Comparison Between Self-rated and Dentist-rated Dental Care

Comparison Between Self-rated and Dentist-rated Dental Care Comparison between self-rated and dentist-rated dental care need among university students in Xi’an city, China Running title: self-rated and dentist-rated dental care ABSTRACT Objective: This study aimed to compare the difference between the self-rated and dentist-rated dental care need among university students in China and to evaluate the related factors. Participants: 757 university students aged 17-26 years. Methods: The study was carried out in 2013 in Xi’an city, China. The students were asked to complete a questionnaire that included the participants’ general information, the self-rated dental care need and their experiences of dental care. Dental conditions of each student were examined by six dentists by field survey. Results: Totally 52% of the students had consistent self-rating with dentist-rating (30.1% need and 21.9% not need). 39.0% of the students in need of dental care chose â€Å"not need† and 9.0% did not need but chose â€Å"need†. The self-rated dental care need had statistical differences in gender, census register and major. While the dentist-rated dental care need did not. Only 30.9% of the respondent stu dents did not need dental care. Conclusion: Self-rated dental care need was significantly associated with gender, census register and major and a number of Chinese university students inaccurately rated their dental care need. Their dental health status was not good. Key words: dental care; self-rating; dentist-rating; university students; major; census register Introduction Survey of the self-rated dental care need is a basic method for dental care studies. It is a simple direct way to study the perceptions of dental health, which is considered valid, reliable and cost-effective 1. And the accuracy of the self-rated dental care need can truly reflects the dental care ability of either individuals or communities. Hongjun Yin, from the Long Island University thinks that self-rated method has already been widely used in health surveys as a single-item measurement of health-rated quality of life 2. And it has been proved reliable and valid 3. There are few differences in the effects of variables associated with self-rated dental care need by different nationalities 4. So self-rated dental care need is an important method to observe dental health status and attitudes of either individuals or communities. Self-rated dental care need has been extensively studied in university students, where a range of associated factors has been identified 1-5. Now days, most research on self-rated dental care need is concentrating on the factors that affect the need 2, 6-15. What’s more, these studies have found many associated factors, such as gender, socioeconomic characteristics, age and education 16. However, the significance of each factor stills remained to be confirmed. Meanwhile, there has been relatively less study on the comparison of self-rated and dentist-rated dental care need. The comparison can truly reflect the accuracy of the self-rated dental care need and the dental care need status. It can also provide reference for the public health bureaus in policy making. The data from National Bureau of Statistics showed that, by the end of 2010, the number of university students would reach to 22.318 million in China 17. The age of university students ranges between 17-24 years. This age group is considered less vulnerable to sicknesses. Meanwhile, they also considered themselves to be less likely to get sick 18. So the public health bureaus often ignore this group of people 19. However, there is little study focusing on this group of people’s dental status to which we must pay attention. Therefore, we carried out the survey of the self-rated dental care need and dentist-rated need among university students in Xi’an city, China. In this study, we investigated both the census register and major, which two were seldom reported before. We also designed a new classification for the dental care need to replace the â€Å"need† and â€Å"not need† classification, which is more detailed and comprehensive. Methods and materials Subjects The study was approved by the University of Nebraska Lincolns institutional review board; all subjects gave informed consent. The subjects, undergraduate students ranging from 18 years of age and above, were recruited from 11AMto 1:30 PM during January 2009 at the 2 university unions. Participants received nominal gifts for completing the questionnaires. Study Sample This study was carried out in 2013 in the city of Xi’an (population 8.467.837) in Shaanxi province, China. Sample design consisted of 5 universities that were selected randomly in Xi’an. The 757 students, including 574 males and 183 females were selected randomly from each department of every university and the age ranged from 17 to 26 years old (20.5 ±1.4 years old, median 21 years old). The student source was nationwide, that covered 31 different provincial administrative regions of China (there are total 34 provincial administrative regions in China) (Table 1). 2.2 Design of the Dentist-Rated Dental Care Need the Self-Rated Dental Care Need According to the damage and urgency of dental diseases, we divided dental care need into four degrees by different conditions20. The first degree was designed to represent healthy dental condition, and the other three degrees were designed to include various dental diseases. The first degree: Dental condition is healthy. The respondent does not need specific dental care. The second degree: Dental condition is not healthy. The respondent needs selective dental care, but does not need treatment urgently, including 6 types: (1) moderate dental calculus; (2) shallow caries do not develop; (3) periodontal disease localizing in a small range, do not develop (4) need orthodontic treatment (5) need preventative treatment (6) need prosthodontics treatment. The third degree: Dental condition is not healthy. The respondent needs dental care as soon as possible, including 6 types: (1) severe caries; (2) severe periodontal disease; (3) chronic dental pulp disease or periapical disease; (4) severe dental calculus; (5) chronic oral infections; (6) one or more teeth need extraction. The fourth degree: Dental condition is not healthy. The respondent needs dental care urgently, including 4 types: (1) oral and maxillofacial trauma (2) acute dental pulp disease or periapical disease (3) acute oral infections (4) acute pericoronitis. 2.3 Assessments and Measurements The self-rated dental care need was represented by the question: â€Å"Considering to your dental status, do you think you have the need of dental care?† 21. The answers were: â€Å"need† and â€Å"not need† 6. The whole process was strictly based on the international dental survey method standards established by the WHO 22. Dental conditions of each student were examined by six dentists using field survey method1. All the dentists had passed the standard test survey. Inter and intra consistency check coincidence rate was higher than 95% 3. All the examinations were conducted under standard inspection light 23. 2.4 Statistical Analyses The age range was divided into three groups: â€Å"≠¤19†, â€Å"20† and â€Å"≠¥21†. Census register was divided into urban and rural; gender was divided into male and female; and the major was divided into science and artS 24. In addition, the self-rated dental care need was compared with the dentist-rated dental care need. Chi-square test was used to assess the significance (P 25. FoxPro 6.0 was used to build up the database. Afterwards, SPSS 17.0 (SN: 5068167, PN: 33132001) was used for statistical description and analysis. Results 3.1 The factors affecting the self-rated and dentist-rated dental care need The self-rated dental care need had statistical differences in gender, census register and major. In addition, the number of students who chose â€Å"need† increased accordingly with the age (Table 1). While the dentist-rated dental care need did not show significant differences in these four aspects (Table 2). 3.2 Comparisons between the self-rated and dentist-rated dental care need Self-rated dental care need showed that 296 students chose â€Å"need† and 461 students chose â€Å"not need†. The comparison between self-rated and dentist-rated dental care need showed that 48.0% (39.0%+9.0%) of the students rated their dental care need inaccurately. 39.0% of the students in need of dental care but chose â€Å"not need†; 9.0% of the students not in need but chose â€Å"need†. Totally 69.1% (39.0%+30.1%) of patients were in need of dental care rated by dentists (Table 3). 3.2 The dental care need rated by dentists and the clinic experience of the students The results of the dentist-rated dental care need showed that only 30.9 % of the students did not need dental care (the first degree); 57.2% of the students needed selective dental care (the second degree); 11.1% of the students needed dental care as soon as possible (the third degree); 0.8% of the students needed dental care urgently (the fourth degree) (Table 4). We collected the dental clinic experiences of the students at the same time. Among the 757 respondent students, 540 (71.3%) said that they didn’t have been to dental clinic before. Discussion 4.1 Associated factors with the self-rated dental care need (age, gender, census register, major) In community health studies, self-rated dental care need is frequently used, including national health surveys. It is a helpful general indicator of overall dental statuS10, 26-28. Jylha et al. from the University of Tampere believes that the way to judge the health status of the students may vary according to gender, age groups, social and cultural backgrounds8. Results showed that the rate of choosing â€Å"need† increases proportionately with age (Table 1). The study of 26,111 Hong Kong students conducted by Lee et al. from The Chinese University of Hong Kong showed that older students had higher prevalence rates of health-compromising behavior than younger students 19. At the same time, a study by Shin et al. from Chonnam National University Medical School showed that the older students rated their self-rated health more negatively in both men and women9. So, age could be one of the factors associated with the self-rated dental care need. In our study, 47.0% of the female students thought that they were in need of dental care. While only 36.6% of the male students thought they were in need of dental care (Table 1). It indicated that female students were more likely than male students to rate their dental conditions poorly. The results corresponded to the research by Hee-Young Shin et al. ,9 their studies also showed that women were more likely than men to rate their self-rated health as poor. Therefore, gender could be another factor associated with the self-rated dental care need. In accordance with their census register, university students can be divided into urban and rural sourced in China5. In this study, the students from rural areas were more likely to think that they were in need of dental care than the students from urban areas (Table 1), though these two groups were not statistically different in the dentist-rated dental care need (Table 2). Meanwhile, there were no previous studies we could refer to. Therefore, whether the census register is one of the factors associated with the self-rated dental need is still need to be confirmed by studies with larger sample size. The results also showed that the arts students were more likely to think themselves in need of dental care than the science students. Despite the fact that they had no statistical difference in the dentist-rated dental care need. Therefore, the major might be one factor associated with the self-rated dental need. 4.2 Comparison between Self-Rated and Dentist-Rated Dental Care Need In most developed countries and some developing countries, health care is regarded as one of the public services 14. Nowadays in China, health care reform is being intensified, and people are paying more and more attention to their health29. But overall, the demand for health care is the starting point for the Chinese government to make health care reform. In this study, there were a large number of Chinese university students who could not rate their dental care need accurately. The results showed that 60.9% of the students thought that they had no need of dental care, but only 36.0% of which were proved really not need dental care after dental examination. The remaining 64% of them all had dental care need at different degrees, among which 54.7% of them needed selective dental care, 8.5% of them needed dental care as soon as possible, and 0.9% of them needed dental care urgently (Table 4). The lack of dental care consciousness might account for a significant problem. In this study, 39.0% of the students had dental care need but considered themselves not in need. It showed that the university students were lack of dental knowledge and self-awareness30. Meanwhile, the results showed that only 30.9% of the respondent students did not need any specific dental care. The other 69.1% all had dental care needs to different degrees. It showed that dental diseases had become common among university students. There was an urgent need to strengthen the dental care services in universities31. The data from the National Bureau of Statistics showed that, by the end of 2010, the number of university student would reach to 22.318 million in China17. So it will be a huge need for dental care services. 4.3 Limitations Compared to the 45.7% given by the state council information office of the Peoples Republic of China, in this research, the female students accounted for 24.2% in all the respondent students. We think the difference came from the sample universities we chose. Because the major subjects for three of the five universities are science and technology, military or engineering, the students in these three universities are mostly male which led to the difference. 4.4 Implications School is one of the most basic places to prevent dental diseases. Students would benefit for a lifetime if they formed good dental care habits at university. We suggest strengthening the dental care knowledge propaganda in university students in China32. We also suggest adding dental knowledge, lectures and pictures in university TV shows and distributing dental care manuals to university students. Lastly, we suggest the Chinese government deepen the health care reform, pay more attention to the dental health care conditions of the university students. This research used a new design for dentist-rated dental care need, which was first introduced to the survey of university students. It have been applied in the survey of the residents in quake-hit areas in Dujiangyan city in 200820. It is designed to include most types of the dental diseases that a dentist could meet. Moreover, obviously, this new classification provides a unified reference for the dentists, which is more scientific and accurate. Background:When assessing health status, physicians may focus on objective symptoms and diagnoses, whereas individuals may focus more on subjective symptoms, functional limitations and quality of life.(25) Table 1. Results of the self-rated dental care needs, stratified by age, gender, census register and major (2013à ¯Ã‚ ¼Ã…’n=757) * The self-rated dental care need had statistical differences in gender, census register and major. * The number of students who chose â€Å"need† increased accordingly with the age. Table 2. Results of the dentist-rated dental care needs, stratified by age, gender, census register and major (2013à ¯Ã‚ ¼Ã…’n=757) * The dentist-rated dental care need did not show significant differences in age, gender, census register and major. Table 3. Comparison between the self-rated dental care needs and dentist-rated needs by different degree (2013, n=757) Dentist-rated dental care needs Self-rated Dental care needs Total n=757 χ2 P 2-sided Need n=296 Not need n=461 Sample % Sample % sample % The first degree 68 23.0 166 36.0 234 30.9 14.343 0.000 The second degree 181 61.1 252 54.7 433 57.2 3.732 0.053 Type 1 113 38.2 175 38.0 288 38.1 0.004 0.953 Type 2 45 15.2 57 12.4 102 13.5 1.246 0.264 Type 3 9 3.0 12 2.6 21 2.8 0.128 0.721 Type 4 61 20.6 69 15.0 130 17.2 4.032 0.045 Type 5 9 3.0 14 3.0 23 3.0 0.000 0.998 Type 6 13 4.4 2 4.0 15 2.0 14.540 0.000 The third degree 45 15.2 39 8.5 84 11.1 8.088 0.004 Type 1 19 6.4 13 2.8 32 4.2 5.767 0.016 Type 2 4 1.4 0 0.0 4 0.5 6.263 0.012 Type 3 7 2.4 1 0.2 8 1.1 7.954 0.005 Type 4 28 9.5 33 7.2 61 8.1 1.288 0.256 Type 5 5 1.7 3 0.7 8 1.1 1.859 0.173 Type 6 16 5.4 7 1.5 23 3.0 9.245 0.002 The forth degree 2 0.7 4 0.9 6 0.8 0.085 0.771 Type 1 0 0 0 0 0 0 0.000 0.000 Type 2 1 0.3 2 0.4 3 0.4 0.042 0.837 Type 3 0 0.0 1 0.2 1 0.1 0.643 0.423