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OBJECTIVE: To establish baseline data of dental utilization and determine the predictors of receipt of dental procedures by Medicaid-enrolled senior adults who reside in Iowa nursing facilities. METHODS: This was a longitudinal retrospective analysis of Iowa Medicaid claims data for SFY 2007-2014 of senior adults who were 68 years or older upon entry to a nursing facility and continuously enrolled (eligible 58 out of 60 months) in Medicaid for three years prior to and at least two years after admission. RESULTS: Controlling for the subject and nursing facility level variables, the strongest predictor of dental utilization after entry was the receipt of a dental procedure before entry (p< 0.001). Subjects residing in a facility located in an urban area (p< 0.002) or in two regions of Iowa (p=0.035, p=0.019, respectively) also had increased odds of receiving a dental procedure. CONCLUSION: Our results show that approximately 50% of the subjects never received a dental procedure in the 5-year study period. The strongest predictor of receipt of dental procedures in the 2 years after entry was the receipt of dental procedures in the 3 years before entry. It is important for Medicaid-enrolled senior adults to establish a dental home while community-dwelling.

Purpose. This study was conducted to identify factors that influence preventive dental behaviors and, from the results, target groups for intervention.Methods. Data were collected using the 1997 Behavioral Risk Factor Surveillance System (BRFSS) resulting in a probability sample of 399 dentate adults living in Richmond City, Henrico, Chesterfield and Hanover Counties in Virginia. All analyses were performed using the statistical software program STATA. Initial hypothesis testing was performed using univariate logistic regression models. Multivariate logistic regression models were used to test the significance of independent variables while controlling for other possible predictors of behavior.Results. Females were more likely than males to brush and floss their teeth at the recommended frequencies (OR 2.7, 95% CI 1.4-5.1; OR 2.8, 95% CI 1.5-5.1 respectively). Individuals with higher levels of education were more likely than those with lower levels of education to brush twice daily and have preventive dental visits (OR 4.2, 95% CI 1.3-13.2; OR 5.3, 95% CI 2.0-14.4 respectively). There was no racial difference in the three preventive dental behaviors.Conclusions. Findings suggest that sex and education are important considerations when planning dental health interventions. In the Richmond area, less educated males are in the greatest need of education and other interventions aimed at twice-daily toothbrushing and daily flossing. Further, men and women with lower levels of education are in need of interventions for increasing the utilization of preventive dental services.

Abstract The purpose of this study was to analyse the effectiveness and cost of fissure sealant treatment in preventing dental caries in children in a practice-based research network using survival analysis. The survival times of first permanent molars in children were analysed in three countries: in Finland (age cohorts 1970–1972 and 1980–1982), in Sweden (1980–1982) and in Greece (1980–1982), and additionally at two municipal health centres in Finland (age cohorts 1988–1990 in Kemi and 1990 in Vantaa). The study population comprised altogether 8 551 children. The data were collected manually from paper dental records (Finland, Sweden and Greece), and an automatic data-mining system for collecting data from electronic dental records was used in the case of the two health centres in Finland (Kemi and Vantaa). Comparisons of the survival times of first molars caries-free were performed between sealed and non-sealed individual teeth, and between the subjects in cases where a subject’s all first permanent molars were either sealed or non-sealed before the age of eight years. The cumulative costs of caries risk determination, use of xylitol, fissure sealant treatment, and restorations were calculated based on the data from the digital dental records of the health centres of Kemi and Vantaa. The results stressed the importance of caries-risk assessment on a tooth and subject level, when estimating the need for sealing treatment. Sealing of first molars of very high caries risk children (caries present in any of the permanent first molars before the age of eight years) seemed to be insufficient to prevent further dental decay later on. Instead, sealants were beneficial in caries prevention in medium-risk children (caries present in any of the permanent first molars between the ages of eight and ten years). Low-risk children (no caries in any of the permanent first molars before the age of ten years) did not benefit remarkably from sealant treatment. When sealant treatment were targeted only at high caries risk children based on risk-determination at the age of two years and all their permanent first molars were sealed (Kemi), their total treatment costs later were higher compared to the low-risk children, who were left unsealed. Significant differences in the survival curves of sealed and non-sealed first molars on a tooth and subject level confirmed that a translational approach is needed to study the effectiveness of preventive dental treatment in practice. The practice-based study model provides a good overview on the situation in real-life circumstances and helps to incorporate the evidence-based dentistry study results into everyday dental practice. / Tiivistelmä Tutkimuksen tarkoituksena oli analysoida fissuurapinnoituksen tehokkuutta ja kustannuksia lasten hammaskariesta ehkäisevänä toimenpiteenä käytäntöön perustuvan tutkimusmenetelmän ja elinkaarianalyysin avulla. Ensimmäisten pysyvien poskihampaiden elinkaarianalyysi tehtiin Suomen (ikäkohortit 1970–1972 ja 1980–1982), Ruotsin (1980–1982) ja Kreikan (1980–1982) aineistojen sekä lisäksi kahden suomalaisen terveyskeskusaineiston (Kemi 1988–1990 and Vantaa 1990) perusteella. Tutkimusaineisto koostui yhteensä 8 551 lapsesta. Tutkimukseen tarvittavat tiedot kerättiin manuaalisesti potilaspapereista Suomen, Ruotsin ja Kreikan aineistoista sekä elektronisesti suoraan kahden suomalaisen terveyskeskuksen (Kemi ja Vantaa) digitaalisista potilastietojärjestelmistä. Ensimmäisten pysyvien poskihampaiden elinkaarikäyriä verrattiin pinnoitettujen ja pinnoittamattomien hampaiden sekä pinnoitettujen ja pinnoittamattomien henkilöiden (kaikki neljä pysyvää ensimmäistä poskihammasta joko pinnoitettu tai pinnoittamatta kahdeksanteen ikävuoteen mennessä) välillä. Kumulatiiviset kustannukset karieksen riskimäärityksestä, ksylitolin käytöstä, pinnoituksista ja täytteistä laskettiin Kemin ja Vantaan terveyskeskusaineistojen perusteella. Tutkimuksen tulokset korostavat riskimäärityksen tärkeyttä pinnoituspäätöksen tekemisessä sekä hammaskohtaisesti että potilaskohtaisesti. Korkean kariesriskin lapsille (kariesta yhdessä tai useammassa ensimmäisessä pysyvässä poskihampaassa ennen kahdeksatta ikävuotta) pinnoitusten teho näytti olevan riittämätön estämään karieksen kehittymisen myöhemmällä iällä. Pinnoitukset olivat tehokkaita keskisuuren kariesriskin (kariesta yhdessä tai useammassa ensimmäisessä pysyvässä poskihampaassa kahdeksan ja kymmenen ikävuoden välillä) lapsilla. Matalan kariesriskin lapset (ei kariesta yhdessäkään ensimmäisessä pysyvässä poskihampaassa ennen kymmenettä ikävuotta) eivät hyötyneet merkittävästi pinnoitteiden kariesta ehkäisevästä vaikutuksesta. Kun pinnoitteet kohdennettiin valikoidusti lapsille joilla oli kahden vuoden iässä todettu korkea kariesriski ja heidän kaikki ensimmäiset pysyvät poskihampaat pinnoitettiin (Kemi), heidän osaltaan kokonaishoidosta seuranneet kustannukset myöhemmin olivat korkeampia verrattuna lapsiin joilla oli matala kariesriski ja joiden hampaita ei pinnoitettu. Pinnoitettujen ja pinnoittamattomien ensimmäisten pysyvien poskihampaiden hammas- ja henkilökohtaisten elinkaarikäyrien tilastolliset erot tutkituissa kohorteissa osoittavat, että käytäntöön perustuva tutkimusmenetelmä on suositeltava analysoitaessa hammashoidon tehokkuutta jokapäiväisessä toiminnassa. Käytäntöön perustuva tutkimusmalli antaa hyvän käsityksen todellisissa hoito-olosuhteissa tehtyjen toimenpiteiden tehokkuudesta ja avaa siihen uuden näkökulman sekä edesauttaa soveltamaan näyttöön perustuvan hammaslääketieteen tutkimustuloksia jokapäiväiseen hammaslääkärintyöhön vastaanotolla.

ABSTRACT:The purpose of this literature study is to study the dental caries status (DMFT) of 12-years-olds in Scandinavia and describe and compare the different preventive strategies and methods used by different dental care personal in each country and between these three countries. To achieve the objective information from scientific literature and publications, and data from WHO database on these three countries were used.DMFT for 12-year olds in Norway was 1.7 (2004), 0.7 for Denmark (2008) and in Sweden 0.9 (2008). During the past decade, changes have occurred in the prevention system of population- based prevention to individual-based prevention. This is a result partly of the low caries prevalence and partly because of a disproportional distribution of caries in this target group. It is regarded as a smart solution to be able to access the most affected or at risk patients who have the most dental care needs.The results showed different dental personals used different preventive strategies. Choices related to the use of fluoride vehicles were also varied. There were also differences in prevention strategies between different countries. This shows that despite the similarities in the dental teams, free and subsidized dental care for children there are also differences in quality of the offering of policies and practices. All this data confirm the differences between all three countries in choice of preventive method for risk and none-risk patients. This seems to be influenced by different cultural patterns within the dental professional communities of each country. Differences in caries incidence probably could be due to different combinations of preventive methods. There is a need for more research in this area. There is a need for a consensus about which strategy and approach is most effective and which one should be used against dental caries in risk and non risk patients, a consensus in which all countries agree to implement.