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Health Services Research on Dentistry in Aged Society

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Oral Health".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 24301

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Special Issue Editor

Prof. Dr. Hiroko Miura

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Guest Editor

Department of Oral Growth & Development, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan
Interests: community oral health; gerontology; preventive dentistry; health service research regarding dentistry; medical sociology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As the global aging of the population will continue, there is an urgent issue to provide enough oral healthcare services to all generations. Fortunately, the prevalence of dental caries in children is being improved in many countries through the expansion of fluoride applications. However, adequate oral health services are not yet being provided to the elderly.

Because the systems for providing dental services vary from country to country, there has been inadequate knowledge gathering on oral health care delivery. In particular, there is little information regarding the extent to which public services cover oral health for the elderly. Another major challenge for health services research in dentistry is the analysis of the dental professional workforce, which is essential for providing adequate dental health services to all generations.

Health services research requires multidisciplinary approaches that examine the relationship between social factors, financial systems, medical technology, accessibility to health care, and the quality and cost of health care. It has been shown that improvement of oral health plays a major role in improving quality of life. The provision of appropriate oral health services is expected to make a significant contribution to the maintenance and improvement of overall health status. We hope that the keywords listed below provide an outline of this topical collection.

Prof. Dr. Hiroko Miura
Guest Editor

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Keywords

oral health care service delivery
workforce analysis of dental profession
health care quality assessment
geriatric oral health
health insurance system
cost of oral health services
universal health coverage
real world data on dentistry

Related Special Issue

2nd Edition of Health Services Research on Dentistry in Aged Society in International Journal of Environmental Research and Public Health (4 articles)

Published Papers (9 papers)

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Research

19 pages, 1588 KiB

Open AccessArticle

On the Necessity of a Geriatric Oral Health Care Transition Model: Towards an Inclusive and Resource-Oriented Transition Process

by Ina Nitschke, Siri Nitschke, Cornelius Haffner, Bernhard A. J. Sobotta and Julia Jockusch

Int. J. Environ. Res. Public Health 2022, 19(10), 6148; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19106148 - 18 May 2022

Cited by 3 | Viewed by 1852

Abstract

People in need of care also require support within the framework of structured dental care in their different life situations. Nowadays, deteriorations in oral health tend to be noticed by chance, usually when complaints or pain are present. Information on dental care is also lost when life situations change. An older person may rely on family members having oral health skills. This competence is often not available, and a lot of oral health is lost. When someone, e.g., a dentist, physician, caregiver, or family member notices a dental care gap, a structured transition to ensure oral health should be established. The dental gap can be detected by, e.g., the occurrence of bad breath in a conversation with the relatives, as well as in the absence of previously regular sessions with the dental hygienist. The aim of the article is to present a model for a structured geriatric oral health care transition. Due to non-existing literature on this topic, a literature review was not possible. Therefore, a geriatric oral health care transition model (GOHCT) on the basis of the experiences and opinions of an expert panel was developed. The GOHCT model on the one hand creates the political, economic, and legal conditions for a transition process as a basis in a population-relevant approach within the framework of a transition arena with the representatives of various organizations. On the other hand, the tasks in the patient-centered approach of the transition stakeholders, e.g., patient, dentist, caregivers and relatives, and the transition manager in the transition process and the subsequent quality assurance are shown. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

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10 pages, 458 KiB

Open AccessArticle

Clinical Study of Oral Mucosal Lesions in the Elderly—Prevalence and Distribution

by Małgorzata Radwan-Oczko, Kinga Bandosz, Zofia Rojek and Joanna E. Owczarek-Drabińska

Int. J. Environ. Res. Public Health 2022, 19(5), 2853; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052853 - 01 Mar 2022

Cited by 6 | Viewed by 2074

Abstract

Background: The aim of the study was to determine the prevalence, pattern, and distribution of oral mucosa lesions in elderly patients attending an outpatient oral pathology clinic. Methods: A retrospective analysis of 2747 patients’ medical files was performed. Of these, 1398 (50.6%) belonged to seniors. The mean age was 69.8 ± 7.1, and women were in the majority. Results: Among the entire group of patients, the three most common mucosal lesions were: oral lichenoid diseases (OLDs), lingual changes, and small nodules. In the female group, the most common diagnoses were: OLDs, lingual changes, and oral candidiasis; in the male population, the most common diagnoses were: lingual changes, small nodules, and OLDs. Those suffering from OLDs were the youngest patients, and those with focal oral mucosa erosions and ulcerations were the oldest patients. In the groups aged 60–70 and 71–80 years old, the most common diagnoses were OLDs, and in the oldest group (+80 years old), they were lingual lesions. Conclusions: Oral health has an obvious impact on the functional, psychological, and behavioral quality of life. There is a small number of publications concerning the prevalence and distribution of oral mucosa lesions in the senior population of European countries. Our study is filling in that void. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

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15 pages, 1778 KiB

Open AccessArticle

Use of Oral Health Impact Profile-14 (OHIP-14) in Different Contexts. What Is Being Measured?

by Lucas Arrais Campos, Timo Peltomäki, João Marôco and Juliana Alvares Duarte Bonini Campos

Int. J. Environ. Res. Public Health 2021, 18(24), 13412; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182413412 - 20 Dec 2021

Cited by 41 | Viewed by 4366

Abstract

The Oral Health Impact Profile-14 (OHIP-14) has been used to assess the impact that oral health problems can have on an individual’s life. Different theoretical models were proposed to evaluate the results. The aims of this study were to evaluate the fit of different factorial models of the OHIP-14 to non-dental patients (NDP) and dental patients (DP) samples from Brazil and Finland and to estimate the differential functioning of the items in the OHIP-14 between the samples. Two studies were conducted, one in Brazil and the other in Finland, composed of five samples (Brazil—Sample 1 (S1): DP, n = 434, age: 25.3 [SD = 6.3] years; S2: NDP, n = 1486, age: 24.7 [SD = 5.6] years; S3: DP, n = 439, age: 29.0 [SD = 6.7] years; Finland—S4: DP, n = 482, age: 26.3 [SD = 5.4] years; S5: NDP, n = 2425, age: 26.7 [DP = 5.5] years). The fit of the OHIP-14 models to the data was estimated using a confirmatory strategy (validity based on the internal structure). Differential item functioning (DIF) between samples was estimated. For NDP from both countries, the response pattern severely violated the normality assumption in six items of the OHIP-14, indicating that the instrument does not fit for these samples. For DP, the model with the best fit was unifactorial, which deals with the estimation of the general impact of oral health on an individual’s life, without addressing specific dimensions. Configural invariance was refuted between samples. DIF indicated that the characteristic of the sample (NDP and DP) in both countries interfered in the response given to the items, with the response level being more adequate for the latent PD trait. The validity of data related to the impact of oral health problems on an individual’s life was confirmed through a unifactorial model. OHIP-14 works properly in DP samples and was limited in NDP samples, being also influenced by cultural context and age. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

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13 pages, 1507 KiB

Open AccessArticle

Development of a New Application-Based Chewing Efficiency Test (Mini Dental Assessment) and Its Evaluation by Nursing Staff in Geriatric Care: A Pilot Study

by Alexander Schmidt, Maximiliane Amelie Schlenz, Clara Sophie Gäbler, Steffen Schlee and Bernd Wöstmann

Int. J. Environ. Res. Public Health 2021, 18(22), 11889; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182211889 - 12 Nov 2021

Cited by 4 | Viewed by 1647

Abstract

The increasing average life expectancy worldwide results in an elderly population with significant health care needs. However, dental care is often not a focus of care. It is well known that oral and overall health are directly related. Therefore, the Mini Dental Assessment (MDA) was developed to provide a simple analysis of oral health status, although it is currently only available in paper form, with all associated drawbacks, from illegible writing to the inability to quickly search the collected forms. This study aimed to develop a digital application (app) for mobile devices that can overcome the problems associated with paper forms. After the digital MDA was developed, its usability was evaluated by nurses, a questionnaire was answered, and it was compared to the analog MDA with patients in a pilot study. The usability of the app (System Usability Scale) was 95.18 ± 4.26, representing a very high usability. Furthermore, this app showed good clinical applicability. The results also showed that the digital MDA was accepted by nurses in their daily routine and was preferred to the analog MDA. A follow-up study with a higher number of subjects is highly recommended. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

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12 pages, 1162 KiB

Open AccessArticle

Japan’s Dental Care Facing Population Aging: How Universal Coverage Responds to the Changing Needs of the Elderly

by Etsuji Okamoto

Int. J. Environ. Res. Public Health 2021, 18(17), 9359; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179359 - 04 Sep 2021

Cited by 7 | Viewed by 3271

Abstract

Although universal health coverage (UHC) is pursued by many countries, not all countries with UHC include dental care in their benefits. Japan, with its long-held tradition of UHC, covers dental care as an essential benefit, and the majority of dental care services are provided to all patients with minimal copayment. Being under UHC, the scope of services as well as prices are regulated by the uniform fee schedule, and dentists submit claims according to the uniform format and fee schedule. The author analyzed the publicly available dental health insurance claims data as well as a sampling survey on dental hygiene to illustrate how Japan’s dental care is responding to the challenges from population aging. A marked improvement was found in dental health status in the elderly population as measured by improved tooth-specific survival. The improvement may be attributable to the universal coverage of dental care, as evidenced by the steady increase in home visits by dentists/dental hygienists as well as home oral rehabilitation services. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

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10 pages, 317 KiB

Open AccessArticle

Multilevel Analysis of the Association of Dental-Hygienist-Related Factors on Regular Dental Check-Up Behavior

by Yuko Inoue, Yoshihiro Shimazaki, Akiko Oshiro, Takashi Zaitsu, Michiko Furuta, Yuichi Ando, Hideo Miyazaki, Masaki Kambara, Kakuhiro Fukai and Jun Aida

Int. J. Environ. Res. Public Health 2021, 18(6), 2816; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062816 - 10 Mar 2021

Cited by 4 | Viewed by 2936

Abstract

Few studies have examined the factors related to dental clinics during dental check-ups. We examined the association between dental-hygienist-related factors and patients’ regular dental check-ups. This nationwide cross-sectional study was based on a survey conducted in Japan in 2014. The analyzed population included 12,139 patients from 1181 dental clinics. We used three-level Poisson regression analysis, considering patient‒clinic‒prefecture, to examine the association of dental-hygienist-related factors with dental check-up behavior. Patients attending treatment and regular check-ups constituted 63.0% and 37.0%, respectively. The adjusted prevalence ratios (PRs) for patients undergoing regular dental check-ups at dental clinics with dedicated dental hygienists’ units, spending ≥20 min in patient education (compared to 0 min), and with three or more dental hygienists (compared to 0 hygienists) available were 1.17 (95% confidence interval [CI]: 1.06–1.30), 1.25 (95%CI: 1.07–1.46), and 2.05 (95%CI: 1.64–2.56), respectively. The median PR indicates that when a patient randomly moves to another dental clinic with more regular dental check-ups, this prevalence increased 1.69 times. These results suggest that dental check-up behavior is determined not only by individual factors but also dental-clinic-level factors. Improving the dental-hygienist-related factors is necessary to encourage people to visit dentists for regular check-ups. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

16 pages, 770 KiB

Open AccessArticle

by Ina Nitschke, Sebastian Hahnel and Julia Jockusch

Int. J. Environ. Res. Public Health 2021, 18(4), 2048; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18042048 - 19 Feb 2021

Cited by 11 | Viewed by 2660

Abstract

The aim is to analyze protective and modifying factors (e.g., vulnerability, resilience, sense of coherence) in relation to the utilization of dental services by seniors at different levels of the healthcare system. Terminological imprecision in the use and transfer of existing terms (sense of coherence, resilience, salutogenesis) to gerodontology is clarified. Factors influencing a reduced utilization (static/dynamic factors) can occur isolated or in combination and, thus, model the risk of a reduced utilization of dental services (influencing-factor mechanism). Protective factors of utilization include patient-specific factors for self-motivation and factors that promote oral-health-related resilience. Resistance forces that counteract can be identified as oral-health-related resilience factors. Achieving social and individual appreciation and establishing a prevention-oriented approach to utilization will be increasingly challenging, since the population is becoming older and access is not equal in terms of opportunity. Resistance forces need to be strengthened in an ethical context. Studies should increasingly present resilience processes, determinants and modes of action at the various interfaces in the healthcare system, which can ensure sustainable medical care in old age. The concepts conveyed here are generally valid and able to point out inequalities and ageism in access to dental services. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

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8 pages, 546 KiB

Open AccessArticle

The Relationship between the Sense of Coherence of Dental Hygiene Students in Their Graduation Year and Their View of the Profession and Attitude to Work: A Cross-Sectional Survey in Japan

by Rumi Tano, Hiroko Miura, Katsuo Oshima, Kanako Noritake and Hideki Fukuda

Int. J. Environ. Res. Public Health 2020, 17(24), 9594; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249594 - 21 Dec 2020

Cited by 4 | Viewed by 2191

Abstract

Objective: The need to make sense of coherence in placement support for student dental hygienists has been shown. On this basis, this study investigated the relationship between the sense of coherence of student dental hygienists and their view of the profession and attitude to work in order to clarify how they perceive their prospects for employment. Methods: The subjects were graduation-year students at all of the dental hygienist training institutions in Japan, and anonymous, self-administered questionnaires were sent to the institutions by post in 2019. The results were analyzed by χ² tests, as well as one-way analysis of variance and multiple comparisons using Tukey’s test, with the level of significance set at 5%. Results: Of 6270 questionnaires that were returned, 6264 were analyzed. The sense of coherence (SOC) component senses were manageability (F(26,221) = 5306.06, p < 0.01), meaningfulness (F(26,222) = 4373.48, p < 0.01), and comprehensibility (F(26,216) = 3986.12, p < 0.01), with meaningfulness scoring significantly higher than the other two (p < 0.01). Analysis with SOC scores divided into the low, medium, and high groups showed a relationship between the SOC of student dental hygienists and their view of the profession and attitude to work (p < 0.01), such that higher SOC scores were associated with a better view of the profession and a better attitude to work (F(26,225) = 282.18, p < 0.01). Conclusions: The results suggest that education that increases SOC in dental hygienist training programs may positively affect future prospects for student dental hygienists. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

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16 pages, 1722 KiB

Open AccessArticle

A Nationwide Survey on Working Hours and Working Environment among Hospital Dentists in Japan

by Tomoko Kodama, Yusuke Ida and Hiroko Miura

Int. J. Environ. Res. Public Health 2020, 17(23), 9048; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17239048 - 04 Dec 2020

Cited by 7 | Viewed by 2116

Abstract

Sustainable human resource is one of the main issues in healthcare delivery and the way hospital dentists work has a significant impact on oral and dental healthcare services. This study is the first large-scale nationwide survey aiming to investigate the working hours including the working environment among hospital dentists in Japan. A total of 2914 hospital dentists responded to self-administered questionnaires from general hospitals (GHs) and medical educational institutions (MEIs) across the country. Among full-time dentists, the younger generation (i.e., those in their 20s and 30s) of both male and female dentists working in GHs engage in over 40 h of in-hospital clinical practice per week, apart from their self-learning hours. In contrast, the middle-aged dentists (i.e., those in their 40s and 50s) at MEIs work for more than 50 h on average due to the added teaching and research responsibilities. In a multiple logistic regression model using “more than 60 h of work per week” as the dependent variable, higher ORs (Odds Ratios) were found in males (OR = 1.83, 95%CI 1.50–2.22), MEIs (OR = 1.92, 1.52–2.42), and individuals specializing in dental and oral surgery (OR = 1.85, 1.47–2.32). Task-shifting was requested by 22.6% of the respondents for preventive care and dental guidance. Only a few male dentists experienced taking a parental leave and the peak distribution of working hours was shorter for females working in GHs. The support for child-rearing in the work environment is still insufficient and a consensus on the involvement of male dentists in childcare is needed. Full article

(This article belongs to the Special Issue Health Services Research on Dentistry in Aged Society)

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