Multilevel Analysis of the Association of Dental-Hygienist-Related Factors on Regular Dental Check-Up Behavior
Abstract
:1. Introduction
2. Methods
2.1. Data Source
2.2. Dependent Variables: Reason for the Dental Visit
2.3. Independent Variables: Dental-Hygienist-Related Factors
2.4. Covariates
2.5. Ethical Considerations
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Richards, W.; Ameen, J. The impact of attendance patterns on oral health in a general dental practice. Br. Dent. J. 2002, 193, 697–702. [Google Scholar] [CrossRef]
- Bullock, C.; Boath, E.; Lewis, M.; Gardam, K.; Croft, P. A case-control study of differences between regular and causal adult attenders in general dental practice. Prim. Dent. Care 2001, 8, 35–40. [Google Scholar] [CrossRef] [PubMed]
- Almoznino, G.; Aframian, D.; Sharav, Y.; Sheftel, Y.; Mirzabaev, A.; Zini, A. Lifestyle and dental attendance as predictors of oral health-related quality of life. Oral Dis. 2015, 21, 659–666. [Google Scholar] [CrossRef]
- Thomson, W.M.; Williams, S.M.; Broadbent, J.M.; Poulton, R.; Locker, D. Long-term Dental Visiting Patterns and Adult Oral Health. J. Dent. Res. 2010, 89, 307–311. [Google Scholar] [CrossRef]
- Karimalakuzhiyil Alikutty, F.; Bernabé, E. Long-term regular dental attendance and periodontal disease in the 1998 adult dental health survey. J. Clin. Periodontol. 2016, 43, 114–120. [Google Scholar] [CrossRef] [Green Version]
- Cunha-Cruz, J.; Nadanovsky, P.; Faerstein, E.; Lopes, C.S. Routine Dental Visits Are Associated with Tooth Retention in Brazilian Adults: The Pró-Saúde Study. J. Public Health Dent. 2004, 64, 216–222. [Google Scholar] [CrossRef]
- Åstrøm, A.N.; Ekback, G.; Ordell, S.; Nasir, E. Long-term routine dental attendance: Influence on tooth loss and oral health-related quality of life in Swedish older adults. Community Dent. Oral Epidemiol. 2014, 42, 460–469. [Google Scholar] [CrossRef] [PubMed]
- Matsuyama, Y.; Aida, J.; Watt, R.G.; Tsuboya, T.; Koyama, S.; Sato, Y.; Kondo, K.; Osaka, K. Dental Status and Compression of Life Expectancy with Disability. J. Dent. Res. 2017, 96, 1006–1013. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Woolfolk, M.W.; Lang, W.P.; Borgnakke, W.S.; Taylor, G.W.; Ronis, D.L.; Nyquist, L.V. Determining Dental Checkup Frequency. J. Am. Dent. Assoc. 1999, 130, 715–723. [Google Scholar] [CrossRef]
- Kino, S.; Bernabé, E.; Sabbah, W. Social Inequalities in Use of Preventive Dental and Medical Services among Adults in European Countries. Int. J. Environ. Res. Public Health 2019, 16, 4642. [Google Scholar] [CrossRef] [Green Version]
- Locker, D.; Maggirias, J.; Quiñonez, C. Income, dental insurance coverage, and financial barriers to dental care among Canadian adults. J. Public Health Dent. 2011, 71, 327–334. [Google Scholar] [CrossRef] [PubMed]
- Khan, A.; Thapa, J.R.; Zhang, D. Preventive Dental Checkups and Their Association With Access to Usual Source of Care Among Rural and Urban Adult Residents. J. Rural Health 2017, 33, 419–426. [Google Scholar] [CrossRef] [PubMed]
- Sabbah, W.; Tsakos, G.; Chandola, T.; Sheiham, A.; Watt, R.G. Social Gradients in Oral and General Health. J. Dent. Res. 2007, 86, 992–996. [Google Scholar] [CrossRef]
- Sohn, W.; Ismail, A.I. Regular dental visits and dental anxiety in an adult dentate population. J. Am. Dent. Assoc. 2005, 136, 58–66. [Google Scholar] [CrossRef]
- Miura, Y.; Shinada, K.; Shimoyama, K.; Mizoguchi, R.; Mataki, S.; Kurosaki, N.; Kawaguchi, Y. A Study of Oral Status of Adults who Received Regular Checkups and Professional Care. J. Stomatol. Soc. Jpn. 2002, 69, 285–289. [Google Scholar] [CrossRef] [Green Version]
- Tamaki, Y.; Nomura, Y.; Nishikawara, F.; Motegi, M.; Teraoka, K.; Arakawa, H.; Tsurumoto, A.; Hanada, N. Correlation between patient satisfaction and dental clinic credibility in regular dental check-ups in Japan. J. Oral Sci. 2005, 47, 97–103. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Luciak-Donsberger, C. Origins and benefits of dental hygiene practice in Europe. Int. J. Dent. Hyg. 2003, 1, 29–42. [Google Scholar] [CrossRef]
- Thevissen, E.; De Bruyn, H.; Colman, R.; Koole, S. Attitude of dental hygienists, general practitioners and periodontists towards preventive oral care: An exploratory study. Int. Dent. J. 2017, 67, 221–228. [Google Scholar] [CrossRef]
- The 8020 Promotion Foundation. Health Japan 21 Dental Care Institutions Report. Available online: https://www.8020zaidan.or.jp/pdf/jigyo/kenko21_shisetsu.pdf (accessed on 2 November 2020).
- Fukai, K.; Furuta, M.; Aida, J.; Shimazaki, Y.; Ando, Y.; Miyazaki, H.; Kanbara, M.; Sumitomo, M.; Sato, T.; Yamashina, T.; et al. The Oral Health and General Health of Japanese Dental Patients: Results from the Baseline Data of the 8020 Promotion Foundation Study on the Health Promoting Effect of Dental Care. J. Jpn. Assoc. Dent. Sci. 2016, 35, 39–50. [Google Scholar]
- Saito, M.; Shimazaki, Y.; Fukai, K.; Furuta, M.; Aida, J.; Ando, Y.; Miyazaki, H.; Kambara, M. Risk factors for tooth loss in adult Japanese dental patients: 8020 Promotion Foundation Study. J. Investig. Clin. Dent. 2019, 10, e12392. [Google Scholar] [CrossRef] [PubMed]
- Furuta, M.; Fukai, K.; Aida, J.; Shimazaki, Y.; Ando, Y.; Miyazaki, H.; Kambara, M.; Yamashita, Y. Periodontal status and self-reported systemic health of periodontal patients regularly visiting dental clinics in the 8020 Promotion Foundation Study of Japanese Dental Patients. J. Oral Sci. 2019, 61, 238–245. [Google Scholar] [CrossRef] [Green Version]
- Fukai, K.; Furuta, M.; Aida, J.; Shimazaki, Y.; Ando, Y.; Miyazaki, H.; Kambara, M.; Kobayashi, R.; Sumitomo, M.; Yamashina, T.; et al. Association Between Oral Health and General Health of Japanese Dental Patients: The 8020 Promotion Foundation Study on the Health Promotion Effects of Dental Care -A3year- Cohort Study. J. Jpn. Assoc. Dent. Sci. 2019, 38, 84–93. [Google Scholar]
- Saito, M.; Shimazaki, Y.; Fukai, K.; Furuta, M.; Aida, J.; Ando, Y.; Miyazaki, H.; Kambara, M. A multilevel analysis of the importance of oral health instructions for preventing tooth loss: The 8020 Promotion Foundation Study of Japanese Dental Patients. BMC Oral Health 2020, 20, 328. [Google Scholar] [CrossRef] [PubMed]
- Barros, A.J.D.; Hirakata, V.N. Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio. BMC Med. Res. Methodol. 2003, 3, 21. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Austin, P.C.; Stryhn, H.; Leckie, G.; Merlo, J. Measures of clustering and heterogeneity in multilevel Poisson regression analyses of rates/count data. Stat. Med. 2018, 37, 572–589. [Google Scholar] [CrossRef]
- Rubin, D.B.; Schenker, N. Multiple imputation in health-are databases: An overview and some applications. Stat. Med. 1991, 10, 585–598. [Google Scholar] [CrossRef]
- Freeman, R.; Kerr, G.; Salmon, K.; Speedy, P. Patient-active prevention in primary dental care: A characterisation of general practices in Northern Ireland. Prim. Dent. Care 2005, 42–46. [Google Scholar] [CrossRef]
- Hussein, R.; Schneller, T.; Walter, U. Preventive activity of dentists and its associations with dentist and dental practice characteristics in northern Germany. J. Public Health 2013, 21, 455–463. [Google Scholar] [CrossRef]
- Aida, J.; Fukai, K.; Watt, R.G. Global Neglect of Dental Coverage in Universal Health Coverage Systemsand Japan’s Broad Coverage. Int. Dent. J. 2020, in press. [Google Scholar]
- Murakami, K.; Aida, J.; Ohkubo, T.; Hashimoto, H. Income-related inequalities in preventive and curative dental care use among working-age Japanese adults in urban areas: A cross-sectional study. BMC Oral Health 2014, 14, 117. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Japan Dental Hygienists Association. Dental Hygienist Working Conditions Survey Report. Available online: https://www.jdha.or.jp/pdf/aboutdh/r2-dh_hokoku.pdf (accessed on 2 November 2020).
Treatment N = 7651 (63.0%) | Dental Check-Ups N = 4488 (37.0%) | p-Value | ||||
---|---|---|---|---|---|---|
N | % | N | % | p | ||
Dental units dedicated to dental hygienists | ||||||
None | 5921 | 65.6 | 3102 | 34.4 | p < 0.01 | |
≥1 dental unit | 1730 | 55.5 | 1386 | 44.5 | ||
Time spent on oral health education | ||||||
0 min | 1510 | 71.9 | 590 | 28.1 | p < 0.01 | |
1–9 min | 2531 | 63.1 | 1483 | 37.0 | ||
10–19 min | 2394 | 60.7 | 1553 | 39.3 | ||
≥20 min | 1217 | 58.5 | 862 | 41.5 | ||
Number of dental hygienists (full-time equivalent) | ||||||
0 | 1072 | 78.2 | 298 | 21.8 | p < 0.01 | |
<0–0.9 | 1833 | 72.5 | 697 | 27.6 | ||
1–1.9 | 1734 | 64.2 | 967 | 35.8 | ||
2–2.9 | 1373 | 57.1 | 1031 | 42.9 | ||
≥3 | 1639 | 52.3 | 1,495 | 47.7 | ||
Number of dentists (full-time equivalent) | ||||||
1 | 4728 | 66.0 | 2441 | 34.1 | p < 0.01 | |
<1–1.9 | 2003 | 59.2 | 1383 | 40.8 | ||
≥2 | 920 | 58.1 | 664 | 41.9 | ||
Sex | ||||||
Male | 2950 | 68.1 | 1381 | 31.9 | p < 0.01 | |
Female | 4701 | 60.2 | 3107 | 39.8 | ||
Age (years) | ||||||
20–29 | 582 | 59.6 | 394 | 40.4 | p <0.01 | |
30‒39 | 903 | 60.3 | 595 | 39.7 | ||
40‒49 | 1136 | 60.3 | 747 | 39.7 | ||
50‒59 | 1341 | 64.5 | 737 | 35.5 | ||
60–69 | 1826 | 63.1 | 1066 | 36.9 | ||
70–79 | 1456 | 64.9 | 786 | 35.1 | ||
80–89 | 386 | 70.7 | 160 | 29.3 | ||
≥90 | 21 | 87.5 | 3 | 12.5 | ||
Subjective economic status | ||||||
Low | 1642 | 68.3 | 763 | 31.7 | p < 0.01 | |
Middle | 5049 | 62.1 | 3,086 | 37.9 | ||
High | 960 | 60.1 | 639 | 39.9 | ||
Years of education | ||||||
≤9 | 724 | 72.3 | 277 | 27.7 | p < 0.01 | |
10–12 | 3344 | 64.9 | 1810 | 35.1 | ||
14–15 | 2122 | 59.8 | 1430 | 40.3 | ||
≥16 | 1460 | 60.1 | 971 | 39.9 |
Crude | Model 1 | Model 2 | Model 3 | Model 4 | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
PR | 95%CI | PR | 95%CI | PR | 95%CI | PR | 95%CI | PR | 95%CI | ||||||||||||
Fixed effects | |||||||||||||||||||||
Dental units dedicated to dental hygienists | |||||||||||||||||||||
None | 1.00 | 1.00 | 1.00 | ||||||||||||||||||
≥1 dental unit | 1.29 | 1.17 | - | 1.43 | 1.24 | 1.11 | - | 1.37 | 1.17 | 1.06 | - | 1.30 | |||||||||
The time spent on oral health education | |||||||||||||||||||||
0 min | 1.00 | 1.00 | 1.00 | ||||||||||||||||||
1–9 min | 1.30 | 1.12 | - | 1.50 | 1.24 | 1.08 | - | 1.42 | 1.18 | 1.03 | - | 1.35 | |||||||||
10–19 min | 1.41 | 1.23 | - | 1.62 | 1.31 | 1.16 | - | 1.49 | 1.19 | 1.05 | - | 1.36 | |||||||||
≥ 20 min | 1.50 | 1.28 | - | 1.75 | 1.40 | 1.20 | - | 1.63 | 1.25 | 1.07 | - | 1.46 | |||||||||
Number of dental hygienists (full-time equivalent) | |||||||||||||||||||||
0 | 1.00 | 1.00 | 1.00 | ||||||||||||||||||
<0–0.9 | 1.28 | 1.07 | - | 1.53 | 1.28 | 1.07 | - | 1.55 | 1.23 | 1.01 | - | 1.50 | |||||||||
1–1.9 | 1.66 | 1.35 | - | 2.04 | 1.61 | 1.31 | - | 1.98 | 1.51 | 1.23 | - | 1.86 | |||||||||
2–2.9 | 1.96 | 1.60 | - | 2.41 | 1.92 | 1.57 | - | 2.35 | 1.82 | 1.48 | - | 2.24 | |||||||||
≥3 | 2.28 | 1.85 | - | 2.83 | 2.18 | 1.75 | - | 2.72 | 2.05 | 1.64 | - | 2.56 | |||||||||
Number of dentists (full-time equivalent) | |||||||||||||||||||||
1 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||||||||||
<1–1.9 | 1.17 | 1.04 | - | 1.30 | 1.14 | 1.03 | - | 1.27 | 1.12 | 1.01 | - | 1.25 | 1.04 | 0.94 | - | 1.16 | 1.03 | 0.93 | - | 1.14 | |
≥2 | 1.23 | 1.08 | - | 1.40 | 1.15 | 1.01 | - | 1.31 | 1.14 | 0.99 | - | 1.31 | 0.95 | 0.83 | - | 1.10 | 0.91 | 0.79 | - | 1.04 | |
Sex | |||||||||||||||||||||
Male | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||||||||||
Female | 1.25 | 1.17 | - | 1.33 | 1.20 | 1.13 | - | 1.26 | 1.19 | 1.13 | - | 1.26 | 1.20 | 1.14 | - | 1.26 | 1.20 | 1.13 | - | 1.26 | |
Age (years) | |||||||||||||||||||||
20–29 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||||||||||
30–39 | 0.98 | 0.68 | - | 0.88 | 0.97 | 0.88 | - | 1.06 | 0.97 | 0.88 | - | 1.07 | 0.96 | 0.87 | - | 1.06 | 0.96 | 0.88 | - | 1.06 | |
40–49 | 0.98 | 0.57 | - | 0.90 | 0.99 | 0.91 | - | 1.07 | 0.99 | 0.91 | - | 1.08 | 0.99 | 0.91 | - | 1.07 | 0.99 | 0.91 | - | 1.07 | |
50–59 | 0.88 | 0.02 | - | 0.78 | 0.89 | 0.80 | - | 0.99 | 0.89 | 0.80 | - | 0.99 | 0.90 | 0.81 | - | 1.00 | 0.90 | 0.80 | - | 1.00 | |
60–69 | 0.90 | 0.08 | - | 0.80 | 0.94 | 0.85 | - | 1.04 | 0.94 | 0.85 | - | 1.04 | 0.95 | 0.86 | - | 1.05 | 0.95 | 0.86 | - | 1.05 | |
70–79 | 0.86 | 0.02 | - | 0.76 | 0.93 | 0.83 | - | 1.03 | 0.93 | 0.83 | - | 1.03 | 0.94 | 0.84 | - | 1.05 | 0.94 | 0.85 | - | 1.05 | |
80–89 | 0.72 | 0.00 | - | 0.60 | 0.83 | 0.71 | - | 0.96 | 0.83 | 0.72 | - | 0.96 | 0.85 | 0.73 | - | 0.99 | 0.85 | 0.73 | - | 0.99 | |
≥90 | 0.31 | 0.04 | - | 0.10 | 0.46 | 0.16 | - | 1.30 | 0.46 | 0.16 | - | 1.30 | 0.46 | 0.16 | - | 1.30 | 0.47 | 0.17 | - | 1.31 | |
Subjective economic status | |||||||||||||||||||||
Low | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||||||||||
Middle | 1.19 | 1.10 | - | 1.28 | 1.13 | 1.06 | - | 1.21 | 1.13 | 1.05 | - | 1.21 | 1.12 | 1.04 | - | 1.20 | 1.12 | 1.04 | - | 1.20 | |
High | 1.23 | 1.11 | - | 1.38 | 1.13 | 1.04 | - | 1.24 | 1.13 | 1.03 | - | 1.24 | 1.13 | 1.03 | - | 1.23 | 1.12 | 1.03 | - | 1.23 | |
Years of education | |||||||||||||||||||||
≤9 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||||||||||
10–12 | 1.26 | 1.13 | - | 1.41 | 1.13 | 1.01 | - | 1.25 | 1.13 | 1.01 | - | 1.25 | 1.13 | 1.02 | - | 1.26 | 1.13 | 1.02 | - | 1.26 | |
14–15 | 1.43 | 1.28 | - | 1.60 | 1.20 | 1.08 | - | 1.34 | 1.20 | 1.08 | - | 1.34 | 1.20 | 1.08 | - | 1.34 | 1.20 | 1.08 | - | 1.34 | |
≥16 | 1.42 | 1.27 | - | 1.59 | 1.25 | 1.13 | - | 1.39 | 1.25 | 1.13 | - | 1.39 | 1.26 | 1.13 | 1.39 | 1.26 | 1.13 | - | 1.40 | ||
Random effects (SE) | |||||||||||||||||||||
Prefecture | 0.02 * | (0.01) | 0.01 | (0.01) | 0.02 | (0.01) | 0.02 | (0.01) | 0.02 | (0.01) | |||||||||||
Dental clinic | 0.30 * | (0.03) | 0.26 | (0.03) | 0.25 | (0.03) | 0.21 | (0.02) | 0.19 | (0.02) | |||||||||||
Median prevalence ratio (MPR) | MPR | 95%CI | MPR | 95%CI | MPR | 95%CI | MPR | 95%CI | MPR | 95%CI | |||||||||||
Prefecture | 1.14 * | 1.10 | - | 1.21 | 1.10 | 1.10 | - | 1.21 | 1.14 | 1.10 | - | 1.21 | 1.14 | 1.10 | - | 1.21 | 1.14 | 1.10 | - | 1.18 | |
Dental clinic | 1.69 * | 1.60 | - | 1.79 | 1.63 | 1.55 | - | 1.72 | 1.61 | 1.55 | - | 1.70 | 1.55 | 1.55 | - | 1.72 | 1.52 | 1.45 | - | 1.60 | |
Variance partition coefficient (VPC) | |||||||||||||||||||||
Prefecture | 0.6% * | 0.3% | 0.6% | 0.6% | 0.6% | ||||||||||||||||
Dental clinic | 8.4% * | 7.3% | 7.1% | 6.0% | 5.5% |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Inoue, Y.; Shimazaki, Y.; Oshiro, A.; Zaitsu, T.; Furuta, M.; Ando, Y.; Miyazaki, H.; Kambara, M.; Fukai, K.; Aida, J. Multilevel Analysis of the Association of Dental-Hygienist-Related Factors on Regular Dental Check-Up Behavior. Int. J. Environ. Res. Public Health 2021, 18, 2816. https://doi.org/10.3390/ijerph18062816
Inoue Y, Shimazaki Y, Oshiro A, Zaitsu T, Furuta M, Ando Y, Miyazaki H, Kambara M, Fukai K, Aida J. Multilevel Analysis of the Association of Dental-Hygienist-Related Factors on Regular Dental Check-Up Behavior. International Journal of Environmental Research and Public Health. 2021; 18(6):2816. https://doi.org/10.3390/ijerph18062816
Chicago/Turabian StyleInoue, Yuko, Yoshihiro Shimazaki, Akiko Oshiro, Takashi Zaitsu, Michiko Furuta, Yuichi Ando, Hideo Miyazaki, Masaki Kambara, Kakuhiro Fukai, and Jun Aida. 2021. "Multilevel Analysis of the Association of Dental-Hygienist-Related Factors on Regular Dental Check-Up Behavior" International Journal of Environmental Research and Public Health 18, no. 6: 2816. https://doi.org/10.3390/ijerph18062816
APA StyleInoue, Y., Shimazaki, Y., Oshiro, A., Zaitsu, T., Furuta, M., Ando, Y., Miyazaki, H., Kambara, M., Fukai, K., & Aida, J. (2021). Multilevel Analysis of the Association of Dental-Hygienist-Related Factors on Regular Dental Check-Up Behavior. International Journal of Environmental Research and Public Health, 18(6), 2816. https://doi.org/10.3390/ijerph18062816