Occlusal perceptions of children seeking orthodontic treatment: impact of ethnicity and socioeconomic status.

INTRODUCTION: With the growth of orthodontic intervention at younger ages and increased interest in improving dentofacial appearance among the general public, it is important to assess whether demand for treatment is uniform across ethnic and socioeconomic groups. METHODS: This study compared 3 groups of children who varied by location, payment source, and ethnicity. The sample consisted of 150 children in the Bronx, NY, and 100 in Seattle, Wash, who were undergoing or anticipating orthodontic treatment in publicly funded dental clinics. Ethnic minorities comprised 69% and 92%, respectively, of these groups. The third group consisted of 84 children in Seattle, Anchorage (Alaska), and Chicago who had sought treatment by private practitioners; ethnic minorities comprised 22% of this group. Data were collected from children and parents or guardians by questionnaires. RESULTS: Desire for treatment was higher among children in the publicly funded clinics and among black children than whites or Asian Americans. Children in publicly funded clinics rated themselves as having worse occlusions as determined by anterior crowding, overbite, overjet, diastema, and open bite. Children in the Bronx clinic accepted a wider range of occlusion as attractive. Stage of treatment affected judgments of attractiveness. Vicarious experience with orthodontics through parents or siblings made children more tolerant of dentofacial disharmony, with more favorable ratings of malocclusion in this group than among children who had no family experience with orthodontics. Hispanic and mixed-ethnicity children rated themselves more negatively on all dimensions. CONCLUSIONS: These results suggest that both socioeconomic status and ethnicity play roles in children's desire for treatment, self-assessed need, and judgments of esthetics. A clinician's sensitivity to such differences can improve patient cooperation with treatment.

Barriers to and enablers of older adults' use of dental services.

The theme of the Elders' Oral Health Summit is older adults' access to dental care and how this situation can be improved for future cohorts. A major question is whether older adults today, as well as baby boomers who will be entering their seventies within the next decade, will demand dental care as part of their overall well-being. The current cohort of elders varies widely in its use of dental services, from regular preventive users to non-users who report that they have not been to a dentist in more than twenty years. In 1999, 53.5 percent of older adults reported that they had visited a dentist, the lowest rate of any age group beyond eighteen. This article examines some determinants of older persons' dental service utilization, both barriers and enablers, as a means of understanding why some people continue seeking preventive dental care throughout their lives while others are lifelong irregular users and still others discontinue regular use after retirement or relocation to a new community or long-term care facility. Based on the epidemiological and psychosocial literature available on this topic, barriers and enablers include cohort and age, race and ethnicity, income and education, availability of dental and medical insurance, urban vs. rural residence, physical access to a dental office, and systemic and functional health. Attitudes toward oral health and dental care and other psychosocial variables may override some of these demographic and structural variables. Research in medical and dental service utilization offers insights into the relative predictive ability of these variables. Dental providers can also be potent enablers or barriers to older adults' access to dental care. Each of these factors plays a role in older adults' use of dental services. Under different situations some serve as both barriers and enablers.