Magister Scientiae Dentium - MSc(Dent) / A good oral health self-perception can contribute to improved knowledge of oral health self-care and practice as well as increase the proper use of dental care services. This study evaluated how adolescents from urban and peri-urban Maputo City assess their oral health status, behaviour and oral health risk factors. This is an analytic cross-sectional study, conducted in the urban and peri-urban schools of Maputo City involving adolescents in the age groups of 12 and 15-19 years old. The study was carried out in five schools, three Complete Primary schools and two Secondary schools from urban and peri-urban areas in Maputo City selected by convenience due to their geographic location. The size of the sample was 500 comprising 236 twelve year olds and 264 15-19 year olds. Data was collected using a self-completion questionnaire designed by the World Health Organization (WHO) and translated into Portuguese. The questionnaire included variables such as socio-demographic data (age, gender, location and parent or guardian level of education), self-assessment of oral health status and quality of life; self reported oral health behaviour and lifestyles, oral health risk factor knowledge (alcohol, tobacco and dietary), dental visits and daily impact of oral health. Chi-square for associations and a Spearman correlation tests were used to determine relationships between categorical data. All tests were assumed statistically significant at p≤0.05. The results showed that most of the adolescents classified their teeth (49.7%) and gum (38.2%) health as normal. There was no statistical difference between adolescents from urban and peri-urban schools (Spearman rs (399) = 0,114, p =0,02). The majority (n=322; 65.2%) of the adolescents clean their teeth twice a day. There was no difference between school level (primary and secondary school) and frequency of teeth cleaning. Most of the adolescents use a toothbrush (97.8%) and toothpaste (93.5%) to clean their teeth and only 11.9% also use dental floss but 52.1% didn´t know if their toothpaste was fluoridated or not. Smoking was reported by less than 1% of the adolescents. The main reason for dental service utilization, (reported by 67.5%) was pain or problems with teeth, gums or mouth. There was an association between oral health status and problems experienced in daily life because of their teeth and mouth. There was no significant difference for oral health assessment, risk factors and behaviours, between adolescents from urban and peri-urban schools. Although some satisfactory results were found, the need to strengthen oral health promotion in schools is high, especially considering the causes for dental service utilization were mostly pain and trouble with teeth in this group.

OBJECTIVES: To investigate determinants of dental care utilization among low-income African-American women, focusing on psychosocial factors and predictors relevant to this population. METHODS: We used data from Wave I and II of the Detroit Dental Health Project. Participants were selected to represent African-American women caring for young children, and living in Detroit households below 250% of the federal poverty level. Papers I and II are cross-sectional, using baseline data from 969 women. Paper III follows 736 women longitudinally. Our main outcome variable was dental care utilization. The main independent variable in paper I was depression. The role of social support as a moderator was also assessed in that paper. In paper II, the main independent variables were depression, perceived discrimination, and food insufficiency, both individually and in combination. Paper III employs the framework of the Behavioral Model for Vulnerable Populations to assess predisposing, enabling and need factors predicting the incidence of dental visits. RESULTS: Only 41.8% of the women had a dental visit within the past year. Cross-sectional analyses indicated that depressed women had lower odds of having a dental visit within the past year (OR=0.71, 95%CI=0.53-0.94). Emotional social support attenuated the effect of depression on dental visits. Women with high levels of perceived discrimination and those with food insufficiency were less likely to have dental visits in the past year (OR=0.65, 95%CI=0.44-0.95, and OR=0.64, 95%CI=0.44-0.93, respectively). Depression and perceived discrimination were also associated with less preventive visits. When psychosocial stressors were combined, they acted synergistically to lower the odds of having dental visits, including preventive and treatment visits. Longitudinal analyses of the data identified significant interactions between dental insurance and perceived discrimination (P =0.02) and between dental insurance and having a dental home (P =0.04). Experiencing pain in the teeth or gums was also a significant predictor of future dental visits. CONCLUSIONS: Our findings indicate the importance of considering psychosocial factors when studying dental care utilization among low-income African-American women. Our findings also suggest that establishing dental homes, graduating culturally competent dental providers, and providing emotional support resources might improve dental care utilization among these women. / 2019-09-26T00:00:00Z

Introduction: Oral health impacts much more than a person’s teeth and smile. Research indicates a connection between oral health and illnesses like cardiovascular disease and depression. Poor oral health could lead to social stigmatization and affects a person’s quality of life. Increased dental visits help detect and treat dental disease and offer opportunities for preventive care. Notably, the proportion of older adults in Tennessee is rapidly increasing, coupled with the growing complexity of older adults’ dental treatment. The first aim of this longitudinal study was to examine the prevalence of dental care visits among older persons (≥60 years) in Tennessee from 2010 to 2018. Our second aim was to examine the determinants of dental care visits among our target population. Methods: This study used five even years of Behavioral Risk Factor Surveillance system (BRFSS) data including years 2010, 2012, 2014, 2016, and 2018. BRFSS is a network of health-related telephone surveys conducted by all 50 states, the District of Columbia, and participating US territories. Our data was limited to Metropolitan and Micropolitan statistical areas, including East, Middle, and West Tennessee, while focusing on seniors (≥60 years old). Descriptive statistics were conducted. Weighting was conducted to account for the complex sampling design. Logistic regression analysis was performed to determine the factors associated with dental clinic visits among Tennessee seniors from 2010 to 2018. A p-value<0.05 was considered statistically significant. Results: The current study comprised of 5,362 Tennessee seniors. The year 2012 had the most seniors (1,324) and 2018 had the least number of seniors (787). About 64% of participants visited dentists or dental clinics within the past year while 18% reported that their last dental visit was ≥ 5 years ago. The percentage of older individuals visiting dental clinics within one year gradually decreased from 76.46% in 2010 to 71.17% in 2018. The majority of participants were females (51.7%), Whites (81.3%), never-smokers (46.3%), had good/better health (71.2%), and were located in Middle Tennessee (43.5%). Approximately 19% of Tennessee seniors removed all their permanent teeth. Logistic regression showed that those more likely to visit dentists or dental clinics included females (OR: 1.40; 95% CI: 1.11-1.77), former smokers (OR: 2.23; 95% CI: 1.46-3.41), never-smokers (OR: 2.21;95% CI: 1.46-3.35), individuals who had some college education (OR: 1.64 ;95% CI: 1.11-2.44), and graduated from college (OR: 2.74; 95% CI: 1.78-4.20). Likewise, individuals with a higher level of socioeconomic status, including a high income of $>50,000 (OR: 5.49; 95%CI: 3.60-8.36), were more likely to report dental visits. Conversely, Blacks (OR: 0.60; 95% CI: 0.43-0.82), participants with fair/poor health (OR: 0.67; 95% CI: 0.51-0.84), and those that have never-married (OR: 0.46;95% CI: 0.29-0.74) were less likely to report dental visits. Conclusions: The percent of Tennessee seniors visiting dental clinics within one year has gradually decreased from 76.46% in 2010 to 71.17% in 2018. The factors associated with a higher likelihood of seeking dental care include non-smoking status, identifying as females, and high socioeconomic status. Effective interventions to improve dental visits should take the identified factors into account.