needs,demand etc

1. 12/7/2018
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2. D R . A E S H A Z A F N A
2 N D Y R P O S T G R A D U A T E
D E P T . O F P U B L I C H E A L T H D E N T I S T R Y
Utilization of
dental care

3. Contents
 Introduction
 Needs and demands
 Factors affecting utilization
 Studies on utilization
 Barriers to utilization
 Recommendations
 Conclusion
 References
 Previous year questions
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4. Utilization
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Refers to the number of individuals that utilize dental
services.
Utilization rate:
Refers to the proportion of a population that utilizes
dental services over a specified period of time.

5. FACTORS
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 Subjects must feel susceptible to disease .
 Must feel disease is potentially serious .
 Must feel that course of action that will prevent/alleviate the
disease for him .

6. Needs
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“A state of health assessed as in need of treatment by
a medical practitioner.”
– Cooper (1975)

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• Professionally defined quantity
of care that is required to
achieve or maintain health
optimal for a particular patient.
Need
• Quantity of care individuals
themselves feel that they need.
Want

8. Types of needs(bradshaw-1972)
Normative
need
Felt need
Expressed
need
Comparative
need
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9. APPROACHES
Normative-
dental health
survey
Felt –dental
care
questionnaire
Expressed-
analysis of Rx
records
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10. Need actually
existing in the
patient’s
mouth
Absolute
need
Which the
dentist can
detect.
Detectable
need
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11.  Dunning points out important questions such as:
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What are the dental needs of the community?
To what extent will prevention obviate the need of treatment?
How large is the demand for dental treatment in the population at current or
at different prices?
What dental manpower is available to serve the population and how efficiently
is it used?

12. Dental Needs
Primary
dental
care
Blood and
vulcanite
Systemic
infection
of dental
origin
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13. NEEDS ASSESSMENT
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IDENTIFY NEEDS CENTRAL TO PROFESSION
Identify critical needs of the population
Setting up of priorities
Provides baseline data for planning and evaluation

14. DEMAND
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Quantity of service that a consumer will buy at a
given price
Can be influenced by a number of factors & can vary as a
result of manipulation

15. Demand
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Potential
demand
• Unqualified
desire for
dental care
Effective
demand
• Desire plus
ability to
obtain dental
service
NEED
POTENTIAL
DEMAND
EFFECTIVE
DEMAND

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 According to PELTON
•GROSS INCREASE IN
POPULATION
•URBANIZATION
•EDUCATION
•OCCUPATIONAL CHANGES
•INCOME PER CAPITA
ed demand
s

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•EXPENSIVE DENTAL CARE
•COST OF TRAVEL
•TIME LOST FROM WORK
•COST OF CHILD CARE IN
FAMILIES WITH MORE
CHILDREN
ed (depressed)
demand
s

18. Overtreatment and Under
treatment
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Supply:
Quantity of service that will be provided at a given
price.

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21. Perfect Competition
Product of one seller must be the same as the product of any
other seller.
Each buyer or seller must represent so small a part of the
total market that he or she cannot individually affect the
price.
All resources are completely mobile.
All people involved, both dental professionals and patients
have complete information about the prices, needs, all
alternative treatments and all possible outcomes.
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manpower

23. Supply of dentists
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 The most commonly used approach for gauging dental manpower
supply is dentist : population ratio.
 Better the ratio the more the likelihood there is that the demand
for dental care can be met.
 Ratio does not indicate volume, nature, quality of dental care
provided.
 Nor does it allow for social, economic and political
characteristics, patterns of dental disease, paradental personnel
and regional distributions in manpower distribution within a
country.

24. Productivity of dentists
 Has an important effect on dentist : population ratio.
 Decreases with increasing age.
 Often related to quantity of work carried out and in dental terms
to numbers of teeth filled, extracted and replaced.
 Manpower productivity takes into account not only the amount of
disease prevented or treated but the level of training of the worker
carrying out the procedures.
 Productivity is improved when functions are delegated from one
level of performance to a lower one and by substitution of jobs.
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25. Utilization of dental health
manpower
 Areas with greatest shortage of manpower has the poorest
utilization of dental services.
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26. Factors affecting utilization
Age Gender Education
Socio -
economic
factors
Income Occupation Residence
Socio –
cultural factors
Socio –
psychological
factors
Organizational
factors
Economic
factors
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27. Age
 Lowest – < 5 yrs and > 65yrs
 Inverse U shape (Newman and Anderson in 1972)
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28. Gender
 Females > Males
 14 -24 yrs and 65yrs – Males = Females
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Bradley,
Meng and
Heft (2007)
studied fear
on dental
utilization
Females >
Males

29. Education
 Level of education
 Education level of the head of the household.-important predictor
 White > non white (Anderson and Newman 1972)
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Miguel
et al
2005
Socio-
economic
variables on
dental
service
utilization
Children of
parents with
lowest
educational
level were 1.36
times less likely
to have visited a
dentist.

30. Socioeconomic status
 Higher social class > lower social class
Income
 Family income – imp factor
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Higher utilization
Good
educational
background
High status
occupations
High
incomes

31. Miguel et al
2005
Socio-economic
variables on dental
service utilization
Likelihood of not
having visited a
dentist rose 2.3 fold
in cases where
monthly
income<900euros.
Jamieson and
Thomson
2006
Studied adult Oral
health inequalities
using household
based method of SES
High SES had lowest
prevalence of caries
and had more no of
visits to the dentist in
the last 2 years.
Bradley,
Meng, Heft
and Lang
2007
Fear and other
factors on dental
utilization
Participants with
annual house hold
income -$50,000-
$99,999 were regular
dental attenders .
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32. Occupation
 Occupation of head vital
 Professional group – Highest utilization
 More in Non shift workers than shift workers
( Peterson 1981 )
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33. Geographic location
• Location of both individual and family
• More utilization in US and Far West Countries
• Urban area more utilization
• Dental services Density More utilization
(Henderson 1977)
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34. Socio – cultural factors
 Family, its kinship, friendship networks influences the manner in
which individuals define and act upon symptoms of life crisis.
(Mc Kinlay 1972)
 Zola 1966 particular symptoms acted upon are defined by the
culture, ethnic or reference group and that the structure of a group
and the health orientation and value system played an important
role in defining utilization behavior.
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35. Social – psychological factors
 Why do some people attend regularly for preventive and
therapeutic care before symptoms appear while others attend
only when they experience pain or discomfort???
 Fear of dental treatment to inevitability of tooth loss with age
 Motivation, perception and learning !!!!
 Mc Kinlay three major principles(1972)
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The extent to which people see the problem as
having serious consequences.
Behavior emerges out of the conflict among motives
and among courses of action .
Health related motives may not always give rise to
health related behavior

36.  In a study by Meng, Bradley, Heft and Lang in 2007 in Florida,
they found that
1. Participants reporting high fear of dentistry were nearly four times more often
to put off making an appointment than those reporting low fear.
2. Blacks significantly put off more appointments than whites.
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 In another study by Gilbert and Heft in 2006 in Florida, people
with positive dental attitudes reported higher number of
preventive and restorative visits than other participants. The
frustated believers have access to dental care equivalent to the
favorable group but may delay seeking dental care until oral
diseases become more severe.

38. Community variables
• Low utilization in fluoridated area
(Anderson & Neumann 1975)
• Large community more utilization
(Mc Farlaine 1985)
• Health care facilities utilization
Organizational and economic
factors
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39. Health behavior and utilization
 Douglass and Cole
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Health behavior
demographic
characteristic
Show a relation between
preventive visits and the
information that the
potential patients have
about teeth and gums
Early childhood training
and education of parents.
Health belief
model
Individuals must feel
susceptible to disease
Individuals must feel that
disease is potentially
serious in its effects in
regard to them
The course of action will
prevent or alleviate the
disease is available to
them
Motives and
barriers to seeking
asymptomatic care
Strength of motivation
must be weighed against
the barriers, real or
perceived to gain a
clearer understanding of
patterns of preventive
utilization.

40. Prepaid care and utilization
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The effect of dental insurance coverage
varied with the socioeconomic class of
insured population
Groups who voluntarily purchased dental
insurance had the highest utilization rates
Marketing and enrollment characteristics of
the plan did not affect utilization
substantially
After an initial marked increase, utilization
rates decreased as the length of time
coverage increased.

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NORC/ University
of Chicago study
Studies
in INDIA
USPHS/
University of
Colorado study
Institute
of
Medicine
study
Studies

42. NORC/ University of Chicago
Study
- studied - reported
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1964 1972
•Highest users – highest incomes and highest level of education
•Newman and Anderson – dental utilization had remained relatively
low.
•Mean no of visits per family – 4.6
•Proportion of families visited – 65%
•Mean visits per person – 1.5
•Proportion of persons with visits – 45%
•Utilization, when plotted against the demographic variable of age,
resulted in a curve of an inverse U

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•Females utilized dental services more than males, whites more
than non whites
•Differences also influenced type of dental service received.
•Cleanings, examinations and x rays, fillings and inlays - whites
•Dentures, extractions, other services – non whites
•Newman and Anderson – impact of dental insurance much
less in terms of utilization than might be anticipated.
•Newman and Anderson – overriding importance of dental health
status in relation to utilization.

44. USPHS/ University of Colorado
Study
 Bauer and colleagues at University of Colorado under contract of
U.S. Public Health Service.
 Reviewed 44 studies from 300 studies
 Common defect – widespread reliance on retrospective data.
 Problems –measure of utilization Annual no. of dental visits
per person.
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 ADA’s Bureau of Economic
and Behavioral research
purports to show that while
the number of dental visits
per capita has remained
relatively constant between
1959 and 1979, the number
of dental procedures per
capita has increased almost
two fold.

46.  Conclusion:
 Most important determinants of dental care utilization:
1. Income
2. Dentist : Population ratio
3. Social class
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47. Institute of Medicine Study
 Douglass and Cole for Institute of Medicine and funded by
Kellogg Foundation.
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•Increase in percentage of persons visiting a dentist within a 2
year period from 55 to 62%
•Increase in gradual increments.
•No of people who have never seen a dentist declined in
proportionately from 17% in 1963-64 to under 10% in 1976.
•Inverse U shaped curve by age
•Females > males
•Whites > non whites

48.  Urban > farm / non farm rural residents
 Residents in Northeast > Residents of South
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Income
Educational
level
Occupation
Social class
Socioeconomic
status
Directly
proportional to
utilization

49. The UAW Study of Utilization with
Dental Coverage
 Glasser and Hoffman 1981 of United Auto workers
 2 phases:
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1st phase
A prebenefit survey
of random sample of
596 Michigan auto
workers’ families
was conducted prior
to institution of the
united auto workers
dental contract in
october 1974.
2nd phase
Analysis of actual
claim forms
submitted to Delta
dental plan of
Michigan for the
Pontiac UAW auto
workers

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subject seminar - dr. deepti
Simply stated “ several important changes were noted in the
patterns of dental utilization from before to after the benefit
plan went into effect.
1. Male and female differences were eliminated.
2. More adults and families with children used the care, especially
those in the child rearing ages of 25 -45.
3. Percentages of persons seeking care increased over the three year
period studied – especially for preventive services.
4. Mean number of visits was almost the same in the 1st 2 years.
5. So called backlog phenomenon did not occur.
6. Percentage of sample receiving care was no different from the
that reported for the year prior to the plan, so they claimed.
7. More children, whites, and those with higher education and
income had more visits received more services and received more
preventively oriented services.

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STUDIES IN INDIA

52. Oral health status in relation to socioeconomic factors
among the municipal employees of Mysore city.
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 A study was conducted among the municipal employees of
Mysore city in 2004 to assess the prevalence of dental caries,
periodontal diseases, oral pre-malignant, and malignant lesions in
relation to socio-economic factors.
 According to the findings of the study, subjects who had caries
were higher in the persons with lower socio-economic status.

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 This can be attributed towards poor utilization of dental services
which can be related to the cost and lack of awareness on the
etiological factors for oral diseases.
 During any dental program planning, priority should be given to
lower class people having higher prevalence of diseases and
unmet treatment needs.

54. Barriers to the utilization of dental services in
udaipur, India.
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 Kakatkar G, et al conducted a cross-sectional survey among 427
randomly selected individuals in Udaipur in 2009 using a pre-
tested questionnaire.
 OBJECTIVES :
 To determine the barriers in regular dental care and home care
and to assess their association with age, sex, education, and
income..

55. Results
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 Male group had more dental visits, but females experienced higher
dental fear.
 The younger age group had more visits within 1 year in comparison to
the older group.
 Increase in education decreases the barriers for regular dental care.
Income had a significantly negative correlation with dental visit.
 This study also revealed the patient's perceived need that people visited
the dentist only if they had symptoms which may be due to their belief
that dental conditions are not serious or life threatening.

56. Measurement of utilization
• Annual number of visits for dental care per Person
• Proportion of persons in a population group visiting a dentist
every year
• Number of visits to a dentist within certain specific period of
time
• Reported number of first visit to a dentist by patients making
a series of visits within a specified time
• Number of annual visit among persons who make at least one
visit to a dentist
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57. Problems in Information of
utilization
Sampling problems
Frequency rather
than type
Difficulty of recall
Blaming the
deviant
Source of
data
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58. Utilization
Probability of
Use
% of people
visiting dentist at
least once within
defined period
Level of Use Intensity of Care
Number and mix
of services
received
Number of visits
made by those
making at least
one visit
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59. Barriers to dental care
utilization
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Perceived need for care - psychosocial Lack of perceived need
Lack of knowledge about systems
Priorities in life
Inconvenience of appointments
Too busy/problem of work
Low priority to dentistry
Acceptability
Access problems
Fear and anxiety
Cost

60. Recommendations
National utilization studies
Each mutable variable affecting dental health status
Regular data gathering
Plans to monitor impact of national ,state and local
health policies
How actual dental need influence level of perceived need
and how these two effect utilization.
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61. Conclusion
 Dental needs do exist in the populations but type of care to be
rendered should be based on resources available and the demand
for care.
 Dental needs vary with sex, race, frequency of treatment, income
and region.
 Demand for care can be influenced by a number of factors and
can vary as a result of manipulation.
 Scope for service includes incremental dental care,
comprehensive dental care but the emphasis is on prevention
rather than treatment in any public health programme catering to
the needs of children, elderly and other needy groups.
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 In India, people encounter various obstacles in utilization of dental
services.
 These barriers can be removed by motivating people and making them
aware about the oral health problems that remove anxiety and fear so that
they develop positive attitude towards dental treatment.
 It is suggested that mobile dental clinics, dental camps, and dental
outreach programs could be solutions to spread awareness and disseminate
treatment.
 There is a need for reasonably priced, rural oral health centers to make
dental care available to rural strata of the population.

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 Unmet treatment needs of the people belonging to lower class
should be addressed during conduction of dental programs.
School-based screening and motivation programs significantly
improve the percentage of children who seek free dental
treatment at a dental school.
 These programs can also target lifestyles and needs of the school
children.

64. References
 Geoffrey L Slack, Brian A Burt , Dowell TB. Dental Public Health –An
introduction to community dental health .Planning National Dental Health
Services 2nd Ed, John.Wright & Sons,1981: 133-148.
 Stiffler F D, Young O W, Burt A B. Dentistry, dental practice, the community,
3rd Ed, W B Saunders company, 1983:318-338.
 Cynthia M.Pine. “Community Oral Health”. Health needs assessment, 1st Ed,
John.Wright & Sons,1997: 40-42.
 Hiremath SS, Textbook of preventive and community dentistry, Elsevier ,pg
219-223
 Jamieson L.M.,Thomson M, Adult oral heath inequalities described using area
based and household based socioeconomic status measures. J Public Health
Dent ;2006;66;104-109
 Miguel et al. Influence of sociodemographic variables on dental service
utilization and oral health among the children included in the year 2001
spanish national health survey. J public Health Dent 2005; 65;215-220
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 Bei wu.dental service utilization among urban and rural older adults in china –
a brief communication J public health dent 2007;67;185-188
 Gilbert GH, Heft MW dental attitudes:proximal basis for oral health disparities
in adults. Comm Dent Oral Epidemiol 2006;34;289-98
 Meng,heft,Bradley,Lang effect of fear on dental utilization behaviors and oral
health outcome Comm Dent Oral Epidemiol 2007;35;292-301
 Public Policy Options for Better Dental Health: Report of a
Study.chap 4.supply of dental services
 Chandra Shekar BR, Reddy C. Oral health status in relation to
socioeconomic factors among the municipal employees of Mysore
city. Indian J Dent Res. 2011;22:410–8. [PubMed: 22048581]
 Kakatkar G, Bhat N, Nagarajappa R, Prasad V, Sharda A, Asawa K, et
al. Barriers to the utilization of dental services in udaipur, India. J
Dent

66. Previous year questions
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 Utilization of dental services ( rguhs)
 Needs (rguhs 2018)

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