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Dental care has great importance in the overall health of every individual. Many do not realize the effect oral health plays in their overall health and many areas in the United States do not have access to the dental care needed to obtain proper healthcare standards. In many of these areas, such as the Appalachian region, dental services for low-income citizens are limited. Specifically, in the Northeast Tennessee region, these dental services are severely limited. Washington County and Hawkins County of Northeast Tennessee are specific underserved areas in the Appalachian region. The purpose of this project was to explore the services for low-income residents of upper East Tennessee (the Tri-Cities region) to analyze if the services being provided are utilized, if they are meeting the needs of the individuals that are utilizing the service, and if there are barriers for access to dental care for low-income East Tennesseans. In this research, we surveyed three of the four safety-net dental clinics in the Tri-Cities region to determine the number of patients seen in a year; number of dental appointments filled in a week; if they have volunteer, full-time, or part-time dentists; and if they would expand their dental services if they could; and reasons a patient could be turned away. After analyzing the surveys, there is a need for more accessible dental care in the Tri-Cities region. While these clinics are seeing many patients, there is a lack of dentists and a lack of extensive care being given, which is often what these patients are seeking. Possible solutions to this problem could be proper oral health education in schools and dental hygienists working alongside school nurses, forms of transportation for patients to safety-net dental clinics, a mobile in-home dental office, and HRSA grants for dental personnel.

Philosophiae Doctor - PhD / Oral diseases are a major public health problem in the Seychelles, amidst a contracting budget coupled by a lack of national oral health policy and strategic plan to promote oral health. The oral disease burden is attributed to numerous determinants operating at different levels –macro, population and community, and at the person level. The study set out to examine the determinants that contribute to poor oral health in the Seychelles through an exploration of the social, cultural, economic and environmental factors influencing the oral health of adults. The purpose of the study was to develop an evidence-based theoretical framework that would inform future policy and practice for oral health. Set in the mixed research paradigm, a qualitative and quantitative research approach was used to obtain a deeper understanding of the pathways and mechanisms operationalizing determinants. Using a purposive sampling approach, individual and group interviews were conducted with patients, dental staff and a representative of the upper management.

Safety net clinics across the country struggle with a lack of resources to tackle the needs presented. Screening programs set up for children and elderly have proven to be effective in triaging need, prioritizing care, and maximizing resources. These programs do not currently exist for working uninsured adults. Research was initiated to answer the question: Does the screening process improve patient care for the community clinic? During a 6-week pilot study a licensed dental hygienist performed 30 screenings in the community clinic setting. Findings were recorded and coded according to patient’s level of need identified. Pre- and posttest data for patient care factors were attained. Statistical tests showed a significant effect on patient care factors. While the evidence existed to support the implementation of screening, more research would quantify the specific impact on this population.

Maintaining dental health is vital as it contributes to the psychological well-being of an individual and the overall systemic health through preventing chronic diseases. Unfortunately, poor oral health has been identified as a common trend in individuals with Autism Spectrum Disorder (ASD). There is limited research regarding the barriers that result in rates of increased dental manifestations in patients with ASD compared to neurotypical individuals. This study strived to identify the barriers that contribute to poor oral health in individuals with ASD in order to establish interventions to break those barriers and improve overall dental health in the Autism community. A descriptive, mixed methods study design was utilized that included 10 participants: adults with ASD (n=4), parents of children with ASD (n=4) and dental professionals (n=2). The ASD population were asked to complete a questionnaire that asked about home/office dental care, dental issues and anxiety, sensitivity to external stimuli in a dental office, physical challenges and parafunctional habits. Semi-structured interviews were conducted with dental professionals regarding their experience and training in treating patients on the Autism Spectrum. Three of the four parents reported that their child had high levels of anxiety regarding dental visits. Only one adult with ASD reported flossing on a regular basis, and bruxism was reported by all adults with ASD and all but one parent as an area of concern. Interviews with the two dentists revealed that families of individuals with ASD face financial barriers and reported infrequent visits from adults with ASD. Additionally, both dentists received minimal training in working with special populations. Further research is needed to improve the frequency of dental visits in adults with ASD, which can lead to an overall increased quality of life. Additionally, more training and guidance should be provided to dental offices on working with patients with ASD.

The purpose of this study was to find out the attitudes and beliefs of minority college students enrolled at Missouri College in Brentwood, Missouri in reference to the dental hygiene profession. In particular, does their oral health and dental knowledge relate to their knowledge of profession of dental hygiene? One hundred and six students gave their consent to participate in the study via Survey Monkey. The study was conducted in May 2015 for a period of four weeks. Four statements were designed to gauge minority students’ knowledge of dental hygiene as a career. No differences were found based on gender, age, education and ethnicity. A difference was found based upon the respondent’s program of study. Further research is needed spread the word about dental hygiene programs and to explain the role of the dental hygienist.

This qualitative study focused on the dental disparities in Blount County, TN and sought to determine if there are enough dental clinics within the dental safety net. Interviews were conducted with 18 individuals who were either service providers or clients of organizations such as the Salvation Army, Alcoa Good Samaritan Clinic, the local health department, Trinity Dental Clinic, Volunteer Ministry Center, Remote Area Medical, and Blount Memorial Hospital. Inclusion criteria for clients included: homeless or living below the poverty level, uninsured, 18 to 65 years of age, has not seen a dentist in the past year and currently suffering a dental problem. The most obvious common theme among the 11 clients interviewed was that they struggle with getting dental care. Patients were asked when the last time they had seen a dentist and they answered years ago, most over ten years ago. Eight of the eleven clients did not know of any facilities they could go to. Cost was the main reason for these clients not seeking dental care. Two dentists were asked about the reasons for disparities in dental care. The major common themes between the dentists were cost, access to care, and education. All five case managers said that they had clients experiencing dental needs ranging from a simple cleaning to an abscess. Currently in Blount County only one dental clinic serves over 17,000 residents who live in poverty.

Background / Objective: Children under the age of 5 years bear a disproportionate burden of oral disease. The aim of this study is to investigate how child, family, and community determinants impact dental care utilization, and parental report of child’s oral health. Methods: Data for this study came from the 2011/2012 National Survey of Children’s Health for children aged 1 to 5 years old. Dependent variables evaluated were if the child had an oral health problem, been to a dentist in the past year, and parents description of the child’s teeth. Independent variables were selected from child, family, and community levels. Binary logistic methods were applied to each outcome and predictor variable. Stepwise logistic regression models were constructed for child, family, and community variables. Additionally the mediating effect of oral health services utilization in the association between child, family and community factors and parental perception of child’s oral health was evaluated. National results and Health Resource Service Area (HRSA) region IV results were compared. Results: In the national (n=24,875) and HRSA region IV sample (n=4,017) 9.7% and 10.2% of caregivers, reported that the child had an oral health problem in the past 12 months. Fewer than half (46.7%) of caregivers reported that their child had visited a dentist in the past 12 months. Absence of neighborhood cohesion, neighborhood amenities, and residence in metropolitan statistical area all had positive significant effects on children seeing a dentist. There was a mediating effect by utilization of oral health services between child with special health care needs (p=0.005), number of children (p=0.045) and adults (p=0.046) in the household, and tobacco use (p=0.018) and parents perception of oral health in the HRSA region IV population. Conclusion: This study identified several factors as correlates of poor oral health outcomes. Our results expand our knowledge of early childhood oral health by studying how oral health is impacted not only by child factors but also the family and community at large. Our results begin identifying the unique constellation of risk factors that contribute to early childhood oral health.

This study investigated the effect of geographic location on Severe Early Childhood Caries (S-ECC) in Native American Children three years of age from a Norther Plains Tribal Community. Geographic location of study participants was ascertained by postal district and categorized into geographic regions as well as dental clinic accessibility, defined as dental services present or absent in that district. The association of location category and dental caries (dmfs) was evaluated cross-sectionally at 36 months of age. Descriptive statistics demonstrated differences in dental caries distribution by geographic region and accessibility category. Bivariate analysis of disease by location showed a significant difference in dmfs between 4 geographic regions (p=0.0159) but not between accessibility categories (p=0.0687). Multivariable regression modeling for geographic region demonstrated the unique effect of geographic region on dental caries experience as well as five other key risk factors. Incident Rate Ratios (IRR) were computed for each of the risk factors, including number of erupted teeth (IRR=1.89, p=0.0147), fluoride exposure from tap water (IRR=1.70, p=0.0173), annual family income (IRR=1.58, p=0.0392), maternal DMFS (IRR=1.02, p=0.0040), and Mean Adequacy Ratio (IRR=1.05, p=0.1042). This study demonstrated statistically significant variation in cumulative dental caries experience of Native American children aged 36 months among geographic regions and identified the specific unites of association through multivariate modeling. These findings can be used for local dental caries prevention programs and contribute to a broader understanding of S-ECC among very young Native American children.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.