Of the subjects (n = 726), 60% were women and 58% were under 35 years of age. The subjects' mean age was 33.5 years with no difference by gender (P = 0.24) and the majority had public insurance (91%). Of all the subjects, 60% selected FOP. Good interpersonal aspects were the strongest reason for selecting FOP (OR = 4.6), follow by good technical aspects (OR = 2.3). Those subjects who were unaware of their benefit had 4.6 times the odds of selecting FOP. CONCLUSIONS: Despite the opportunity to use highly-subsidized dental services, good interpersonal and good technical aspects lead patients to select private dentists and to pay fully out of pocket.

Impact of insurance scheme on adults' dental check-ups in a developing oral health care system.

OBJECTIVES: To find out the relationship between dental insurance and demand for dental care, the present study evaluated impact of insurance scheme on adults' dental check-ups in a developing oral health care system. METHODS: The target population included adults in the city of Tehran where the only telecommunication company provides 90% of the 1.9 million households with a fixed telephone. Of the 1531 subjects who answered the phone call, 224 were outside the target age (under 18), 67 said that they never had visited a dentist, and 221 refused to respond, leaving 1019 subjects in the final sample. Each interview lasted 15 minutes and was carried out using a structured questionnaire with fixed and open-ended questions. RESULTS: 71% of the subjects reported having dental insurance and 16% having visited a dentist for a check-up; 55%, more women than men, reported having had a dental visit within the past 12 months. CONCLUSIONS: The present results revealed the positive relationship between insurance and demand for dental care. Those having dental insurance were more likely to go to check-ups despite their generally low rate found in this country with a developing oral health care system. In such countries, health insurance schemes should therefore include obligatory regular dental check-ups to emphasize prevention-oriented dental care.

Dental attendance by insurance status among adults in Tehran, Iran.

OBJECTIVE: To evaluate dental attendance among adults in Tehran, Iran in relation to their dental insurance status. DESIGN: A cross-sectional survey based on telephone interviews. PARTICIPANTS: 1,531 adults in Tehran. METHODS: Using a two-stage stratified random technique, 3,200 phone numbers were drawn; 1,669 were unavailable (busy, no answer, fax, line blocked). Of the 1,531 subjects answering the phone call, 224 were excluded (aged <18 years) and 221 refused to participate, leaving 1,086 subjects (83%) in the final sample. Data analysis included the Chi-square test, logistic regression and the corresponding odds ratios (OR). RESULTS: Of the respondents (n=1,086), 57% were women, 62% were under 35 years of age, 70% had dental insurance and 52%, more women than men (p=0.03), reported having had a dental visit within the past 12 months. Dental attendance was more likely for women (OR=1.4), for those with a medium (OR=1.5) or high (OR=1.9) level of education, and for those with commercial insurance (OR=2.0). CONCLUSION: In a country with a low dentist-population rate dental attendance is positively related not only to insurance status, but also to gender and to level of education. Accordingly, dental insurance coverage should be expanded to facilitate access to dental care.