A change in the regional disparity based on the national insurance coverage of dental sealant in Korea / 대한구강보건학회지

OBJECTIVES: In 2002, the Ministry of Health and Welfare initiated a national sealant program (NSP) in public health centers in order to promote oral health among children in rural areas as well as among children with low socio-economic status in urban areas. However, this program was terminated in 2009 and substituted with the national insurance coverage of sealants (NICS). The aim of this study is to evaluate the impact of the change from NSP to NICS on regional inequality. METHODS: Based on data obtained from the 2010 and 2012 Korea National Oral Health surveys conducted, we analyzed the average number of permanent teeth with sealants (mean sealant) on the first molars and the prevalence of active dental caries in permanent teeth (D rate), segregated by region, in 8-year-old children. Analyses were performed using SPSS 21.0 (SPSS Inc., Chicago, IL, USA) after taking into consideration the complex design of the samples. RESULTS: The D rate of rural children was higher than that of those in metropolitan and city areas. Compared to the 2010 data on the mean sealants on the first molars, a 14.4% and 48.1% increase was observed in the mean sealants in children in the metropolis and in cities in 2012, respectively. However, this number decreased by 7.5% only in the rural areas. CONCLUSIONS: Accessibility to dental services was limited in the rural areas as compared than in other areas; this result is based on the fact that the D rate in rural areas was higher than that in other areas. The NSP has decreased this regional inequality with regard to the accessibility to dental services. However, it was suggested that the mean sealant on the first molars was reversed due to a change from NSP to NICS.

Trends in oral health inequality in 12-year-old Korean children: A study using the Gini coefficient / 대한구강보건학회지

OBJECTIVES: This study was conducted to analyze the current state and tendency of oral health inequality in 12-year-old Korean children by calculating the Gini coefficient from decayed, missing, or filled teeth (DMFT) data. METHODS: Ten-year trends were empirically estimated by calculating the Gini coefficient from the Lorenz curve plotted based on the DMFT data of 12-year-old children, obtained from the Korean National Oral Health Survey from 2000 to 2010. RESULTS: While the oral health improved in general, oral health inequalities increased with the decrease in the number of DMFT each year, and the DMFT-based Gini coefficient increased from 0.53 in 2000 to 0.61 in 2010. The increase in the number of decayed and missing teeth was strongly affected by the increase in oral health inequality. CONCLUSIONS: To resolve Korea's continually increasing oral health inequality, it is necessary to establish support measures for vulnerable populations and to develop and manage a surveillance system for continuous monitoring of oral health inequality in the future.

Socio-economic inequalities in the self-rated oral health status of South Koreans / 대한구강보건학회지

OBJECTIVES: This study aimed to assess the socio-economic inequalities in the self-rated oral health status in the study group of South Koreans, as associated with other factors (health behaviors factors, psychological factors, and oral health status) on the social gradients in the self-rated oral health status. METHODS: The cross-sectional data was from the Forth Korea National Health & Nutrition Examination Survey. Subjects were 18,886 people over the age of 6 years who participated in the health interview, dental examination, and dietary survey. They were divided into four groups according to their life course: children (6-11 years), adolescents (12-18 years), adults (19-64 years), and the elderly (65 years and older). The income and education level brackets were selected as measures of socio-economic position (SEP). The complex samples logistic regression models were used to analyze the data. To assess the association of the other factors, additional models (which adjusted for the gender, age, and each of the other factors) were compared to the initial model (which adjusted for the gender and age only). RESULTS: We found that there were socio-economic differences in the self-rated oral health status at all stages of life, and that the differences were up sharply for the vulnerable social groups. Dental care utilization factors and the oral health status mainly affected the socio-economic inequalities of the poor self-rated oral health status group at all stages of life. Socio-eoconomic differences remained statistically significant in the models that controlled for all related factors except the models of household income in adults. CONCLUSIONS: There were socio-economic differences in the poor self-rated oral health status at all stages of life. But it is difficult to definitely confirm the pathway of socio-economic inequalities in the self-rated oral health status, because of the limitations of the cross sectional study and the use of restricted variables in this survey. Therefore more extensive longitudinal research is required to better address the pathways that explain the socio-economic inequalities in the self-rated oral health status throughout the life courses in the Republic of Korea.

Socio-economic inequalities in tooth loss and chewing difficulty in the Korean elderly / 대한구강보건학회지

OBJECTIVES: This study aimed to assess socio-economic inequalities in subjects with 20 or more natural teeth and chewing difficulty in the Korean elderly, and to assess the association of health behavior factors, psychological factors, and oral health status on social gradients of subjects with tooth loss and chewing difficulty. METHODS: Cross-sectional data were from the Fourth Korea National Health & Nutrition Examination Survey. Subjects were 3,598 people over the age of 65 years, who participated in a health interview, dental examination and dietary survey. Income status and educational status were selected as measures of socio-economic position (SEP). Logistic regression models were used to assess socio-economic inequalities of subjects with 20 or more natural teeth and chewing difficulty. To assess the association of related factors, a logistic model that was adjusted for each group of variables was compared to those that were not adjusted for it. RESULTS: We found that there were socio-economic differences in subjects with 20 or more natural teeth and chewing difficulty in Korean elderly. The social gradient for subjects with 20 or more natural teeth and chewing difficulty persisted, after adjusting for different factors. While adjusting for oral hygiene factors and smoking factors attenuated the association between 20 or more natural teeth and SEP, adjusting for oral health status and psychological factors attenuated the association between chewing difficulty and SEP. Education status was a more apparent measure than income status, in socio-economic inequalities in oral health among the Korean elderly. CONCLUSIONS: Socio-economic inequalities in oral health among the Korean elderly might be important social problems. More extensive longitudinal research to confirm the pathways that explain oral health inequalities among the elderly is required, to develop effective intervention strategies to reduce socio-economic differences in oral health among the Korean elderly.

The differences of oral health-related behaviors by type of school among high school students in Gangneung city / 대한구강보건학회지

OBJECTIVES: The principle purpose of this study was to investigate the differences of oral health-related behaviors by a type of school among high school students in Gangneung city. The secondary purpose was to assess the influences of other factors (father's education status, mother's education status, subjective economic status, FAS, experienced part-time job, pocket money and perceived stress) on these differences. METHODS: A cross-sectional survey of 1,282 high school students was conducted in Gangneung city. The response rate was 93.4%; general high school students were 773 and vocational high school students were 509. The data were collected by self-administered structured questionnaires. The differences of oral health-related behaviors of high school students by school type were assessed by a chisquare test. Logistic regression models were used to analyze the influences of other factors on these differences. RESULTS: Oral health-related behaviors were markedly better in students attending general high school, rather than vocational high school (P<0.001). The differences of oral health-related behaviors by school type were persisted after adjusting for gender (Model 1), socio-economic factors (Model 2), part-time job and pocket money (Model 3), psychological variables (Model 4) and all variables (Model 5), except for visiting a dental clinic. CONCLUSIONS: We found a marked influence of school type in oral health-related behaviors. This finding suggests that school type is a risk factor of oral health-related behaviors in high school students. Therefore, one of the best ways to enhance oral health for high school students is to develop oral health promotion programs for vocational high school students.

Socio-economic inequalities in dental caries in Korea / 대한구강보건학회지

OBJECTIVES: This study aimed to assess the socio-economic inequalities in dental caries in the Korean population, throughout the life course and to assess the association of demographic, oral health behavior and psychological factors on the socio-economic differences in dental caries. METHODS: Cross-sectional data were from the Forth Korea National Health & Nutrition Examination Survey. Subjects were 20,400 people over the age of 1 year, who participated in the health interview, dental examination and dietary survey, and were divided into five groups, according to their life course; infant (1-5 years), children (6-11 years), adolescent (12-18 years), adults (19-64 years), and the elderly (65 years and older). To assess the socio-economic inequalities in dental caries and related factors, we used complex samples logistic regression models. RESULTS: We found that there were socio-economic differences in dental caries among children, adolescents and adults. After adjusting for related factors, the socio-economic inequalities in dental caries persisted. While there were no significant difference in dental caries of infants, according to the household income, there were significant socio-economic difference in the elderly. But after adjusting for all related factors, statistically significant differences disappeared. Oral hygiene factors, diet factors and dental care utilization factors partly affected the socio-economic inequalities in dental caries, and the dental care utilization factors were more effective than the others. CONCLUSIONS: There were socio-economic differences in the dental caries in Korean children, adolescents and adults. But it is hard to assess the pathway of the socio-economic inequalities in dental caries because of the limitation of cross sectional study and other possible variables that could not be used as a measurement for socio-economic position because of the restricted variables in this survey data. Therefore, more extensive longitudinal research is required to better address the pathways that explain the socio-economic inequalities in dental caries throughout the life course in Korea.