Self-perceived oral health, dental utilization and satisfaction with dental care - a longitudinal study in one Swedish age cohort

Abstract: From an outline of a general model of inequalities in oral health, three main issues are addressed: (1) Self-perceived oral health; (2) Utilization of dental care; and (3) Satisfaction with dental care. The aim was to study these aspects in relation to each other as well as aspects such as socio-economic factors, health factors, and attitudes to teeth and care organization. Another aim was to study changes between the two study years. The study is a questionnaire study of a longitudinal sample: people born in 1942 and at the time of the studies living in Örebro or Östergötland county in Sweden. A cohort (5363 persons) was established with those who completed the questionnaire in both 1992 and 1997. The main results were that there were social differences in self-perceived oral health, with those born outside Sweden, those living single, those with lower level of education and those being blue-collar worker perceiving worse oral health. Changes between the two study years were moderate despite major cutbacks in dental care insurance during this period. Socio-economic factors affected dental care utilization as well. Having a private care provider gave higher utilization and higher cost for care. Health perception, both oral and general health, and dental anxiety also affected utilization. Increasing patient cost for care did not appreciably affect utilization. The overall satisfaction with dental care was high, both in general terms and with the most recent dental visit. Differences between the two studied years were small. Persons not visiting dental care within the last year were more dissatisfied, both generally and with the most recent visit. A large number of regular attenders had no feelings of anxiety, pain or unpleasantness at all. Oral health related factors and dental care factors such as cost for care and care organization were related to satisfaction with dental care. So were experiences from the most recent dental visit and, to some extent, past care experiences, like school dentistry. Almost no correlation was seen between socio-economic factors and satisfaction with dental care. Change between the two study years was affected by self-perceived oral health, experiences from the most recent dental visit and care organization. As a whole, the study confirms models of oral health and care utilization.