Exploring the Contexts, Mechanisms and Outcomes of a Dental Anxiety Service in Norway: A Realist Evaluation

Abstract Background: Torture, abuse and dental phobia are often precursors to developing a pathological relationship with dental care due to elevated anxiety and the risk for re-traumatisation. Consequently, this patient group tends to avoid dental services, leaving them with severe tooth decay that affects both their general and psychosocial health. Norwegian dental services have implemented a specific dental service targeting this patient group, aiming to both alleviate their dental anxiety and restore their oral health. The outcomes of this service have been positive, but for this model to be transferrable to other national contexts, it is necessary not just to understand whether the service works, but also how and why it works. Therefore, this study developed theories on how the structure of the service alleviates dental anxiety and restores patients’ oral health. Although developed specifically in a Norwegian context, these theories may be applicable to other national and international contexts. Methods: This realist evaluation comprised sequential, multiple methods encompassing a review of service and policy documentation (n=12), followed by realist interviews with service developers and deliverers (n=12). Guided by a retroductive approach consisting of coding, cataloguing and configuring through content analyses and context-mechanism-outcome (CMO) heuristics, the analyses generated four programme theories.Results: First, the state-subsidised dental service affects service access and service uptake. Second, this service can be adapted and tailored to regional resources to meet the needs of the heterogenous patient group. Third, regional service teams are cohesive because of a lack of national communication and cooperative practice. Fourth, the complexity of migration processes and poor dissemination practices leads to poor recruitment of torture survivors to the service. Conclusions: The service follows a hybrid bottom-up, top-down approach, allowing teams to practise discretion and tailor their approach to meet individual needs. With its bi-dimensional structure, the service reaches a patient population that would otherwise avoid dental services. Service uptake is beneficial as patients report experiencing improved quality of life. However, the service is struggling to reach torture survivors, which may be attributable to multiple contextual factors. More research is therefore required to understand the lack of service uptake among torture survivors.

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Profile of users of the oral health service in Comendador Levy Gasparian/RJ

Panorama brasileiro de tungstênio (w) entre os anos de 2008 e 2014 ◽

10.32749/nucleodoconhecimento.com.br/dentistry/oral-health ◽

2020 ◽

pp. 73-91

Author(s):

Renata Patrícia Pereira de Melo ◽

Natália Leal da Silva ◽

Fátima Lúcia Cartaxo Machado ◽

Rafael de Souza

Keyword(s):

Quality Of Life ◽

Oral Health ◽

The Elderly ◽

Dental Service ◽

Descriptive Statistics ◽

Urban Center ◽

Dental Services ◽

Study Population ◽

Basic Health Units

The health of teeth and the oral cavity affects people’s quality of life, as it interferes with the ability to eat, communicate, aesthetics and prevent other diseases. The aim of this research is to identify the profile of users of oral health services in basic health units in the municipality of Comendador Levy Gasparian/RJ. The study population was composed of all users of the dental service of the municipality and the sample size for collection used a nonparametric sampling of the type for convenience. The research was carried out using the quantitative approach and data analysis using Descriptive Statistics. To facilitate analysis and compression, graphs were constructed with univary and bidata data. The results showed women, young people, the elderly, people of the yellow race and patients with Higher Education represent groups that least use the dental services of the municipality and strategies that attract such audiences can increase access to the service. The units near the urban center of the municipality received a larger number of participants.

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Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis

PLoS ONE ◽

10.1371/journal.pone.0254310 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254310

Author(s):

Maria Helena Rodrigues Galvão ◽

Arthur de Almeida Medeiros ◽

Angelo Giuseppe Roncalli

Keyword(s):

Oral Health ◽

Multilevel Analysis ◽

Behavioral Model ◽

Dental Service ◽

Individual Factors ◽

Service Utilisation ◽

Health Coverage ◽

Dental Services ◽

Cross Sectional ◽

Public Dental Service

Background This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. Methods The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey– 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was ‘public dental service utilisation’, and Andersen’s behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. Results The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. Conclusions Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.

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Demand organization in public oral health services: analysis of a traditional model

RGO - Revista Gaúcha de Odontologia ◽

10.1590/1981-863720160003000053143 ◽

2016 ◽

Vol 64 (4) ◽

pp. 393-401 ◽

Cited By ~ 1

Author(s):

Angelo Giuseppe RONCALLI ◽

Suzely Adas Saliba MOIMAZ ◽

Adrielle Mendes de Paula GOMES ◽

Cléa Adas Saliba GARBIN ◽

Nemre Adas SALIBA

Keyword(s):

Public Schools ◽

Oral Health ◽

School Attendance ◽

Dental Service ◽

Access To Services ◽

Dental Services ◽

Unified Health System ◽

Documentary Analysis ◽

Equity In Access ◽

Basic Network

ABSTRACT Objective: To discuss the municipal experience of the organization and the demand for dental services, based on the guidelines of the Unified Health System (UHS), which point to the structuring of an assistance model based on universality and integrality of care and equity in access to services. Methods: The research, realized in Araçatuba/SP, was based on documentary analysis and interviews with key-informants of the UHS dental service. The traditional court model has a care system for schoolchildren and a basic network with priority for pregnant women. Results: In total, the network has 59 dental surgeons, 31 oral health auxiliaries and 17 Oral Health Teams; however, the school attendance model persists, with 10 professionals attending public schools. Based on the discussions, it is concluded that there are no established criteria for the organization of demand. Conclusion: Most of the attendance occurs by free demand, and the reference and counter-referral system is incipient, damaging the service's resoluteness.

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Strategies to improve access to and uptake of dental care by people experiencing homelessness in Australia: a grey literature review

Australian Health Review ◽

10.1071/ah18187 ◽

2020 ◽

Vol 44 (2) ◽

pp. 297

Author(s):

Jacqueline Goode ◽

Ha Hoang ◽

Leonard Crocombe

Keyword(s):

Oral Health ◽

Dental Care ◽

Service Providers ◽

Grey Literature ◽

Homeless People ◽

Dental Service ◽

Dental Services ◽

Free Care ◽

Improve Access

Objectives The poor oral health of Australians experiencing homelessness negatively affects their quality of life. Better oral health is associated with having annual dental check-ups. Because there is limited peer-reviewed literature describing strategies that improve access to and uptake of dental care by homeless people, in this study we searched the grey literature to discover what strategies are used. Methods The Informit database and Google and Bing search engines were searched using the keywords ‘homeless and oral and dental services’. Bing and Google were searched unrestricted by site and Google was searched for sites ending in ‘org.au’. Searches were restricted to Australia from June 2008 to June 2018. The first 300 websites were read, and those describing or linking to pages describing a strategy that improved access to or uptake of dental care were included in the study. The content of the webpages was evaluated and summarised, with common strategies reported as a narrative description. Results Nineteen programs were described. Common strategies were providing free care, in-reach care, outreach care and the need to work closely with support organisations. Conclusions To improve access to and uptake of dental care by people experiencing homelessness, dental services need to be free and organised in collaboration with support organisations. What is known about the topic? The peer-reviewed literature describing strategies used to improve access to and uptake of dental care by people experiencing homelessness in Australia is limited. The authors could only locate two such studies, one based in Melbourne and one in Brisbane. Both programs had a similar aim, but used different strategies to achieve it, suggesting a lack of consensus about the best way to encourage dental visiting by people experiencing homelessness. What does this paper add? This paper used the grey literature to describe common strategies used in Australia to improve access to and uptake of dental care by people experiencing homelessness. What are the implications for practitioners? Dental service providers aiming to increase access to and uptake of dental care by people experiencing homelessness need to work collaboratively with support organisations and provide care free of charge.

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Behavioral Sciences in the Promotion of Oral Health

Journal of Dental Research ◽

10.1177/0022034519873842 ◽

2019 ◽

Vol 98 (13) ◽

pp. 1418-1424 ◽

Cited By ~ 4

Author(s):

C. McGrath

Keyword(s):

Oral Health ◽

Behavior Change ◽

Health Behaviors ◽

Behavioral Therapy ◽

Dental Anxiety ◽

Behavioral Models ◽

Behavioral Sciences ◽

Dental Services ◽

The Past ◽

Oral Health Behaviors

The importance and value of behavioral sciences in dentistry have long been recognized, and their contribution to dental education, research, clinical practice, and oral health policy has been significant over the past half century. Over time behavioral sciences have expanded our understanding of oral health beyond “disease” to a broader biopsychosocial concept of oral health. This in turn has led dentistry away from a focus of “treatment” to oral health “care,” notably in the new millennium. Key oral health behaviors have been identified for more than half a century: the importance of diet, oral hygiene, dental services, and other factors. Various behavioral models and theories have been proposed, particularly since the 1970s, providing useful frameworks with sound psychological basis to help understand the paths of oral health behaviors. These models draw on theories of self-efficacy, motivation, counseling, and “behavior change.” Since the 1980s, there has been a greater understanding that these behaviors often share a common pathway with the etiology of other diseases (common risk factors). Furthermore, the relationship between individual factors and the broader environmental factors has been increasingly emphasized since the 1990s, leading to a united call for action in addressing oral health inequalities. Within the past decade, there are useful examples of models, frameworks, and techniques of behavior change with respect to oral health, involving planning, prompting, encouraging, goal setting, and/or motivating. In particular, there is a growing interest and use of motivational interviewing. Likewise, behavioral therapies, such as cognitive behavioral therapy, are increasingly being employed in dental practice in the management of dental anxiety, pain, and psychosomatic dental and oral problems, with promising results. Recommendations are outlined for future directions for behavioral sciences in the promotion of oral health.

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Determinants of Dental Care Attendance during Pregnancy: A Systematic Review

Caries Research ◽

10.1159/000481407 ◽

2018 ◽

Vol 52 (1-2) ◽

pp. 139-152 ◽

Cited By ~ 13

Author(s):

Juliana Schaia Rocha ◽

Letícia Yumi Arima ◽

Renata Iani Werneck ◽

Samuel Jorge Moysés ◽

Márcia Helena Baldani

Keyword(s):

Oral Health ◽

Latin American ◽

Dental Care ◽

Dental Service ◽

Behavioral Factors ◽

Service Usage ◽

Dental Services ◽

Perceived Need ◽

Utilization Of Dental Services ◽

Year 2000

Despite the fact that dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among pregnant women. The aim of this study was to identify and analyze the determinants of dental care attendance during pregnancy. We performed a systematic literature search in the electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Library in Dentistry, Cumulative Index to Nursing and Allied Health Literature, and Medline using relevant keywords. Studies were filtered by publication year (2000-2016) and language (English, Portuguese, Spanish, and French). The included studies were assessed for quality. Their characteristics and statistically significant factors were reported. Fourteen papers were included in the review. The prevalence of dental service usage during pregnancy ranged from 16 to 83%. Demographic factors included women's age, marital status, parity, and nationality. The socioeconomic factors were income, educational level, and type of health insurance. Many psychological and behavioral factors played a role, including oral health practices, oral health and pregnancy beliefs, and health care maintenance. Referred symptoms of gingivitis, dental pain, or dental problems were perceived need. Demographic, socioeconomic, psychological, behavioral factors and perceived need were associated with the utilization of dental services during pregnancy. More well-designed studies with reliable outcomes are required to confirm the framework described in this review.

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Social backgrounds, oral behaviors and dental service utilization among Thai older adults: data from the national oral health survey

Journal of Health Research ◽

10.1108/jhr-11-2019-0253 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Punkanit Harirugsakul ◽

Issarapong Kaewkamnerdpong ◽

Sudaduang Krisdapong ◽

Piyada Prasertsom ◽

Kornkamol Niyomsilp ◽

...

Keyword(s):

Older Adults ◽

Oral Health ◽

Service Utilization ◽

Health Survey ◽

Social Background ◽

Dental Service ◽

Dental Services ◽

Cross Sectional ◽

Content Type ◽

Social Backgrounds

PurposeThe number of older adults in Thailand is currently increasing. To create the appropriate oral health service for this age group requires an understanding of the factors that are associated with their dental service utilization. This study aimed to determine the associations between social backgrounds, oral behaviors and dental service utilization among Thai older adults.Design/methodology/approachThis was a cross-sectional study on a representative sample of older adults in the 8th Thai National Oral Health Survey (TNOHS). Data of 4,130 Thai older adults were collected through interviews. The association between social backgrounds, oral behaviors and dental service utilization were investigated using chi-square and logistic regression models.FindingsOf the older adults aged 60–74 years old, 38.4% had used dental services in the last 12 months. Smokers used dental services the least (32.1%). Location, income, education and social welfare were significantly associated with dental service utilization. Among the oral behaviors evaluated, smoking was significantly associated with low dental service utilization.Originality/valueThai older adults with a poor social background including location, income, education, entitlement to the Universal Coverage Scheme (UCS) and smoking made less use of dental services.

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The association of knowledge on oral health and utilization of dental services among pregnant women

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n6p1 ◽

2019 ◽

Vol 9 (6) ◽

pp. 1

Author(s):

Ola Mousa ◽

Asmaa Hamed ◽

Norah Al Omar

Keyword(s):

Oral Health ◽

Pregnant Women ◽

Dental Service ◽

Dental Services ◽

Cross Sectional ◽

Dental Floss ◽

Expectant Mothers ◽

Level Of Knowledge ◽

High Level ◽

Utilization Of Dental Services

Good oral health during pregnancy can possibly reduce complications and this will improve the quality of life of the pregnant woman. In addition, this will prevent the risk of the child to develop early childhood dental caries in the future. The main objective of this study was to determine if there is an association existingbetween the level of knowledge on oral health and utilization of dental services among pregnant women. Furthermore, the study determined the (a) proportion among pregnant women who had high level of knowledge regarding dental careduring pregnancy, (b) proportion of pregnant women who ever visited the dentist during pregnancy, (c) proportions of expecting women who are regularly brushing her teeth and whouses dental floss during pregnancy, and (d) factors that hinders the expecting women from visiting the dentist during pregnancy. A descriptive cross-sectional study was conducted at El Minia University Maternal and Child Health Hospital, El Minia, Egypt. A cross-sectional self-administered questionnaire-based survey was conducted among 200 expectant mothers, approached 156 out of them returned completed questionnaires, representing a response rate of 78%. Results revealed that: (a) nearly 65% of pregnant mothers had a high level of poor knowledge regarding dental care during pregnancy, (b) roughly 24% of pregnant women ever visited the dentist during pregnancy, (c) about 80% and 43% of expecting women regularly brush their teeth at least twice per day and use dental floss during pregnancy, respectively, and (d) among the factors that hinder the expecting women from visiting the dentist during pregnancy include having no time to visit, the consultation cost, fear and anxiety about the procedure, long waiting time, transportation problem and the idea of not needing the dental care. Moreover, the results showed that there was no sufficient evidence to say that the level of knowledge regarding dental service during pregnancy is associated with the utilization of dental service during pregnancy (Pearson Chi-square p-value = .160). The study concludes that health promotion on oral care during prenatal visits should address the mythologies and misconceptions among pregnant women. Therefore, healthcare providers should raise awareness among expectant mothers about giving special attention to oral health needs due to the higher risk of oral diseases that may affect pregnancy and the child inside the womb.

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Utilisation of Dental Services of Older People in Australia: An Economic Explanatory Model Based on Cost and Geographic Location

Geriatrics ◽

10.3390/geriatrics6040102 ◽

2021 ◽

Vol 6 (4) ◽

pp. 102

Author(s):

Wisam Kamil ◽

Estie Kruger ◽

Marc Tennant

Keyword(s):

Oral Health ◽

Older People ◽

Cost Model ◽

Geographic Location ◽

Dental Service ◽

Service Utilisation ◽

Ageing Population ◽

Dental Services ◽

Australian Census ◽

Natural Dentition

The increased percentage of older people retaining their natural dentition was associated with a burden of poor oral health and increased service demands. This study analyses the dental service utilisation of the ageing population in Australia and develops a modelled cost design that estimates the dental expenditure required to cover dental services for the aged population. Using the Australian Census of Population and Housing, ageing population and socioeconomic data were mapped to geographic boundaries and integrated with dental service provision data to estimate a model for the utilisation of dental services. The estimated financial cost of dental services was calculated based on the mean fees as per the Australian Dental Association’s Dental Fees Survey. The utilisation of the services varied considerably across the states and also by type of service, with limited numbers using periodontic services. However, there was an increase in cost for replacement and restorative services (5020 million AUD), most evident in the socioeconomic deprivation areas. In addition, the average dental services utilisation cost increased noticeably in the lower socioeconomic deciles of all regions outside major cities. The geographic maldistribution of older people significantly affects the utilisation of dental services, especially among disadvantaged communities. A predicted cost model of 6385 million AUD would cover the oral health needs of older Australians.

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