RESUMEN
PURPOSE: The purpose of this scoping review was to determine the health-equity issues that relate to childhood obesity. METHODS: Health-equity issues related to childhood obesity were identified by analyzing food environment, natural and built environment, and social environment. The authors searched Medline, PubMed, and Web of Science, using the keywords "children" and "obesity." Specific terms for each environment were added: "food desert," "advertising," "insecurity," "price," "processing," "trade," and "school" for food environment; "urban design," "land use," "transportation mode," "public facilities," and "market access" for natural and built environment; and "financial capacity/poverty," "living conditions," "transport access," "remoteness," "social support," "social cohesion," "working practices," "eating habits," "time," and "social norms" for social environment. Inclusion criteria were studies or reports with populations under age 12, conducted in the United States, and published in English in 2005 or later. RESULTS: The final search yielded 39 references (16 for food environment, 11 for built environment, and 12 for social environment). Most food-environment elements were associated with obesity, except food insecurity and food deserts. A natural and built environment that hinders access to physical activity resources and access to healthy foods increased the risk of childhood obesity. Similarly, a negative social environment was associated with childhood obesity. More research is needed on the effects of food production, living conditions, time for shopping, and exercise, as related to childhood obesity. CONCLUSIONS: Most elements of food, natural and built, and social-environments were associated with weight in children under age 12, except food insecurity and food deserts.
Asunto(s)
Dieta , Disparidades en el Estado de Salud , Obesidad Infantil/etiología , Determinantes Sociales de la Salud , Medio Social , Niño , Planificación Ambiental , Abastecimiento de Alimentos , Humanos , Características de la Residencia , Factores de Riesgo , Factores SocioeconómicosRESUMEN
BACKGROUND: Except for a small increase in caries prevalence in young children from 1999 through 2004, the prevalence of pediatric caries in the United States has remained consistent for the past 3 decades. METHODS: The authors used data from the National Health and Nutrition Examination Survey (NHANES) (from 1999 through 2004 and from 2011 through 2014) to ascertain changes in caries prevalence in youth aged 2 to 19 years. The authors evaluated changes in the prevalence of caries experience, untreated caries, and severe caries (3 or more teeth with untreated caries) in the primary, mixed, and permanent dentition according to poverty status. RESULTS: Untreated dental caries in the primary dentition decreased (24% versus 14%) for children aged 2 to 8 years regardless of poverty status from the period from 1999 through 2004 to the period from 2011 through 2014. Severe caries in primary teeth decreased between the period from 1999 through 2004 and the period from 2011 through 2014 for 2- to 8-year-olds (10% versus 6%). Among preschool-aged children in families with low incomes, caries experience decreased from nearly 42% to 35%, and untreated caries decreased from 31% to 18%. Furthermore, there were significant reductions in the number of carious dental surfaces and significant increases in the number of restored dental surfaces. Overall, there was little change in the prevalence of caries in older children and adolescents. CONCLUSIONS: The prevalence of caries in primary teeth in preschool-aged children has improved in the previous decade in the United States; however, the prevalence of having no caries experience in permanent teeth in children and adolescents remains unchanged. PRACTICAL IMPLICATIONS: Although the oral health status of young children has improved in the previous decade, few changes have occurred for many older children and adolescents.
Asunto(s)
Caries Dental/epidemiología , Pobreza/estadística & datos numéricos , Adolescente , Factores de Edad , Niño , Preescolar , Índice CPO , Femenino , Humanos , Masculino , Encuestas Nutricionales , Prevalencia , Factores Socioeconómicos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To ascertain and compare the oral health status and related sociodemographic risk indicators in children in Los Angeles (LA) County with children in the United States. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 were used to calculate prevalence estimates for children aged 2-13 years living in LA County and in the United States. Sociodemographic indicators were evaluated using multiple logistic regression modeling. RESULTS: Overall, children in LA County were more likely to experience dental caries than children in the United States in 1999-2004. In the primary dentition, nearly 40% of preschool children residing in LA County had dental caries compared to 28% of same-age children in the United States. Among children aged 6-13, 44% living in LA County had dental caries in the permanent dentition compared to 27% in the United States. Mexican American children in LA County had higher caries experience in permanent teeth (but not in primary teeth) than US Mexican American children. Among children aged 6-9 years, there was no difference in the prevalence of dental sealants in permanent teeth between those living in LA County and in the United States. However, among children aged 10-13 years, dental sealants were more than twice as prevalent in US children (40.8%) than in LA County children (17.5%). Among LA County children, the adjusted odds of having caries experience or untreated dental caries in permanent teeth were not higher among children from lower income families than in lower income children in the United States. CONCLUSIONS: Children residing in LA County had less favorable oral health than children in the United States in 1999-2004. The usual sociodemographic caries risk indicators identified among children in the United States were not consistently observed among children in LA County. Unlike in the wider United States, poverty was not a risk indicator for dental caries in older children in LA County.
Asunto(s)
Indicadores de Salud , Salud Bucal , Niño , Preescolar , Caries Dental/epidemiología , Femenino , Humanos , Lactante , Los Angeles , Masculino , Encuestas Nutricionales , Selladores de Fosas y Fisuras/uso terapéutico , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Estados UnidosRESUMEN
OBJECTIVE: To describe dental procedures received by US children and adolescents by poverty status and dental insurance coverage. METHODS: Data for this analysis came from the 1999 and 2009 Medical Expenditure Panel Surveys. The primary outcome variable represented the types of dental procedures that were received during dental visits in the preceding year. Descriptive variables included dental insurance and poverty status. Analysis was restricted to children from birth to 20 years. RESULTS: Overall, diagnostic (41.2 percent) and preventive (35.8 percent) procedures accounted for most of the procedures received by children from birth to 20 years of age, while restorative procedures accounted for just 5 percent. Children from low-income families received a higher proportion of restorative procedures than children in higher-income families. The proportion of diagnostic and preventive services was lower among uninsured children than among publicly insured children. Orthodontic services, on the other hand, represented a greater percentage of these procedures among uninsured children than among publicly insured children. DISCUSSION: The vast majority of procedures received by children from birth to 20 years were diagnostic and preventive. Most children with at least one dental visit received a diagnostic or preventive service. Between 1999 and 2009, the proportion of all services received accounted for by diagnostic or preventive services increased. However, the proportion in which each type of procedure was received by children who made at least one visit who received did not change.
Asunto(s)
Servicios de Salud Dental/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Seguro Odontológico , Masculino , Pobreza , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: The results of several studies conducted in the United States show no association between intake of 100 percent fruit juice and early childhood caries (ECC). The authors examined this association according to poverty and race/ethnicity among U.S. preschool children. METHODS: The authors analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) for 2,290 children aged 2 through 5 years. They used logistic models for caries (yes or no) to assess the association between caries and intake of 100 percent fruit juice, defined as consumption (yes or no), ounces (categories) consumed in the previous 24 hours or usual intake (by means of a statistical method from the National Cancer Institute). RESULTS: The association between caries and consumption of 100 percent fruit juice (yes or no) was not statistically significant in an unadjusted logistic model (odds ratio [OR], 0.76; 95 percent confidence interval [CI], 0.57-1.01), and it remained nonsignificant after covariate adjustment (OR, 0.89; 95 percent CI, 0.63-1.24). Similarly, models in which we evaluated categorical consumption of 100 percent juice (that is, 0 oz; > 0 and ≤ 6 oz; and > 6 oz), unadjusted and adjusted by covariates, did not indicate an association with ECC. CONCLUSIONS: Our study findings are consistent with those of other studies that show consumption of 100 percent fruit juice is not associated with ECC.
Asunto(s)
Bebidas , Caries Dental/epidemiología , Frutas , Bebidas/efectos adversos , Preescolar , Caries Dental/etnología , Femenino , Frutas/efectos adversos , Humanos , Lactante , Masculino , Encuestas Nutricionales , Pobreza , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: This paper describes the trends in oral health in Maryland over the past decade. METHODS: Data were compiled from several surveillance systems and then summarized to assess the trends in oral health in Maryland over the past ten years. RESULTS: The percentage of Maryland children with dental sealants increased from 33.8 to 42.8 percent; the percentage of children that have had a dental visit increased from 18.9 to 47.5 percent; and the percentage of children that received "dental treatment" increased from 8.4 to 22.4 percent. CONCLUSIONS: Maryland has made considerable progress in improving the oral health care for children covered by Medicaid. The availability of affordable oral health care for new mothers, adults, and elderly persons is a problem that goes beyond the Maryland boundaries. Following national trends, edentulism and deaths due to oral cancer have declined.
Asunto(s)
Salud Bucal/tendencias , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Niño , Atención Odontológica/estadística & datos numéricos , Atención Odontológica/tendencias , Cuidado Dental para Ancianos/estadística & datos numéricos , Cuidado Dental para Ancianos/tendencias , Atención Dental para Niños/estadística & datos numéricos , Atención Dental para Niños/tendencias , Caries Dental/epidemiología , Femenino , Fluoruración/estadística & datos numéricos , Fluoruración/tendencias , Humanos , Maryland/epidemiología , Servicios de Salud Materna/estadística & datos numéricos , Servicios de Salud Materna/tendencias , Neoplasias de la Boca/epidemiología , Boca Edéntula/epidemiología , Evaluación de Necesidades/estadística & datos numéricos , Evaluación de Necesidades/tendencias , Salud Bucal/estadística & datos numéricos , Selladores de Fosas y Fisuras/uso terapéutico , Vigilancia de la Población , Estados Unidos/epidemiología , Poblaciones Vulnerables/estadística & datos numéricosRESUMEN
BACKGROUND: The authors conducted a study to describe the relationship between the oral health of young children and that of their mothers. METHODS: Using data from the Third National Health and Nutrition Examination Survey and a related birth certificate-linked file, the authors compiled a sample of 1,184 mother/child pairs for children aged 2 through 6 years. The authors performed logistic and cumulative logistic regression analyses by using children's caries experience and untreated caries status as dependent variables. They evaluated the mothers' untreated caries status and tooth loss status along with other covariates, including age, race/ethnicity and poverty status. RESULTS: Children of mothers who had high levels of untreated caries were more than three times as likely (odds ratio [OR], 3.5; 95 percent confidence interval [CI], 2.0-6.2) to have higher levels of caries experience (treated or untreated dental caries) compared with children whose mothers had no untreated caries. A similar relationship was observed between mothers' tooth loss and caries experience among their children. The children of mothers with high levels of tooth loss were more than three times as likely (OR, 3.3; 95 percent CI, 1.8-6.4) to have higher levels of caries experience compared with children of mothers with no tooth loss; for mothers with moderate tooth loss, the OR was 2.3 (95 percent CI, 1.5-3.5). CONCLUSIONS: Mothers' oral health status is a strong predictor of the oral health status of their children.
Asunto(s)
Índice CPO , Estado de Salud , Relaciones Madre-Hijo , Salud Bucal/estadística & datos numéricos , Adulto , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Niño , Preescolar , Caries Dental/epidemiología , Restauración Dental Permanente/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Renta/estadística & datos numéricos , Americanos Mexicanos/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Medición de Riesgo , Pérdida de Diente/epidemiología , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: Recent reports have suggested that dental caries among some young children is increasing in the United States. AIM: To describe changes in paediatric caries prevalence by poverty status in the United States. DESIGN: National Health and Nutrition Examination Survey (NHANES) data for children aged 2-11 years for 1988-1994 and 1999-2004 were used. RESULTS: Caries in the primary dentition increased among poor and non-poor boys aged 2-8 years (45-53% and 23-31%, respectively) and among non-poor boys aged 2-5 years (13-21%) from 1988-1994 to 1999-2004. Caries experience also increased on buccal-lingual, mesio-distal, and occlusal primary dental surfaces among poor children aged 2-8 years and this increase may be attributed to an increase in the number of dental surfaces restored. In the mixed dentition, caries remains relatively unchanged. Caries continues to decline in the permanent dentition for many children, but is increasing among poor non-Hispanic whites aged 6-8 years (8-22%) and poor Mexican-Americans aged 9-11 years (38-55%). CONCLUSIONS: For many older children, caries continues to decline or remain unchanged. Nevertheless, for a subgroup of younger children, caries is increasing and this increase is impacting some traditionally low-risk groups of children.
Asunto(s)
Caries Dental/epidemiología , Pobreza/estadística & datos numéricos , Niño , Preescolar , Índice CPO , Caries Dental/patología , Dentición , Etnicidad , Femenino , Humanos , Masculino , Pobreza/tendencias , Prevalencia , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaRESUMEN
Oral health is associated with overall health, and lack of access to dental care has consequences that go far beyond aesthetics. Most oral diseases are preventable and are relatively easy and inexpensive to address at early stages. However, multiple barriers make dental care unreachable for a sizable portion of the United States population, who consequently has higher incidence and prevalence of disease. Achieving meaningful improvements in oral health status among these groups will require a revamping of the dental infrastructure, augmenting the productivity and skills of the dental workforce, and increasing the population's oral health literacy.
Asunto(s)
Atención Odontológica/economía , Atención Odontológica/estadística & datos numéricos , Odontología , Accesibilidad a los Servicios de Salud , Salud Bucal , Caries Dental/prevención & control , Conductas Relacionadas con la Salud , Estado de Salud , Disparidades en Atención de Salud , Humanos , Neoplasias de la Boca/prevención & control , Enfermedades Periodontales/prevención & control , Odontología en Salud Pública/organización & administración , Calidad de Vida , Estados Unidos , Poblaciones Vulnerables , Recursos HumanosRESUMEN
The goal of this paper was to report the prevalence of dental care--a Healthy People 2010 objective--for nursing home residents 65 years and older, and to assess the association between receipt of dental care with other oral status and workforce measures. Data from 7,363 residents aged 65 years and older with information in the 1997 National Nursing Home Survey (NNHS) were used. Overall, 18.2% of elderly nursing home residents had received dental care in the last month. Multivariable modeling found residents were more likely to receive dental care in the past month if they lived in the Northeast (OR=3.32, 95% CI 2.51-4.39); were dentate (OR=1.46, 95% CI 1.26-1.69); had a length of stay 12 months or longer (OR= 1.37, 95% CI 1.17-1.62); or resided in facilities with dental professional services (OR=2.05, 95% CI 1.60-2.62). The results showed that disparities in receipt of dental care existed by region, length of stay, dentate status, and availability of dental services in nursing homes. Additionally, current oral health surveillance measures for nursing homes may have been inadequate.
Asunto(s)
Cuidado Dental para Ancianos/estadística & datos numéricos , Atención Odontológica/estadística & datos numéricos , Encuestas de Salud Bucal , Disparidades en Atención de Salud , Casas de Salud/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Anciano , Femenino , Financiación Personal/estadística & datos numéricos , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Enfermedades de la Boca/terapia , National Center for Health Statistics, U.S. , Casas de Salud/organización & administración , Características de la Residencia/estadística & datos numéricos , Encuestas y Cuestionarios , Enfermedades Dentales/terapia , Estados Unidos , Población Blanca/estadística & datos numéricos , Recursos HumanosRESUMEN
PURPOSE: The purpose of this study was to describe and substantiate the experience of children, their families, and their caregivers with children's dental pain and to explore implications of these experiences for public policy. METHODS: Data for 301 children presenting to 35 pediatric dentistry training programs during a 1-week period in 2000 for pain relief were collected with a questionnaire asking for: (1) sociodemographic characteristics; (2) oral health status; (3) dental care history; (4) presenting problem; (5) clinical findings; and (6) clinical disposition. Descriptive statistics are presented. RESULTS: Among children presenting to training programs with oral pain, 28% were under age 6, 57% were on Medicaid, and 38% were regarded by their dentists to have "likely or obvious" functional impairment-with 22% reporting the highest pain level. Parents reported that 59% had "poor or fair oral health" and 29% had a prior dental emergency in the previous year. Pain, experienced for several days by 73% of children, was associated with difficulty: (1) eating; (2) sleeping; (3) attending school; and (4) playing. Parent-reported barriers to seeking dental care included: (1) missed work (24%); (2) transportation costs (12%); and (3) arranging child care (10%). CONCLUSION: In this study of children with dental pain, many suffered significant pain: (1) duration; (2) intensity; (3) recurrence; and (4) consequences. This study demonstrates the ongoing need for public policies that assure timely, comprehensive, and affordable dental care for vulnerable children.
Asunto(s)
Atención Dental para Niños , Servicios Médicos de Urgencia , Política de Salud , Odontología Pediátrica/educación , Formulación de Políticas , Absentismo , Adolescente , Niño , Preescolar , Atención Dental para Niños/organización & administración , Escolaridad , Servicios Médicos de Urgencia/organización & administración , Composición Familiar , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Femenino , Accesibilidad a los Servicios de Salud , Estado de Salud , Humanos , Renta , Lactante , Masculino , Medicaid , Salud Bucal , Trastornos del Sueño-Vigilia/etiología , Odontalgia/terapia , Estados UnidosRESUMEN
Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of family's competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.
Asunto(s)
Técnicos Medios en Salud/estadística & datos numéricos , Atención Odontológica/organización & administración , Salud Bucal , United States Indian Health Service/organización & administración , Alaska , American Dental Association , American Public Health Association , Humanos , Indígenas Norteamericanos , Área sin Atención Médica , Estados UnidosRESUMEN
OBJECTIVE: To describe the lifetime prevalence of dental pain among Maryland's school age children. METHODS: Data come from the Survey of Oral Health Status of Maryland School Children conducted in 2000-01. History of dental pain, as reported by an adult respondent, was analyzed for 2,411 kindergarten and third grade students. Percentages with their 95% confidence interval were calculated to obtain state representation of the distribution of dental pain by sociodemographic characteristics and caries status. RESULTS: Overall, 11.8 percent of Maryland school age children in kindergarten and third grade have had some dental pain. Among children who have had caries, the report of dental pain increases to 28.2 percent. Children from families with low educational attainment or eligible for free or reduced meals or covered by Medicaid were more likely to have experienced dental pain. CONCLUSION: Almost a third of Maryland kindergartens and third graders who have caries have experienced dental pain.
Asunto(s)
Odontalgia/epidemiología , Niño , Preescolar , Caries Dental/epidemiología , Encuestas de Salud Bucal , Femenino , Humanos , Masculino , Maryland/epidemiologíaRESUMEN
OBJECTIVE: To compare the dental care utilization practices of rural and urban residents in the United States. METHODS: Data on dental care utilization from the 1999 National Health Interview Survey for persons 2 years of age and older (n=42, 139) were analyzed by rural/urban status. Percentages and 95 percent confidence intervals were calculated to produce national estimates for having had a visit in the past year, the number of visits, reasons given for last dental visit and for not visiting a dentist, unmet dental needs, and private dental insurance. RESULTS: Rural residents were more likely to report that their last dental visit was because something was "bothering or hurting" (23.3% vs 17.6%) and that they had unmet dental needs (10.1% vs 7.5%). Urban residents were more likely to report having a dental visit in the past year (57.7% vs 66.5%) and having private dental insurance (32.7% vs 37.2%), compared to rural residents. There were no significant differences in most reasons given for not visiting the dentist between rural and urban respondents. CONCLUSION: Dental care utilization characteristics differ between rural and urban residents in the United States, with rural residents tending to underutilize dental care.
Asunto(s)
Atención Odontológica/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Intervalos de Confianza , Etnicidad/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Seguro Odontológico/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Estados Unidos , Servicios Urbanos de Salud/estadística & datos numéricosRESUMEN
CONTEXT: The limited information available on the oral health status of rural children in the United States makes it difficult to devise policy strategies to address perceived problems. PURPOSE: To document the oral health status and dental care utilization of US children by place of residence, METHODS: Data from National Health Interview Surveys for 1995, 1997, and 1998, and from the third National Health and Nutrition Examination Survey (1988-1994) were analyzed. FINDINGS: Children residing in rural areas were more likely to be uninsured for dental care than were children from urban areas (41.1% versus 34.7%). A greater percentage of rural than urban children reported unmet dental needs (7.5% versus 5.6%); there was no difference in self-reported poor dental status. Urban children were more likely than rural children to have visited the dentist in the past year (73.6% versus 69.9%) and were also more likely to be regular users of dental care (61.7% versus 51.4%). Differences in percentage of rural and urban children with caries lesions and caries experience were not significant. CONCLUSIONS: Children residing in rural areas have less access to and utilization of dental care compared to children residing in urban areas. Moreover, poor rural children display less utilization of dental services than poor urban children. Differences in the sum of decayed and filled primary teeth and the sum of decayed, missing, and filled permanent teeth were not significant.
Asunto(s)
Atención Dental para Niños/estadística & datos numéricos , Índice de Higiene Oral , Salud Rural , Salud Urbana , Adolescente , Niño , Preescolar , Atención Dental para Niños/economía , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Investigación sobre Servicios de Salud , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro Odontológico , Masculino , Pacientes no Asegurados , Pobreza/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Little is known about the oral health care of older rural residents. The authors describe oral health indicators for the older adult population by place of residence in the United States. METHODS: The authors analyzed data from the Third National Health and Nutrition Examination Survey and the 1995, 1997 and 1998 National Health Interview Surveys. Oral health indicators included perceived oral health (self-reported dental status and unmet dental needs) and dental status (untreated caries; decayed, missing and filled permanent teeth, or DMFT; and edentulism). Dental care utilization and access were measured by number of dental visits, frequency of dental visits and dental insurance status. RESULTS: Older rural adults were more likely than their urban counterparts to be uninsured for dental care (72.1 percent versus 66.1 percent, respectively) and were less likely to report dental visits in the past year (46.9 percent versus 58.4 percent, respectively). A higher proportion of rural residents than urban residents were edentulous (36.7 percent versus 28.2 percent, respectively) and reported poor dental status (50.7 percent versus 42.2 percent, respectively). There were no differences in unmet dental needs, percentage of people with untreated caries or in mean DMFT by place of residence. CONCLUSIONS: Older rural residents inadequately utilize dental care and have less favorable oral health indicators than do older urban residents. CLINICAL IMPLICATIONS: This article shows the need for more dental practitioners in rural areas. With the low density of dentists per person and the high need for care, rural America offers an excellent opportunity for oral health professionals to provide much needed services.
Asunto(s)
Estado de Salud , Enfermedades de la Boca/epidemiología , Salud Rural/estadística & datos numéricos , Enfermedades Dentales/epidemiología , Anciano , Análisis de Varianza , Actitud Frente a la Salud , Índice CPO , Atención Odontológica/estadística & datos numéricos , Caries Dental/epidemiología , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Indicadores de Salud , Humanos , Seguro Odontológico/estadística & datos numéricos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Boca Edéntula/epidemiología , Evaluación de Necesidades , Servicios de Salud Rural/estadística & datos numéricos , Estados Unidos/epidemiología , Salud UrbanaRESUMEN
AIM: The aim of the study was to ascertain periodontal treatment needs and their socio-demographic determinants among adults in the United States by transforming nationally representative periodontal data into an index routinely used internationally. DESIGN: Data were abstracted from a complex, highly stratified, multistage probability cross-sectional study to create a modified Community Periodontal Index of Treatment Needs (CPITN). PARTICIPANTS: 11,339 persons aged 20-79 who participated in the third US National Health and Nutrition Examination Survey (NHANES III), 1988-94. RESULTS: At least 3% of the adult US population required complex periodontal treatment, 90% needed scaling and prophylaxis, and nearly 5% did not need periodontal treatment or oral hygiene instruction. A multivariate cumulative logistic model indicated that being older, male, non-Hispanic black, having lower education, smoking, or not having had a dental visit in the past year increased the likelihood of needing more complex periodontal treatment. The risk factors that indicated the greatest potential for increasing complexity of periodontal treatment, after controlling for all covariates, were being either non-Hispanic black (OR=2.51; 95% CI=1.98, 3.18), or not completing high school (OR=2.10: 95% CI=1.60, 2.77), or a current cigarette smoker (OR=2.02; 95% CI=1.76, 2.33). CONCLUSIONS: The need for increasingly complex periodontal treatment differs by sociodemographic factors. Most American adults need some type of periodontal treatment; however, the majority of periodontal treatment needs in the US are within the clinical skill range of dental hygienists. There is significant disparity in the distribution of need for periodontal treatment; persons from socially disadvantaged groups are more likely to present with increasing complexity of periodontal treatment needs.
Asunto(s)
Evaluación de Necesidades/estadística & datos numéricos , Enfermedades Periodontales/epidemiología , Índice Periodontal , Adulto , Factores de Edad , Anciano , Intervalos de Confianza , Estudios Transversales , Atención Odontológica/estadística & datos numéricos , Profilaxis Dental/estadística & datos numéricos , Raspado Dental/estadística & datos numéricos , Escolaridad , Etnicidad/estadística & datos numéricos , Femenino , Educación en Salud Dental/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Higiene Bucal/estadística & datos numéricos , Grupos Raciales , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología , Estados Unidos/epidemiología , Poblaciones Vulnerables/estadística & datos numéricosRESUMEN
OBJECTIVES: This study describes the relationship between dental needs and dental care utilization among children. METHODS: Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to analyze dental care needs and dental care utilization. RESULTS: Younger children with perceived needs (needs perceived by the child or responsible adult) were more likely to be episodic users of dental care than children without perceived needs. Younger children with normative needs (defined by the presence of untreated caries diagnosed by a dentist) were less likely to be regular users. Older children with perceived or normative needs were more likely to be episodic users and less likely to have had a previous-year visit than children with no needs. CONCLUSIONS: Despite their presence, dental needs do not drive dental care use among children, and children's dental care utilization is inadequate.