Relationship between Oral health Profile, Service utilization and Locations: Building a Model for School Dental Services

Abstract

Aim: This research project aims to provide an update on dental caries profile of 9-to-12-year- old schoolchildren in Al- Madinah, Saudi Arabia (SA); to investigate the factors associated with dental care utilization including sociodemographic characteristics, and oral health needs; to examine regular dental visit and its association with sociodemographic, clinical, and behavioural characteristics; to assess the distribution and accessibility of primary public dental services in Al-Madinah in comparison with that in Jeddah; and to develop a geographic model for school dental services (SDS) in Al-Madinah, SA, geographic information system (GIS)-based on the distribution of child population density. Methods: Data from 1,000 schoolchildren aged 9–12 years old from a cross-sectional oral health survey in Al-Madinah, SA was obtained and analysed. Clinical, sociodemographic and behavioural data were extracted from the survey. Descriptive and inferential statistics were calculated to estimate caries prevalence and severity and their association with sociodemographic factors. A multiple logistic regression model was used to assess the factors influencing dental care use. For geographic analysis, primary public dental services locations; the location of primary public schools and the number of students in each school were mapped using GIS. Analysis of primary public dental services distribution in Al-Madinah compared to Jeddah was conducted. And building a geographic theoretical model for SDS in Al-Madinah, SA was designed. Results: Caries prevalence in primary or permanent teeth was 85.1%, with untreated caries at 76.1%. The mean dmft was 2.66 ± 2.63 while the mean DMFT was 1.43 ± 1.73. Approximately a iii quarter of all participants (23.8%), have never received dental care before while only 9.2% of the sample reported regular dental visits. Pain or trouble with teeth was the most common reason for visiting the dentist (49.4%). The multiple logistic regression model showed that children from low-income families had a reduced likelihood of receiving dental care (OR=0.571, P=0.014). Children who have caries and who reported having toothache in the past 12 months were more likely to visit the dentist (OR=1.599, P=0.028) & (OR=2.188, P>0.001). In addition, regular dental visits were associated with gender (female: OR = 1.715; p = 0.041), high family income (middle income: OR = 0.464; p = 0.024; and low income: OR = 0.517; p = 0.015), and the consumption of sugary food and drinks (almost daily: OR = 0.438; p = 0.017; and several times a week: OR = 0.511; p = 0.050). An uneven distribution of dental services was found, with services concentrated in certain districts in both cities and other districts with far fewer or no dental services. Furthermore, the future locations for SDS were studied: the areas with the higher number of schools; higher number of students; and dense child population as presented in the map suggest the future location of SDS. The total number of dentists required to work in SDS settings was 415 for the first model, and 277 for the second model. Conclusion: Dental caries persists as a public health challenge among schoolchildren in Al- Madinah, SA, with high prevalence and severity among schoolchildren. Dental care utilization is mainly driven by symptomatic dental care and regular dental visits are uncommon behaviour. Establishing SDS is suggested as a solution to this health issue in Al-Madinah and SA in general. A theoretical model was proposed for SDS with the future SDS locations and the number of dentists to hire for the services to meet the child population's oral health needs.