Unmet Dental Needs in Rural Primary Care: A Clinic-, Community-, and Practice-based Research Network Collaborative

The Journal of the American Board of Family Medicine

Sean Benson³  Melinda M. Davis⁴  Thomas J. Hilton²  Lyle Fagnan⁴  Jon Schott³  Paul McGinnis⁴  Alan Howard¹ 

[1] Academic Computing Services, The University of Vermont, Burlington (AH);School of Dentistry (TJH), Oregon Health and Science University, Portland;private practice, Baker City (JS, SB);Oregon Rural Practice-based Research Network (MMD, LF, PM), Oregon Health and Science University, Portland

关键词: Practice-based Research;    PBRN;    Oral Health;    Rural Health;    Community-based Participatory Research;   

DOI  :  10.3122/jabfm.2010.04.090080

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: Oral health is an essential component of general health and well-being, yet barriers to the access of dental care and unmet needs are pronounced, particularly in rural areas. Despite associations with systemic health, few studies have assessed unmet dental needs across the lifespan as they present in primary care. This study describes the prevalence of oral health conditions and unmet dental needs among patients presenting for routine care in a rural Oregon family medicine practice.

Methods: Eight primary care clinicians were trained to conduct basic oral health screenings for 7 dental conditions associated with International Statistical Classification of Diseases and Related Health Problems 9—Clinical Modification codes. During the 6-week study period, patients older than 12 months of age who presented to the practice for a regularly scheduled appointment received the screening and completed a brief dental access survey.

Results: Of 1655 eligible patients, 40.7% (n = 674) received the screening and 66.9% (n = 1108) completed the survey. Half of the patients who were screened (46.0%, n = 310) had oral health conditions detected, including partial edentulism (24.5%), dental caries (12.9%), complete edentulism (9.9%), and cracked teeth (8.9%). Twenty-eight percent of the patients reported experiencing unmet dental needs. Patients with dental insurance were significantly more likely to report better oral and general health outcomes as compared with those who had no insurance or health insurance only.

Conclusions: Oral health diseases and unmet dental needs presented substantially in patients with ages ranging across the lifespan from one rural primary care practice. Primary care settings may present opportune environments for reaching patients who are unable to obtain regular dental care.

• Practice-based Research
• PBRN
• Oral Health
• Rural Health
• Community-based Participatory Research

The Surgeon General's 2000 Report notes that oral health is an essential component of the general health and well-being of all Americans.¹ Oral health influences productivity, quality of life, and systemic health.^2,3 Dental conditions such as periodontal (gum) disease, a source of chronic infection and inflammation in the oral cavity, have been associated with atherosclerosis, diabetes, adverse pregnancy outcomes, and increased risk of myocardial infarction and stroke.^1,4,5 This may be a result of common pathophysiologic pathways that are involved in inflammation and altered host response.⁶ Tooth decay is the most common chronic disease in childhood, occurring 5 to 8 times more often than asthma.^7,8

Many oral health conditions can be detected early and are preventable with appropriate care.⁹ However, researchers have identified dental care as the most frequently reported unmet health need in national studies of both adult and youth populations.^9,10 Although annual dental examinations are an important form of preventive care, approximately 44% of Americans lack dental insurance and therefore may experience difficulties accessing nonemergency dental services.^9,11 Researchers have also documented disparities in the access and use of dental care among rural populations.^12–16 Compared with their urban counterparts, rural residents of all ages are more likely to have unmet dental needs and to report that their last dental visit was because something was “bothering or hurting.”¹³

Objectives of Healthy People 2010 indicate a need to increase the proportion of adults who use the oral health care system annually and to increase the proportion of low-income children and adolescents who receive preventive dental services.³ The availability of dental providers and primary care is associated with healthier teeth.¹⁷ Because of the linkage between oral health and chronic illness, experts encourage collaborative approaches between dental providers, public health, and other health care professionals to address oral health disparities.^18–22

Many consider primary medical care as a venue for reaching children who do not traditionally make dental visits.^23,24 Primary care medical practices in rural Oregon communities report few resources for patients who present with dental health needs.²⁵ Rural clinicians in our primary care research network (the Oregon Rural Practice-based Research Network) wanted to confirm their impression that many patients present to their practices with dental health issues. In addition, local community leaders in medicine, dentistry, and public health sought baseline data regarding the prevalence of unmet dental needs to determine how to best address this local health concern.

We undertook this cross-sectional study to quantify unmet dental needs and oral health conditions in a rural primary care practice. The study emerged as a community-based participatory research project involving members of the county Community Health Improvement Partnership,²⁶ local medical and dental providers, and representatives from 2 practice based research networks (PBRNs) at Oregon Health and Science University (OHSU). One PBRN focused on oral health (Practice-based Research in Oral Health) and the second on rural primary care (Oregon Rural Practice-based Research Network). Though an increasing body of literature is exploring pediatric partnerships to address childhood oral health, there is little work that addresses the prevalence of oral health conditions among all patients who present to a family medicine practice for routine medical care.^22,27–30 We hypothesized that there would be a high prevalence of dental conditions and unmet dental needs as identified by family physicians in routine primary care practice. We also hypothesized that the conditions would be distributed in predictable ways, with caries most common among children and varying degrees of edentulism most common among the elderly.

【 授权许可】

Unknown   

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