Background: The South African National Defence Force (SANDF) like other Defence Forces of the world, conducts medical classification on their members. This medical classification has, as one of the components, an Oral Health Fitness (OHF) classification which is done according to North Atlantic Treaty Organisation (NATO) standards. The aim of the Oral Health Fitness classification is to standardize dental readiness, assess oral health, prioritize dental care, minimize the number of dental emergencies (DE), and emphasize the importance of good oral health to all active duty and reserve forces. Medical classification is conducted by the South African Military Health Services (SAMHS). Aim: The aim of the study was to evaluate the dental emergency outcomes of the Oral Health Fitness classification of the SAMHS in Area Military Health Unit Gauteng (AMHU GT), South Africa Objectives: To determine dental emergency rate for the SAMHS, analyse the dental emergencies and to make recommendations regarding dental emergencies to the SAMHS Methods: A cross-sectional retrospective record analyses of members of the SANDF that received an OHF classification of 1 and 2 in AMHU GT in 2009. The AMHU GT members were followed up for a year to determine if they developed dental emergencies. Data analysis included frequency tables, chi-square tests and logistic regression analysis. The level of significance was set at p<0.05. Results: The dental emergency rate for AMHU Gauteng was 307/1000 per year. The type of dental emergencies were: 58.5% dental restorations, 13% extractions and related complications, 4.3% crown and bridge, 3.9% emergency root canals, 9.9% recementations, 3.6% denture related problems while other emergencies were 6.8%. Patients were more likely to experience a dental emergency if they were white, female, of OHF 2 classification and older than fifty years of age. Conversely they were least likely to experience a dental emergency if they were black, male, of OHF 1 classification and in the age group 31-40. Conclusion: The dental emergency rate of 307/1000 per year for the SANDF is high compared to military health units from other countries and it was influenced by race, age and gender. The types of dental emergencies were mainly preventable. / Dissertation (MChD)--University of Pretoria, 2012. / Community Dentistry / Unrestricted

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Avoidable use of the Emergency Departments (EDs) constitutes a significant public health problem, which has health, economic and ethical implications. The factors that affect avoidable use of the EDs are complex and poorly understood. The goal of this dissertation was to examine the role of medical home in avoidable pediatric ED visits, assess the impact of Medicaid policy on ED visits for dental problems and assess the factors affecting follow-up dental care after a dental ED visit. Iowa Household Health Survey data was used for the first study, which included a sample of families with at least one child residing in Iowa. It was found that 68% of parents who took their child to an ED in the previous year thought the ED visit could have been avoided if primary care was available to them. Having a medical home was not found to be associated with pediatric ED visits; however, food insecurity was significantly associated. Parents of children with public insurance, those who were not referred by a healthcare provider and those who reported difficulty in getting routine care appointments were more likely to report an avoidable ED visit by their child. The second study examined a policy change in California where Medicaid eliminated its comprehensive adult dental coverage on July 1, 2009. State Emergency Department Database were obtained from Agency for Healthcare Research and Quality for California for 2006 through 2011. Interrupted time series, a quasi-experimental approach of was used to examine the impact of the policy change on rate of dental ED visits by Medicaid enrolled adults. Segmented linear regression revealed that policy change led to an immediate significant increase in the rate of dental ED visits. The policy had a differential impact on various subgroups based on age, race-ethnicity and residential location. The annual costs associated with dental ED visits made by Medicaid adults also increase 68%. Survival analytic approach was used in the final study to examine the patterns of dental care following a dental ED visit by Medicaid enrolled adults in Iowa. Medicaid claims and enrollment data were used to identify adults with an index dental ED visit in 2011, and then each subject was followed for up to 6 months. About 52% of all adults who satisfied the study inclusion criteria, had a follow up dental visit within 6 months of the index dental ED visit. Cox regression model revealed that adults who had visited a dentist in the year prior to the ED visit had greater hazards of having an early dental follow up after the ED visit. Having repeated dental ED visits was found to have a dose-response relationship to follow-up time to dentist visit, with those having 1 repeat ED visit having 53% hazards and those with 2 or more repeat ED visits having 34% hazards of having a follow-up dentist visit, compared to those with no repeat ED visits. Collectively, the results from this dissertation provide important insights in understanding the complex problem of avoidable ED visits. Factors such as food insecurity and medical home need to be further investigated in their association with avoidable ED visits. State Medicaid policy plays an important role and limiting Medicaid adult dental coverage may lead to an increased reliance of the affected population on EDs for dental care. However, EDs do not provide any definitive dental care, and our results indicate that almost half of the adults with dental ED visit do not have a follow-up dentist visit in the next 6 months.

Objetivo: Asociar el uso del servicio dental y la necesidad de tratamiento en residentes de Lima, Perú durante el aislamiento social obligatorio por la COVID-19 en el año 2020. Métodos: Estudio observacional, analítico y transversal. La muestra fue conformada por 223 residentes mayores de edad que cumplieron con los criterios de inclusión. Se tomó como base encuestas nacionales de autoreporte para seleccionar preguntas relacionadas a las variables uso del servicio dental, necesidad de tratamiento y covariables como sexo, ocupación, grado de instrucción, distrito de residencia, edad, ingreso económico y seguro de salud. Se realizó un análisis descriptivo mediante frecuencias absolutas y relativas, un análisis bivariado mediante la prueba de chi cuadrado y un análisis multivariado utilizando la regresión de Poisson con varianza robusta donde se reportaron razones de prevalencias crudas y ajustadas. Resultados: El 58.3% de los encuestados no hicieron uso del servicio dental durante el aislamiento social obligatorio a pesar de necesitar atención, siendo el principal motivo de inasistencia la pandemia por la COVID-19 (37.67%). Además, se registró que la urgencia (24,66%) fue la necesidad de tratamiento más predominante. No se halló asociación estadísticamente significativa entre el uso del servicio dental y la necesidad de tratamiento Conclusión: Las personas a pesar de tener una necesidad de tratamiento, no necesariamente utilizaron los servicios dentales durante el periodo de aislamiento social obligatorio en el Perú durante el año 2020. / Objective: To associate the use of dental services and the need for treatment in patients in Lima, Peru during social isolation mandated by COVID-19 in the year 2020. Methods: Observational, analytical and cross-sectional study. The sample consisted of 223 residents who met the inclusion criteria. National self-report surveys were used as a basis for selecting questions related to the variables use of dental services, treatment need and covariates as sex, occupation, level of education, district of residence, age, income and health insurance. A descriptive analysis was carried out using absolute and relative frequencies, a bivariate analysis using the chi-square test and a multivariate analysis using Poisson regression with robust variance where crude and adjusted prevalence ratios were reported. Results: 58.3% of the respondents didn’t make use of the dental service during the mandatory social isolation despite needing care, the main reason for non-attendance being the COVID-19 pandemic (37.67%). In addition, it was recorded that urgency (24.66%) was the most predominant need for treatment. No statistically significant association was found between the use of dental services and the need for treatment. Conclusion: Patients, despite having a need for treatment, did not necessarily use dental services during the period of compulsory social isolation in Peru in the year 2020. / Tesis