Disparities in children's use of oral health services.
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OBJECTIVES: We sought to determine if the recent expansions in Medicaid and the State Children's Health Insurance Program (SCHIP) have resulted in a narrowing of income disparities over time with the use of dental care in children 2 to 17 years of age. METHODS: Six years of data from the National Health Interview Survey were utilized. A trend analysis was conducted using 1983 as a baseline, which predates the expansions, and 2001-2002, the endpoint, which postdates implementation of the expansions. In addition, we examined two intermediate time points (1989 and 1997-1998). We conducted unadjusted and adjusted analyses using logistic regression. RESULTS: Overall, use of ambulatory dental care has increased dramatically for children over the past two decades. In 1983, more than one in three children (38.5%) had no dental care within the previous 12 months. By 2001-2002, about one-quarter of children (26.3%) were reported to have no dental care within the year, a reduction of 12.2% from 1983 (p<0.001). Frequency of unmet dental care remained unchanged between 1997-1998 (the first year this measure was available) and 2001-2002. A reduction in income disparities for use of dental care was found in our unadjusted analysis but this difference became statistically insignificant in the adjusted analysis. No changes in income disparities occurred for unmet dental needs in either the unadjusted or adjusted analyses. CONCLUSIONS: A substantial overall improvement in dental care use has occurred among all income groups, including poor and near poor children. This "keeping up" with their higher-income counterparts represents an important public health accomplishment for children in low-income families. Nevertheless, additional efforts are needed to close remaining disparities in access to dental care. (+info)
Access and care: reports from Canadian dental education and care agencies.
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Representatives of faculties of dentistry and agencies working to improve the oral health of groups with restricted access to dental care were invited to address the access and care symposium held in Toronto in May 2004. They told of their clients" sometimes desperate needs in graphic terms. The agencies" response ranged from simple documentation of the need, to expression of frustration with current trends and the apparent indifference of policy makers, to the achievement of some success in arranging alternative models of care. The presenters consistently identified the need to change methods of financing dental education and both the financing and models of care delivery to meet the needs of those with restricted access to oral health care. (+info)
The impact of an innovative reform to the South Carolina dental medicaid system.
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OBJECTIVE: To evaluate the effectiveness of an innovative reform in 2000 to the Dental Medicaid program in South Carolina. DATA SOURCES/STUDY SETTING: South Carolina Medicaid enrollment data and dental services utilization data from 1998, 1999, and 2000. STUDY DESIGN: The study was observational and retrospective in nature. Quarterly data were used in general linear regression models to examine time trends in the percent of Medicaid enrollees ages 21 and younger who received dental services. Trends in the total number of dental procedures provided per Medicaid enrollee were also analyzed, with sub-analyses performed on the four most frequent categories of procedures. DATA COLLECTION/EXTRACTION METHODS: Data were provided by the state's Quality Improvement Organization. PRINCIPAL FINDINGS: From 1998 to 1999, there was a downward trend in the number and percent of Medicaid enrollees ages 21 and younger receiving dental services and in the total number of services provided. This trend was dramatically reversed in 2000. CONCLUSIONS: The January 2000 dental Medicaid reform in South Carolina had marked impact on Medicaid enrollees' access to dental services. (+info)
Access to dental care among older adults in the United States.
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Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners. (+info)
Barriers to and enablers of older adults' use of dental services.
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The theme of the Elders' Oral Health Summit is older adults' access to dental care and how this situation can be improved for future cohorts. A major question is whether older adults today, as well as baby boomers who will be entering their seventies within the next decade, will demand dental care as part of their overall well-being. The current cohort of elders varies widely in its use of dental services, from regular preventive users to non-users who report that they have not been to a dentist in more than twenty years. In 1999, 53.5 percent of older adults reported that they had visited a dentist, the lowest rate of any age group beyond eighteen. This article examines some determinants of older persons' dental service utilization, both barriers and enablers, as a means of understanding why some people continue seeking preventive dental care throughout their lives while others are lifelong irregular users and still others discontinue regular use after retirement or relocation to a new community or long-term care facility. Based on the epidemiological and psychosocial literature available on this topic, barriers and enablers include cohort and age, race and ethnicity, income and education, availability of dental and medical insurance, urban vs. rural residence, physical access to a dental office, and systemic and functional health. Attitudes toward oral health and dental care and other psychosocial variables may override some of these demographic and structural variables. Research in medical and dental service utilization offers insights into the relative predictive ability of these variables. Dental providers can also be potent enablers or barriers to older adults' access to dental care. Each of these factors plays a role in older adults' use of dental services. Under different situations some serve as both barriers and enablers. (+info)
Dental care for aging populations in Denmark, Sweden, Norway, United kingdom, and Germany.
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This article reviews access to and financing of dental care for aging populations in selected nations in Europe. Old age per se does not seem to be a major factor in determining the use of dental services. Dentition status, on the other hand, is a major determinant of dental attendance. In addition to perceived need, a variety of social and behavioral factors as well as general health factors have been identified as determinants of dental service use. Frail and functionally dependent elderly have special difficulties in accessing dental care; private dental practitioners are hesitant to provide dental care to these patients. One reason may be that the fee for treating these patients is too low, considering high dental office expenses. Another reason may be problems related to management of medically compromised patients. This raises an important question: does inadequate training in geriatric dentistry discourage dentists from seeking opportunities to treat geriatric patients? Overall, the availability of dental services, the organization of the dental health care delivery system, and price subsidy for dental treatment are important factors influencing access to dental care among older people in Europe as well as in the United States. (+info)
Racial and socioeconomic disparities in health from population-based research to practice-based research: the example of oral health.
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Oral health serves as an excellent model for understanding social disparities in health. Associations among race, socioeconomic status, oral health, and dental care are strong. Multiple points along the dental care process allow investigation of disparities and mechanisms; and there are multiple types of treatment services (ranging from those that all patients and clinicians would likely agree on, to multiple treatment options, to discretionary treatments). Florida Dental Care Study (FDCS) data are used to provide examples of these concepts. Without regard to whether the dental care system was ultimately entered, the FDCS found substantive social differences in 1) incidence of need; 2) responsiveness to this need; and 3) propensity to seek preventive services. Once the dental care system had been accessed, substantive social differences were still evident with regard to 1) clinical condition; 2) awareness of treatment options; and 3) treatment discussions and recommendations. Once differences in clinical condition were taken into account, and once analysis was limited to persons who had entered the dental care system, social differences in receipt of care were still evident. Findings suggested that although dental care was effective at treating and preventing certain oral conditions, social differences in treatment effectiveness were evident. (+info)
Dental visits among dentate adults with diabetes--United States, 1999 and 2004.
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One of the major complications of diabetes is periodontal disease, a chronic infection of tissues supporting the teeth and a major cause of tooth loss. Adults with diabetes have both a higher prevalence of periodontal disease and more severe forms of the disease, contributing to impaired quality of life and substantial oral functional disability. In addition, periodontal disease has been associated with development of glucose intolerance and poor glycemic control among adults with diabetes. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease among dentate adults (i.e., those having one or more teeth); moreover, regular dental cleaning improves glycemic control in patients with poorly controlled diabetic conditions. One of the national health objectives for 2010 is to increase the proportion of persons with diabetes who have an annual dental examination to 71% (revised objective 5-15). To estimate the percentage of dentate U.S. adults aged > or =18 years with diabetes who visited a dentist within the preceding 12 months, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for 1999 and 2004. This report describes the results of that analysis, which indicated that, in 2004, age-adjusted estimates in only seven states exceeded 71% and estimated percentages for four states and District of Columbia (DC) increased significantly from their levels in 1999. The findings underscore the need to increase awareness and support for oral health care among adults with diabetes, including support for national and state diabetes care management programs. (+info)