[Social inequalities in the demand for dental care]. / Inégalités sociales dans le recours aux soins dentaires.

BACKGROUND: Despite excellent general health indices, Quebec is in a difficult situation concerning oral health: tooth loss remains at a high level in adults and reveals important social inequalities. The objective of this research was to show that dental health inequalities reflect inequalities in the demand for dental care. METHODS: For the Dental Health Survey of Quebec 1998-1999, 9930 parents of children aged 5 to 8 years were randomly selected across Quebec and received a questionnaire at their home on the demand for dental care. Among them, 8430 adults completed and sent back the questionnaire (responses rate: 85%). After excluding edentulous persons, the sample was reduced to 6585 parents aged 30 to 44 years. RESULTS: The majority of respondents (76.4% of women and 72.8% of men) visit the dentist in a preventive manner rather than wait until dental problems occur. However, our study shows important disparities: the proportion of preventive attenders increases as income increases. A multiple logistic regression model suggests that there are financial as well as cultural barriers in dental care access. CONCLUSION: The proportion of preventive attenders is high in Quebec and allows practitioners to adopt a preventive management of dental caries. Social disparities are high however, and are associated with financial as well as cultural barriers that need to be reduced.

[Utilization of technology and communication technologies (TIC) in public health]. / L'utilisation des technologies de l'information et des communications (TIC) en santé publique.

The development of information and communications technologies (ICT) and Internet offers public health practitioners new tools to fulfill their missions of monitoring public health, health promotion and disease prevention, and public health protection. In recent years, new applications and practices in public health using these technologies have emerged, particularly in the area of communication among practitioners and transmission of information to the population. This article aims to give an overall view of the use of ICT in public health and to discuss the impact of these technologies on public health practices. The discussion is centred around the implications of using these new technologies: implications with regard to the new possibilities provided by these technologies, but also with regard to the difficulties involved in their use as well as issues related to unequal access and ethics. Finally, the question of the evaluation of these technologies and of their impact on public health is discussed.

Dental caries in Quebec adults aged 35 to 44 years.

BACKGROUND: The purpose of this study was to assess the prevalence of dental caries in Quebec adults aged 35 to 44. METHODS: A stratified sample was used. The participation rate was 77% for the questionnaire and 44.5% for the oral examination. A total of 2,110 people were examined. The World Health Organization's caries criteria were used. Examiner agreement with gold standard dentist was excellent at the end of the nine-day training session (Kappa index > 0.8). RESULTS: The level of caries experience is very high in Quebec adults aged 35 to 44. Almost half of dental surfaces (65 of 148) have been affected. These surfaces are mostly missing (39.3) or filled (23.9). However, there were 1.8 decayed surfaces in need of treatment per adult, and more than half the people (55.5%) had no untreated decayed surfaces. Almost three-quarters of decayed surfaces were present in only 14% of the people; lower family income and lower education are risk factors. CONCLUSION: Comparison between Quebec and industrialized countries (United States, England and the Netherlands) shows that in adults 35 to 44, the mean number of decayed teeth is low (between 1.0 and 2.2) and the mean number of filled teeth is relatively similar (between 9.6 and 11.1); however, Quebec has a higher percentage than the United States of edentulous people. As well, in dentate adults, there are 1.6 times more missing teeth among Quebecers than among Americans.

Community periodontal index of treatment needs and prevalence of periodontal conditions.

BACKGROUND/AIMS: In 1977, the World Health Organization (WHO) proposed a new index, the community periodontal index of treatment needs (CPITN) to evaluate the periodontal treatment needs of populations. The aim of this study is to compare different approaches of recording and presenting the CPITN. METHODS: A sample of 2110 subjects aged 35-44 years were examined between September 1994 and July 1995, throughout the province of Quebec, Canada. For each tooth (3rd molars excluded), the presence of bleeding and calculus, the level of epithelial attachment, and the depth of periodontal pockets were measured. Periodontal pocket depths were measured from the edge of the free gingiva, at 2 sites (mesiovestibular and vestibular), as well as all around the tooth. RESULTS: Only 8.5% of adults had at least one tooth with a 6 mm or deeper periodontal pocket when probing on 2 sites, whereas if probing is done all around the tooth, this percentage is 2.5x higher (21.4%). The partial recording of pocket depths (10 index teeth recommended by WHO, or 2 quadrants chosen at random) resulted in an underestimation of the prevalence of subjects with at least one tooth with a periodontal pocket (CPITN score 3 and 4). Among subjects with at least one tooth with a 6 mm or deeper periodontal pocket, 12% were not detected with the 10 index teeth recording, and 25% go undetected with the measure on 2 quadrants. Finally, using the % of subjects with periodontal pockets overestimates the prevalence of deep pockets compared with using sextants. Indeed, close to 30.0% of sextants have no treatment needs, whereas only 5.2% of subjects are in this category. Similarly, 7.7% of sextants have at least one tooth with a 6 mm or deeper periodontal pocket, yet there are 3x more subjects in this category (21.4%).

Comparison between the DMF indices and two alternative composite indicators of dental health.

The DMFT and DMFS indices employed in the majority of oral epidemiological studies have several limitations. In response to this problem, Sheiham et al. (Community Dent Health 1987;4:407-14) proposed two alternative dental health indicators: the number of functioning teeth (hereafter referred to as FS-T) and tissue health (T-Health). Using data from an epidemiological study on the dental health status of adults aged 35-44 from Quebec (N=2110), this article compares the alternative indices with the conventional DMFT and DMFS indices. By comparing Pearson's correlation coefficient for the four indices in this study with the number of decayed, missing and filled surfaces, it is noted that the FS-T index bears the strongest correlation to the three variables. It is also the only index whose correlation coefficient is greater than 0.3 for each of the three DMFS components. A risk group was created for each index, composed of the 18% of people demonstrating the poorest index. The risk group's FS-T index results in an average of 4.3 decayed surfaces (compared with 2.6 for the DMFT), 92.7 missing surfaces (74.4 for the DMFT) and 9.0 filled surfaces (compared with 26.9 for the DMFT). Using linear regression analysis with each index as a dependent variable, and people's socio-demographic characteristics, regular use of dental services and perception of dental health as independent variables, it appears that the percentage of the explained variance (R2) is 21.2% for the FS-T index, 13.8% for the T-Health index, 12.3% for the DMFS index and only 7.6% for the DMFT index.

Indicators of masticatory performance among elderly complete denture wearers.

The literature on current techniques for evaluating the masticatory capacity leads to categorizing them into two groups: objective masticatory tests and questionnaires that evaluate the subject masticatory capacity. This study examines how a simple questionnaire on the reported capacity to chew certain food can predict the masticatory performance of edentulous elderly patients. The masticatory performance of 367 completely edentulous elderly persons was measured with the Swallowing Threshold Test Index and compared with their reported masticatory capacity previously measured with a questionnaire on the capacity of the individual to chew nine food items. A total of 47.4% of the individuals had a low masticatory performance. This problem was more frequent in women (51.7%) than in men (41.8%). In measuring the reported masticatory performance with seven of the nine food items listed in the questionnaire, this indicator predicted the masticatory performance with a sensitivity of 65.5% and a specificity of 81.9%. However, even though the measure of prosthesis retention/stability is related to the masticatory performance, it was not a good predictor.

[Trends in the level of edentulism in Quebec between 1980 and 1993]. / Evolution de l'édentation au Québec entre 1980 et 1993.

Level of edentulism is a good indicator of a populations' bucco-dental health. Thus, the evolution of this phenomena enables us to seek any modification of adults' bucco-dental health. The percentage of adults in Quebec aged 18 and over who are completely edentulous decreased from 26 per cent in 1980 to 20 per cent in 1993. During the same period, the percentage of adults aged 18 and over who are only partially edentulous decreased from 18 per cent to 13 per cent. We note on one hand that this decrease is more prominent among younger adults and among anglophones and on the other hand that income and education are more strongly associated with edentulism in 1993 than in 1980. In 1980, individuals with lower levels of education were three times more edentulous (partially or totally) than those with higher levels of education (73 per cent versus 25 per cent). In 1993, this ratio increased to six times (72 per cent versus 12 per cent). It appears, therefore, that while edentulism has generally decreased in Quebec, it is more concentrated among certain high risk groups.

[Use of dental services and the percentage of persons possessing private dental insurance in Québec]. / Utilisation des services dentaires et pourcentage de personnes possédant une assurance dentaire privée au Québec.

The utilization of dental health services and the percentage of adult members of a private health dental insurance plan are generally lower in Quebec than in the other Canadian provinces. In this study, results of a telephone survey of a representative sample of Quebec adults aged 18 and over (N = 8,042) show that 58 per cent of interviewed individuals visited a dentist (53 per cent) or a denturologist (five per cent) during the 12 months preceeding the interview. A multivariate analysis indicates that the most strongly associated factors related to the utilization of dental health services are, in decreasing order, edentulousness, income and level of education. About one third (36 per cent) of those surveyed had dental insurance coverage. Age and income are the most strongly associated factors concerning the membership to a dental health insurance plan. Finally, among those with dental insurance coverage, 71 per cent had visited a dentist or a denturologist during the last 12 months compared to 51 per cent of those not insured.