Burn out among Iranian dental students: psychometric properties of burnout clinical subtype questionnaire (BCSQ-12-SS) and its correlates.

BACKGROUND: Burnout Clinical Subtype Questionnaire (BCSQ-12-SS) is a short valid questionnaire for assessment of burnout in students. The aim of the present study was to evaluate the psychometric properties of Persian-translated version of the BCSQ-12-SS and assess the burn out clinical subtypes and their correlates in dental students. METHODS: In this psychometry study, the BCSQ-12-SS questionnaire in domains of overload (4 questions), lack of development (4 questions), and neglect (4 questions) was translated to Persian and back-translated. Six experts determined the content and face validity of the Persian version. The questionnaire was then piloted on 167 dental students of Tehran University of Medical Sciences in 2016. Data were analyzed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) for construct validity and Linear Regression modeling in IBM SPSS and AMOS SPSS. To assess reliability, the questionnaire was filled out by 15 students twice and Kappa coefficient and Composite Reliability (CR) were calculated. RESULTS: Content validity Ratio (CVR) and Content Validity Index (CVI) values and Cronbach's alphas were all over 0.8. Kappa coefficient ranged from 65 to 82.5%. The average burnout score was 29.6 out of maximum score of 60. There were no significant differences in burnout scores across the different semesters (8,10 and 12). Financial support by the family significantly affected the total score of burnout and lack of development. In addition, gender, mother's education, residential status of student, preparing for post graduate exam and financial support by the family affected the overload. CONCLUSION: The BCSQ-12-SS has good psychometric properties and therefore can be used to assess burnout in IRANIAN dental students. The BCSQ-12-SS may provide an opportunity to identify individuals at risk for burn out and provide counseling to assist in dental student development.

Electronic and paper mode of data capture when assessing patient-reported outcomes in the National Dental Practice-Based Research Network.

AIM: Our objectives were to describe the approach used in the National Dental Practice-Based Research Network to capture patient-reported outcomes and to compare electronic and paper modes of data capture in a specific network study. METHODS: This was a prospective, multicenter cohort study of 1862 patients with dentin hypersensitivity. Patient-reported outcomes were assessed based on patients' perception of pain using Visual Analog Scales and Labeled Magnitude scales at baseline and at 1, 4 and 8 weeks post-baseline. RESULTS: Eighty-five percent of study patients chose to complete follow-up assessments via an electronic mode; 15% completed them via a paper mode. There was not a significant difference in the proportions of patients who completed the 8-week assessment when comparing the electronic mode to the paper mode (92% vs. 90.8%, P = 0.31, Rao-Scott clustered χ2 -test). CONCLUSION: The electronic mode of data capture was as operational as the traditional paper mode, while also providing the advantage of eliminating data entry errors, not involving site research coordinators in measuring the patient-reported outcomes, and not incurring cost and potential delays due to mailing study forms. Electronic data capture of patient reported outcomes could be successfully implemented in the community dental practice setting.

Concordance between practitioner questionnaire responses and observed clinical treatment recommendations for treatment of dentin hypersensitivity: findings from the National Dental Practice-Based Research Network.

BACKGROUND: Few published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners' questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations. METHODS: A total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen's kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated. RESULTS: For individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner's top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low. CONCLUSIONS: Concordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen's kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration. Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.

Self-Efficacy and Academic Performance in Colombian Dental Students.

Favorable self-efficacy beliefs have been theorized to predict better academic performance, but this association has been untested in dental education. To address this knowledge gap, the aim of this study was to determine the relationship between students' self-efficacy and academic performance in a Colombian dental school. This cross-sectional study was conducted in 2016 with dental students in all five years at the Universidad Cooperativa de Colombia, Pasto, Colombia. Prior to application for the measurement of self-efficacy, the psychometric properties of the Academic Behaviors Self-Efficacy Scale (ABSS) were examined using confirmatory factor analysis (CFA). Participants' semester grade point average was used as a measure of academic performance. Of the total 390 students, 320 participated (82% participation rate). A three-factor model for ABSS with the dimensions of communication, attention, and excellence emerged from the CFA, demonstrating optimal fit indices: χ2 S-B =468.912; p<0.01; NNFI=0.994; CFI=0.996; RMSEA=0.031 (90% CI 0.021, 0.037); SRMR=0.070; AIC=344.912. Self-efficacy was positively associated with academic performance (rho=0.259; p<0.001). This association was statistically significant only among women (rho=0.361; p<0.001) and those in low SES strata (1-2: rho=0.310; p<0.001) and was highest among students with a heavy (>15 credits) academic course load (rho=0.306; p=0.001). The ABSS demonstrated adequate psychometric properties. Academic self-efficacy was positively associated with academic performance, and this association was most pronounced among women students, those in low SES strata, and those taking a heavy course load.

Management of dentin hypersensitivity by practitioners in The National Dental Practice-Based Research Network.

BACKGROUND: Dentin hypersensitivity (DH) is a condition commonly encountered in clinical dental practice. The authors conduct a study to identify the treatments recommended to manage DH among dentists in the United States. METHODS: The authors conducted a multicenter study of 1,862 patients with DH who received a diagnosis and were treated by 171 dentists with The National Dental Practice-Based Research Network. RESULTS: The most common treatment recommended was desensitizing over-the-counter (OTC) potassium nitrate toothpaste (alone or in combination with other treatments) for 924 of 1,862 patients (50%). This was followed by an application of fluoride varnish (FV) for 516 patients (28%) and a prescription for fluoride toothpaste for 314 patients (17%). Restorative treatments were recommended to 151 patients (8%). The most common single treatment recommendation was desensitizing OTC potassium nitrate toothpaste, recommended to 335 patients (18%). The most frequent combination of 2 treatment modalities was FV and desensitizing OTC potassium nitrate toothpaste, recommended to 100 patients (5%). A total of 890 of 1,862 patients (48%) with DH received a recommendation for 1 treatment modality, and 644 of 1,862 patients (35%) received a recommendation for a combination of 2 treatment modalities, most frequently an application of FV along with desensitizing OTC potassium nitrate toothpaste (100/1,862; 5%). CONCLUSIONS: Desensitizing OTC potassium nitrate toothpaste and fluoride products were the most widely recommended products to manage DH in the practice setting. PRACTICAL IMPLICATIONS: Our results suggest that most network clinicians preferred noninvasive treatment modalities when treating DH.

Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiation of a clinical study on this topic.

BACKGROUND: Dentin hypersensitivity (DH) is a common problem encountered in clinical practice. The purpose of this study was to identify the management approaches for DH among United States dentists. METHODS: One hundred eighty five National Dental Practice-Based Research Network clinicians completed a questionnaire regarding their preferred methods to diagnose and manage DH in the practice setting, and their beliefs about DH predisposing factors. RESULTS: Almost all dentists (99%) reported using more than one method to diagnose DH. Most frequently, they reported using spontaneous patient reports coupled with excluding other causes of oral pain by direct clinical examination (48%); followed by applying an air blast (26%), applying cold water (12%), and obtaining patient reports after dentist's query (6%). In managing DH, the most frequent first choice was desensitizing, over-the-counter (OTC), potassium nitrate toothpaste (48%), followed by fluorides (38%), and glutaraldehyde/HEMA (3%). A total of 86% of respondents reported using a combination of products when treating DH, most frequently using fluoride varnish and desensitizing OTC potassium nitrate toothpaste (70%). The most frequent predisposing factor leading to DH, as reported by the practitioners, was recessed gingiva (66%), followed by abrasion, erosion, abfraction/attrition lesions (59%) and bruxism (32%). CONCLUSIONS: The majority of network practitioners use multiple methods to diagnose and manage DH. Desensitizing OTC potassium nitrate toothpaste and fluoride formulations are the most widely used products to manage DH in dental practice setting.

The influence of health care professional characteristics on pain management decisions.

OBJECTIVE: Evidence suggests that patient characteristics such as sex, race, and age influence the pain management decisions of health care providers. Although this signifies that patient demographics may be important determinants of health care decisions, pain-related care also may be impacted by the personal characteristics of the health care practitioner. However, the extent to which health care provider characteristics affect pain management decisions is unclear, underscoring the need for further research in this area. METHODS: A total of 154 health care providers (77 physicians, 77 dentists) viewed video vignettes of virtual human (VH) patients varying in sex, race, and age. Practitioners provided computerized ratings of VH patients' pain intensity and unpleasantness, and also reported their willingness to prescribe non-opioid and opioid analgesics for each patient. Practitioner sex, race, age, and duration of professional experience were included as predictors to determine their impact on pain management decisions. RESULTS: When assessing and treating pain, practitioner sex, race, age, and duration of experience were all significantly associated with pain management decisions. Further, the role of these characteristics differed across VH patient sex, race, and age. CONCLUSIONS: These findings suggest that pain assessment and treatment decisions may be impacted by the health care providers' demographic characteristics, effects which may contribute to pain management disparities. Future research is warranted to determine whether findings replicate in other health care disciplines and medical conditions, and identify other practitioner characteristics (e.g., culture) that may affect pain management decisions.

Age differences in suprathreshold sensory function.

While there is general agreement that vision and audition decline with aging, observations for the somatosensory senses and taste are less clear. The purpose of this study was to assess age differences in multimodal sensory perception in healthy, community-dwelling participants. Participants (100 females and 78 males aged 20-89 years) judged the magnitudes of sensations associated with graded levels of thermal, tactile, and taste stimuli in separate testing sessions using a cross-modality matching (CMM) procedure. During each testing session, participants also rated words that describe magnitudes of percepts associated with differing-level sensory stimuli. The words provided contextual anchors for the sensory ratings, and the word-rating task served as a control for the CMM. The mean sensory ratings were used as dependent variables in a MANOVA for each sensory domain, with age and sex as between-subject variables. These analyses were repeated with the grand means for the word ratings as a covariate to control for the rating task. The results of this study suggest that there are modest age differences for somatosensory and taste domains. While the magnitudes of these differences are mediated somewhat by age differences in the rating task, differences in warm temperature, tactile, and salty taste persist.

The impact of patients' gender, race, and age on health care professionals' pain management decisions: an online survey using virtual human technology.

BACKGROUND: Previous literature indicates that biases exist in pain ratings. Healthcare professionals have been found to use patient demographic cues such as sex, race, and age when making decisions about pain treatment. However, there has been little research comparing healthcare professionals' (i.e., physicians and nurses) pain decision policies based on patient demographic cues. METHODS: The current study used virtual human technology to examine the impact of patients' sex, race, and age on healthcare professionals' pain ratings. One hundred and ninety-three healthcare professionals (nurses and physicians) participated in this online study. RESULTS: Healthcare professionals assessed virtual human patients who were male and African American to be experiencing greater pain intensity and were more willing to administer opioid analgesics to them than to their demographic counterparts. Similarly, nurses were more willing to administer opioids make treatment decisions than physicians. There was also a significant virtual human-sex by healthcare professional interaction for pain assessment and treatment decisions. The sex difference (male>female) was greater for nurses than physicians. CONCLUSIONS: Results replicated findings of previous studies using virtual human patients to assess the effect of sex, race, and age in pain decision-making. In addition, healthcare professionals' pain ratings differed depending on healthcare profession. Nurses were more likely to rate pain higher and be more willing to administer opioid analgesics than were physicians. Healthcare professionals rated male and African American virtual human patients as having higher pain in most pain assessment and treatment domains compared to their demographic counterparts. Similarly the virtual human-sex difference ratings were more pronounced for nurses than physicians. Given the large number of patients seen throughout the healthcare professionals' careers, these pain practice biases have important public health implications. This study suggests attention to the influence of patient demographic cues in pain management education is needed.

Is there a relationship between throbbing pain and arterial pulsations?

Pain can have a throbbing quality, especially when it is severe and disabling. It is widely held that this throbbing quality is a primary sensation of one's own arterial pulsations, arising directly from the activation of localized pain-sensory neurons by closely apposed blood vessels. We examined this presumption more closely by simultaneously recording the subjective report of the throbbing rhythm and the arterial pulse in human subjects of either sex with throbbing dental pain-a prevalent condition whose pulsatile quality is widely regarded a primary sensation. Contrary to the generally accepted view, which would predict a direct correspondence between the two, we found that the throbbing rate (44 bpm ± 3 SEM) was much slower than the arterial pulsation rate (73 bpm ± 2 SEM, p < 0.001), and that the two rhythms exhibited no underlying synchrony. Moreover, the beat-to-beat variation in arterial and throbbing events observed distinct fractal properties, indicating that the physiological mechanisms underlying these rhythmic events are distinct. Confirmation of the generality of this observation in other pain conditions would support an alternative hypothesis that the throbbing quality is not a primary sensation but rather an emergent property, or perception, whose "pacemaker" lies within the CNS. Future studies leading to an improved understanding of the neurobiological basis of clinically relevant pain qualities, such as throbbing, will also enhance our ability to measure and therapeutically target severe and disabling pain.

How dentists diagnose and treat defective restorations: evidence from the dental practice-based research network.

OBJECTIVES: To (1) identify and quantify the types of treatment that dentists use to manage defective dental restorations and (2) identify characteristics that are associated with these dentists' decisions to replace existing restorations. The Dental Practice-Based Research Network (DPBRN) consists of dentists in outpatient practices from five regions: AL/MS: Alabama/Mississippi; FL/GA: Florida/Georgia; MN: dentists employed by HealthPartners and private practitioners in Minnesota; PDA: Permanente Dental Associates in cooperation with Kaiser Permanente's Center for Health Research and SK: Denmark, Norway and Sweden. METHODS: A questionnaire was sent to all DPBRN practitioner-investigators who reported doing some restorative dentistry (n = 901). Questions included clinical case scenarios that used text and clinical photographs of defective restorations. Dentists were asked what type of treatment, if any, they would use in each scenario. Treatment options ranged from no treatment to full replacement of the restoration with or without different preventive treatment options. The authors of the current study used logistic regression to analyze associations between the decision to intervene surgically (repair or replace) and the specific dentist, practice and patient characteristics. RESULTS: A total of 65% of dentists would replace a composite restoration when the defective margin was located on dentin and 49% would repair it when the defective margin was located on enamel. Most (52%) dentists would not intervene surgically when the restoration in the scenario was amalgam. Dentists participating in a solo or small private practice (SPP) chose surgical intervention more often than dentists participating in large group practices (LGP) or in public health practices (PHP) (p < .0001). Dentists who do not routinely assess caries risk during treatment planning were more likely to intervene surgically and less likely to choose prevention treatment (p < .05). Dentists from the SK region chose the "no treatment" option more often than dentists in the other regions. CONCLUSIONS: Dentists were more likely to intervene surgically when the restoration was an existing composite, compared to an amalgam restoration. Treatment options chosen by dentists varied significantly by specific clinical case scenario, whether the dentist routinely performs caries risk assessment, type of practice and DPBRN region.

Restorative treatment thresholds for interproximal primary caries based on radiographic images: findings from the Dental Practice-Based Research Network.

This study sought to quantify the depths of proximal caries lesions that lead dentists in regular clinical practice to intervene restoratively, based on hypothetical scenarios that present radiographic images and patient background information, and to identify characteristics associated with restorative intervention in lesions that have penetrated only the enamel surface. This study surveyed dentists from the Dental Practice-Based Research Network (DPBRN) who had reported doing at least some restorative dentistry (n = 901). Dentists were asked to indicate the depth at which they would restore a lesion, based on a series of radiographic images depicting interproximal caries at increasing lesion depths in a mandibular premolar; in addition, the dentists were questioned regarding two caries risk scenarios: one involving a patient with low caries risk and another involving a patient at higher risk. Logistic regression was used to analyze associations between the decision to intervene restoratively and specific dentist, practice, and patient characteristics. Of the 901 DPBRN practitioner-investigators, 500 (56%) completed the survey. For a high caries risk patient, 66% of respondents indicated that they would restore a proximal enamel lesion, while 24% would do so once the lesion had reached into the outer third of the dentin. For a low caries risk patient, 39% of respondents reported that they would restore an enamel lesion, and 54% would do so once the lesion had reached into the outer third of the dentin. In multivariate analyses that accounted for dentist and practice characteristics, dentists in large group practices were less likely to intervene surgically for enamel caries, regardless of patient's caries risk.

Acculturation and orofacial pain among Hispanic adults.

UNLABELLED: This study examined the associations between acculturation and orofacial pain and healthcare among Hispanic adults. Understanding the effects of acculturation on Hispanic oral health may improve understanding of oral health disparities in the United States. Data were collected from 911 Hispanic adults reporting tooth pain and painful oral sores who were part of a larger study of South Florida residents conducted using random-digit dialing methodology. The survey was conducted in Spanish or English by bilingual interviewers per the choice of each respondent. Greater use of the Spanish language was associated with disparities in healthcare visits for orofacial pain, not having a usual dentist, having greater pain, increased difficulty eating and sleeping, and more depression. Respondents' and their parents' nativity (families that had been in the United States longer) and those identifying more closely to Hispanic culture were also predictive of several of the outcomes. Gender, financial status, and age, independent of acculturation, were also associated with orofacial pain, accessing health care, and pain-related loss of functioning among Hispanics. The data support the hypothesis that Hispanics with less acculturation are less able to access needed oral health care. This study highlights the need for outreach programs targeting recent Hispanic immigrants focusing on oral health care. PERSPECTIVE: This study found that lower levels of acculturation, particularly less frequent use of English, were associated with greater oral pain and depression for Hispanics adults. This emphasizes the need to provide Hispanic patients with information in Spanish and the importance of having bilingual materials and staff in dental clinics.

Gender differences in reported dental fear and fear of dental pain.

OBJECTIVES: Gender differences in dental fear have been of increasing interest among clinicians and researchers. The objectives of this study were to assess: (i) gender differences in reports of global dental fear, global fear of dental pain, and specific fear of dental pain; (ii) how the wording of questions about specific fear of dental pain influences a subjective report, and (iii) the interactions between gender differences and wording effects in the reports of specific fear of dental pain. METHODS: A telephonic survey of 504 adult Floridians was conducted in 2004. Data collected included six measures of specific fear of dental pain, one measure of global fear of dental pain, one measure of global dental fear, and demographic information. RESULTS: Women were more likely to report global dental fear, global fear of dental pain, and specific fear of dental pain than men, and both women and men were more likely to report 'dread' of dental pain than 'fear' of dental pain. CONCLUSIONS: Our findings suggest that: (i) there are gender differences in reports of dental fear and fear of dental pain; and (ii) both men and women are more willing to express their fearful feelings regarding dentistry using a more socially acceptable term.

Effect of fear on dental utilization behaviors and oral health outcome.

OBJECTIVES: This paper assesses the effect of fear on a number of dental utilization behaviors and oral heath outcome in a sample of adult Floridians. METHODS: A telephone survey was conducted in 2004 among 504 adult Floridians. Data collected included sociodemographic factors, specific fear of dental pain (FDP), global FDP, global dental fear, three measures of dental utilization behaviors, and one measure of oral health outcome. Chi-squared tests and logistic regression analyses were conducted to quantify the individual and multivariate associations between fear factors and four behavior and outcome measures. RESULTS: Global FDP was significantly associated with putting off making a dental appointment and approach to dental treatment. Global dental fear showed an independent negative impact on all four behavior and outcome measures; reports regarding specific fear of painful dental events were not significantly associated with four behavior and outcome measures. CONCLUSIONS: Our findings suggest that: (i) dental fear and FDP have independent negative effects on dental utilization behaviors and oral health outcome after controlling for other sociodemographic and general health factors; and (ii) global dental fear encompasses broader components than FDP.

Satisfaction with dental appearance among diverse groups of dentate adults.

OBJECTIVES: To quantify (a) the prevalence of dissatisfaction with dental appearance in a diverse sample of dentate adults and (b) the associations between dissatisfaction with dental appearance, sociodemographic factors, and other measures of oral health. METHODS: Data were taken from the Florida Dental Care Study , a population-based longitudinal cohort study of oral health and related behaviors. The sample included 873 participants at baseline. Descriptive analysis and logistic regression were conducted to analyze the baseline data in the current report. RESULTS: Females, problem-oriented dental attenders, and participants who had not completed high school were significantly more dissatisfied with their dental appearance than their respective counterparts. Dissatisfaction with dental appearance was also independently associated with six specific clinical and self-reported measures of oral health. DISCUSSION: Dissatisfaction with dental appearance was common in this population-based sample of middle-aged and older adults, and was significantly associated with key sociodemographic and oral health factors.

Dental attitudes: proximal basis for oral health disparities in adults.

OBJECTIVES: Behavioral science postulates that underlying characteristics of populations, rather than sociodemographic groupings, are more proximal causes of oral health disparities through differing oral health behaviors. To our knowledge this is the first report in the literature that examines longitudinal correlates of oral health and dental care using groups of persons holding similar attitudes and beliefs. METHODS: The subjects were 873 participants in the Florida Dental Care Study, a longitudinal study of oral health among dentate adults. Hierarchical cluster analysis identified four groups with similar dental attitudes that were labeled 'favorable attitudes about dental care', 'frustrated believers in dental care', 'negative attitudes and cost concerns', 'pessimistic about personal and professional oral care'. RESULTS: The attitudinal groups cut across race, sex, and age with race and educational status the best discriminators among sociodemographic and economic variables. The negative attitude group reported the least preventive care and the largest oral health decrements on clinical examination at baseline and 24 months. The group with favorable attitudes about dental care reported the highest number of preventive and restorative visits and the lowest point-prevalence of toothache pain, temperature sensitivity, and painful gums. The frustrated believers have access to dental care equivalent to the favorable attitude group, but may delay seeking dental care until oral disease becomes more severe, based on their pattern of preventive, restorative, and dental extraction visits. Additional group differences on oral health and dental care are reported. CONCLUSION: This study takes a novel approach to examining oral healthy disparities. Differences in oral health behaviors support the validity of the groups.

Orofacial pain: patient satisfaction and delay of urgent care.

OBJECTIVE: Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will require a better understanding of the patterns of health care associated with orofacial pain. This study examined factors associated with pain-related acute oral health care. METHODS: The authors used data on 698 participants in the Florida Dental Care Study, a study of oral health among dentate adults aged 45 years and older at baseline. RESULTS: Fifteen percent of the respondents reported having had at least one dental visit as the result of orofacial pain. The majority of the respondents reportedly delayed contacting a dentist for at least one day; however, there was no difference between respondents reporting pain as the initiating symptom and those with other problems. Once respondents decided that dental services were needed, those with a painful symptom were nearly twice as likely as those without pain to want to be seen immediately. Rural adults were more likely than urban adults to report having received urgent dental care for a painful symptom. When orofacial pain occurred, those who identified as non-Hispanic African American were more likely than those who identified as non-Hispanic white to delay care rather than to seek treatment immediately, and women were more likely then men. Having a pain-related oral problem was associated with significantly less satisfaction with the services provided; non-Hispanic African American respondents were less likely than non-Hispanic white respondents to report being very satisfied, and rural residents were less likely than urban residents. Furthermore, men were more likely than women to suffer with orofacial pain without receiving either scheduled dental care or an urgent visit. CONCLUSIONS: Barriers to care are complex and likely to be interactive, but must be understood before the goals of Healthy People 2010 can be accomplished.