What determines utilization of dental care services? The case of Iran

Mohammadreza Amiresmaili, Saeed Amini, Arash Shahravan, Reza Goudarzi, Seyed Hossein Saberi-Anari


BACKGROUND AND AIM: Identifying the factors affecting utilization of dental services is one of the best ways to improve the health status. This study aimed to investigate the effective factors on utilization of dental services.

METHODS: In this cross-sectional study, 1185 household heads were selected randomly, and using a researcher-made questionnaire based on World Health Organization (WHO) Global Health Survey and Andersen behavioral model, and through multivariate logistic regression, the predictors of visiting a dentist during 1 year ago were investigated in 2017. The households’ income inequality in utilization of dental services was analyzed using concentration indices (CIs) and Pearson chi2 in STATA software.

RESULTS: The predictor of dental visit during 1 year ago for men was having decayed teeth [odds ratio (OR) = 1.3, P = 0.030], and the predictors for women were lower ages (OR = 0.8, P = 0.001 for 19-29 years old and so on), having 32 natural teeth (OR = 0.7, P = 0.020), and employment (OR = 1.3, P = 0.048). The common predictors were increase in education level (OR = 1.4, P = 0.001 for men, and OR = 1.7, P = 0.001 for women with university degree), brushing (OR = 1.9; P = 0.001 for women, and OR = 1.3; P = 0.040 for men), and having supplementary insurance (OR = 1.7,
P = 0.001 for men, and OR = 1.9, P = 0.001 for women). Being burdensome of dental care costs during 3 years ago (CI: -0.074, P = 0.001), avoiding visiting a dentist during 1 (CI: -0.501, P = 0.001) and 3 (CI: -0.501, P = 0.001) years ago because of its costs, and failure to do all dentistry recommendations during 3 years ago (CI: -0.516, P = 0.001) happen more frequently among the poor. Moreover, the poor used all dental services such as scaling (CI: -0.638, P = 0.001), filling (CI: -0.458, P = 0.001), and root canal (CI: -0.524, P = 0.001) less than the rich.

CONCLUSION: Dental health status is negatively affected by population socio-economic situation; therefore, it is necessary to implement policies to improve access to dental services among the undeserved.


Utilization; Dental Care; Iran

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Marcenes W, Kassebaum NJ, Bernabe E, Flaxman A, Naghavi M, Lopez A, et al. Global burden of oral conditions in 1990-2010: A systematic analysis. J Dent Res 2013; 92(7): 592-7.

Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. J Dent Res 2015; 94(10): 1355-61.

Borrell LN, Crawford ND. Social disparities in periodontitis among United States adults 1999-2004. Community Dent Oral Epidemiol 2008; 36(5): 383-91.

Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG. Social gradients in oral and general health. J Dent Res 2007; 86(10): 992-6.

Wamala S, Merlo J, Bostrom G. Inequity in access to dental care services explains current socioeconomic disparities in oral health: The Swedish National Surveys of Public Health 2004-2005. J Epidemiol Community Health 2006; 60(12): 1027-33.

Schwendicke F, Dorfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S. Socioeconomic inequality and caries: A systematic review and meta-analysis. J Dent Res 2015; 94(1): 10-8.

Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet 2012; 380(9846): 1011-29.

Allin S, Masseria C, Mossialos E. Measuring socioeconomic differences in use of health care services by wealth versus by income. Am J Public Health 2009; 99(10): 1849-55.

Wagstaff A, O'Donnell O, van Doorslaer E, Lindelow M. Analyzing health equity using household survey data: A guide to techniques and their implementation. Washington, DC: World Bank Publications; 2007.

Xu K, Klavus J, Evans DB, Hanvoravongchai P, Zeramdini R, Murray CJ. The impact of vertical and horizontal inequality on the fairness in financial contribution index. In: Murray CJ, Evans DB, Editors. Health systems performance assessment: Debates, methods and empiricism. Geneva, Switzerland: World Health Organization; 2003.

Bernabe E, Marcenes W. Periodontal disease and quality of life in British adults. J Clin Periodontol 2010; 37(11): 968-72.

Stahlnacke K, Unell L, Soderfeldt B, Ekback G, Ordell S. Self-perceived oral health among 65 and 75 year olds in two Swedish counties. Swed Dent J 2010; 34(2): 107-19.

Do LG, Spencer AJ, Slade GD, Ha DH, Roberts-Thomson KF, Liu P. Trend of income-related inequality of child oral health in Australia. J Dent Res 2010; 89(9): 959-64.

Ministry of Health and Medical Education, Oral Health Bureau. Oral health status in Iran 2012 [Online]. [cited 2012]; Available from: URL: http://iranoralhealth.ir/1395/07/13

Pakshir HR. Oral health in Iran. Int Dent J 2004; 54(6 Suppl 1): 367-72.

Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century-the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31(Suppl 1): 3-23.

Andersen RM, Rice TH, Kominski GF. Changing the U.S. health care system: Key issues in health services policy and management. Hoboken, NJ: John Wiley & Sons; 2011.

Van Doorslaer E, Clarke P, Savage E, Hall J. Horizontal inequities in Australia's mixed public/private health care system. Health Policy 2008; 86(1): 97-108.

Suominen AL, Helminen S, Lahti S, Vehkalahti MM, Knuuttila M, Varsio S, et al. Use of oral health care services in Finnish adult-results from the cross-sectional Health 2000 and 2011 Surveys. BMC Oral Health 2017; 17(1): 78.

Ueno M, Ohara S, Inoue M, Tsugane S, Kawaguchi Y. Association between education level and dentition status in Japanese adults: Japan public health center-based oral health study. Community Dent Oral Epidemiol 2012; 40(6): 481-7.

Forghani A. A criticism on health sector evaluation plan [Online]. [cited 2015]; Available from: URL: http://old.alef.ir/vdcdnf0xfyt0596.2a2y.html?271691

Matsuyama Y, Aida J, Takeuchi K, Tsakos G, Watt RG, Kondo K, et al. Inequalities of dental prosthesis use under universal healthcare insurance. Community Dent Oral Epidemiol 2014; 42(2): 122-8.

Murray CL, Knaul F, Musgrove P, Xu K, Kawabata K. Defining and measuring fairness in financial contribution to the health system. Geneva, Switzerland: World Health Organization; 2000.

Spencer AJ. What options do we have for organising, providing and funding better public dental care? Sydney, Australia: The Australian Health Policy Institute at the University of Sydney; 2006.

Ghorbani Z, Peres KG. Is the association between socioeconomic status and nonreplaced extracted teeth mediated by dental care behaviours in adults? Community Dent Oral Epidemiol 2015; 43(6): 532-9.

Frazadmoghadam M, Mohammadi TM, Mohammadi M, Goudarzi R. Evaluation of patient’s utility values for replacement options of lost teeth. Int J Adv Biotechnol Res 2017; 8(3): 1643-8.

Nassani MZ, Locker D, Elmesallati AA, Devlin H, Mohammadi TM, Hajizamani A, et al. Dental health state utility values associated with tooth loss in two contrasting cultures. J Oral Rehabil 2009; 36(8): 601-9.

Kullgren JT, McLaughlin CG, Mitra N, Armstrong K. Nonfinancial barriers and access to care for U.S. adults. Health Serv Res 2012; 47(1 Pt 2): 462-85.

Short ME, Goetzel RZ, Pei X, Tabrizi MJ, Ozminkowski RJ, Gibson TB, et al. How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. J Occup Environ Med 2009; 51(7): 786-96.

DOI: http://dx.doi.org/10.22122/johoe.v0i0.376


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