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Introduction

  1. Top of page
  2. Introduction
  3. Methods
  4. Independent variables
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

Dental caries is one of the most prevalent childhood diseases with more than half of all six-year-old children and almost half of all 12-year-old children having decay experience in the deciduous dentition and in the permanent dentition respectively.1 Dental caries is the most common reason for hospitalization of children between ages 1 and 14 years in Australia.2 School dental services set up in the 1970s to provide free universal access to preventive and treatment services for children in a timely manner have changed substantially in recent years with the introduction of co-payments, requirements for parental attendance and consolidation of clinics. Consequently, private dental attendance by children increased significantly from 2002 to 2005, reflecting this decline in the utilization of the School Dental Service.3

Thus, there is a need to understand some of the determinants of children’s use of dental services in this changing environment. A number of overseas studies have reported that children’s use of dental services has been shown to be positively correlated with parental use.4,5 Hence the aim of this study was to investigate the association between parental and child use of dental services in Australia.

Methods

  1. Top of page
  2. Introduction
  3. Methods
  4. Independent variables
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

Data source

Data presented in this report were sourced from the National Dental Telephone Interview Survey (NDTIS) 2010. The target population for NDTIS 2010 was Australian residents aged two years and over in all states and territories. To select a representative sample of residents a two-stage stratified sampling design was implemented. In the first stage a random sample of households was selected from the Electronic White Pages (EWP). To be able to access the latest version of the EWP, the AIHW DSRU requested the Australian Electoral Commission (AEC) extract a sample of Australian adults aged 18 years and over from the electoral roll. These data were matched against the Sensis MacroMatch database to append a residential telephone number. Matched records that returned either a landline or mobile telephone number formed the basis of the sample frame for the 2010 National Dental Telephone Interview Survey (NDTIS). The sample frame was stratified by state and region, where region was defined as metropolitan or non-metropolitan. Households were randomly selected from each stratum using the inbuilt features of the WINCATI software programme (WinCati 4.2 Sawtooth Technologies, Inc.) and contacted by telephone.

If telephone contact was made with a household, the interviewer established whether the telephone number served a residential dwelling. If the household was in-scope of the survey, an adult aged 18 years or older usually resident in the household was randomly selected. If there was only one adult usually resident in the household, then that person was selected as the target adult. If there were two or more adults usually resident in the household, the householder was asked to identify the person who was due to have the next birthday as well as the person who had the last birthday. The WINCATI programme then randomly selected one of the nominated adults as the target adult to complete the telephone interview. Once the interview was completed with the target adult, if there were children aged 2–17 years usually residing in the household, one child was randomly selected to participate in the survey, with a parent answering the questions on behalf of the child. A total of 10 237 people aged 2+ years were interviewed and asked a range of questions relating to their oral health, access to dental care, dental treatment received and affordability of dental care.

Data were weighted to account for the different probabilities of selection to reflect the 2009 estimated resident population.6

Sample

Only data for matched child-parent interviews with available data on use of dental services were included in the analysis presented in this report. Where the matched survey respondent was not the parent, these children were excluded from analysis. Only children aged 5–17 years were included in the analyses as less than half the children aged 2–4 years that were sampled had ever made a dental visit.

Dependent variables

The dependent variables pertained to child’s use of dental services were: (1) time since child last saw a dental professional about his/her teeth or gums (dichotomized into <12 months versus 1+ years); and (2) avoided or delayed visiting a dental professional in the last 12 months because of the cost (Yes/No response categories).

Independent variables

  1. Top of page
  2. Introduction
  3. Methods
  4. Independent variables
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

A number of independent variables were used to explore associations between parent’s and child’s use of dental services. These variables pertained to:

  • 1
    child characteristics (child’s age (categorized as 5–10 years, 11–14 years, 15–17 years); child needs dental care (Yes/No response categories), parent-rated child’s dental health (dichotomized into Excellent/Very good/Good versus Fair/Poor);
  • 2
     parent characteristics (parent’s gender (Male/Female); parent’s age (categorized as 18–34 years, 35–44 years, 45–54 years, 55+ years); parent’s employment status (dichotomized into employed versus unemployed); household structure (dichotomized into sole adult household, 2 or more adult household); parent’s highest level of education (dichotomized into post-secondary education versus no post-secondary education);
  • 3
     parent visiting characteristics (time since parent’s last dental visit (dichotomized into <12 months versus 1+ years); parent avoided or delayed visiting a dental professional in the last 12 months because of the cost (Yes/No response categories); parent’s usual reason for visiting a dentist (dichotomized into check-up versus problem); parent’s self-perceived need for dental care (Yes/No response categories); parent usually goes to a particular dentist for dental care (Yes/No response categories); and
  • 4
     affordability characteristics (dental insurance status (Yes/No response categories); dwelling ownership (dichotomized into rented accommodation versus other); equivalized income (categorized into <$10 000, $10–<$20 000, $20–<$35 000, $35–<$45 000, $45–<$75 000); difficulty paying a $150 dental bill (dichotomized into Yes versus No); cardholder status (dichotomized into cardholder versus non-cardholder).

Statistical analyses

To account for the stratified sampling design used in NDTIS, SPSS complex samples was used to analyse bivariate associations between parent and child avoidance/delay of dental care because of cost, as well as parent and child use of dental services in the previous 12 months. For the proportions presented, statistical significance was determined by non-overlapping 95% confidence intervals.

Results

  1. Top of page
  2. Introduction
  3. Methods
  4. Independent variables
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

This report presents findings from 1765 matched child-parent interviews.

Sample characteristics

Characteristics of the study sample are presented in Tables 1a and 1b. A slight majority of the children sampled were male (51.8%). Just over 59% of the parents interviewed were female and just over 55% of the parents interviewed were aged between 35 and 44 years. Approximately 54% of the sample had private dental insurance and just over 17% were covered by a Commonwealth Government concession card.

Table 1a.   Overall weighted percentage distribution of socio-demographic variables: child visited dentist in <12 months and child avoided/delayed visiting in <12 months due to cost (unweighted n = 1765)
  Child visited dentist in <12 monthsChild avoided/delayed dental visit in <12 months due to costTotal
<12 months1+ years†YesNo
  1. †Includes ‘Never’ category.

Child factors
GenderMale    51.5    53.252.351.751.8
Female48.546.847.748.348.2
Age group5–10 years45.659.642.049.748.6
11–14 years32.920.931.730.130.4
15–17 years21.519.526.320.221.0
Self-rated dental healthExcellent/Very Good/Good94.593.585.695.694.3
Fair/Poor5.56.514.44.45.7
Parent factors
GenderMale40.640.526.343.140.9
Female59.459.573.756.959.1
Age group18–34 years9.319.413.211.311.6
35–44 years55.654.452.555.955.4
45–54 years31.223.231.529.029.3
55+ years3.83.02.73.83.7
Parent employmentEmployed84.577.568.685.082.8
Unemployed15.522.531.415.017.2
Household structureSole adult household9.920.826.310.212.3
2+ adult household90.179.273.789.887.7
Highest level of educationPost-secondary74.272.272.173.873.6
No post-secondary25.827.827.926.226.4
Table 1b.   Overall weighted percentage distribution of socio-demographic variables: child visited dentist in <12 months and child avoided/delayed visiting in <12 months due to cost (unweighted n = 1765)
  Child visited dentist in <12 monthsChild avoided/delayed dental visit in <12 months due to costTotal
<12 months1+ years†YesNo
  1. †Includes ‘Never’ category.

Affordability factors
Private dental insuranceYes59.436.729.658.054.2
No40.663.370.442.045.8
Difficulty paying a $150 dental billYes16.832.856.815.020.6
No83.267.243.285.079.4
Dwelling OwnershipRented accommodation19.637.935.521.823.6
Other80.462.164.578.276.4
Equivalized income<$10 0003.69.414.33.75.1
$10–<$20 00013.522.331.313.015.5
$20–<$35 00024.226.025.624.624.7
$35–<$45 00025.015.315.523.822.7
$45–<$75 00033.627.013.234.932.0
Cardholder statusCardholder13.130.431.014.917.1
Non-cardholder86.969.669.085.182.9
Parent visiting factors
Parent’s perceived need for dental care (for self)No28.314.88.427.725.2
Yes71.785.291.672.374.8
Time since parent last visited a dentist<12 months64.742.446.661.659.5
1+ years†35.357.653.438.440.5
Parent avoided/delayed dental visit in last 12 months due to costYes34.848.082.331.037.8
No65.252.017.769.062.2
Parent’s usual reason for dental visitCheck-up64.442.038.062.359.1
Problem35.658.062.037.740.9
Usually go to a particular dentistYes84.566.675.781.380.6
No15.533.424.318.719.4

Child and parent use of dental services

Table 1b also shows that almost 60% of parents last visited a dentist in the previous 12 months, but that 37.8% of parents avoided or delayed visiting a dentist in the previous 12 months due to cost. Among children 77.6% of those sampled last visited a dentist in the previous 12 months and 13.1% of children avoided or delayed visiting a dentist in the last 12 months due to cost (Table 2).

Table 2.   Child visited and child avoided/delayed care in the last 12 months by child factors and parent factors
  Child visited dentist in <12 monthsChild avoided/delayed visit in <12 months due to cost
Weighted %95% CIWeighted %95% CI
  1. CI = confidence interval.

  2. *For dependent variable: child last visited dentist in <12 months: statistically significant–non-overlapping confidence intervals.

  3. #For dependent variable: child avoided/delayed visit in <12 months due to cost: statistically significant–non-overlapping confidence intervals.

  4. †Includes ‘Never’ category.

Child factors
Age group*5–10 years   72.667.9–76.8   11.38.3–15.1
11–14 years84.579.5–88.413.710.0–18.4
15–17 years79.273.4–84.0 16.412.1–21.8
Child needs dental care*#No89.684.7–93.14.3 2.6–7.2
Yes72.070.8–77.7 17.114.2–20.5
Self-rated dental health#Excellent/Very Good/Good77.874.7–80.511.99.8–14.4
Fair/Poor74.662.3–83.933.121.8–46.8
Time since last dental visit#<12 mths8.56.7–10.7
1+ years†28.722.3–36.1
Avoided/delayed dental visit in last 12 months due to cost*Yes81.778.7–84.3
No71.363.9–77.7
Parent factors
Parent gender#Male77.672.9–81.78.45.9–11.9
Female77.573.6–81.016.313.3–19.9
Age group*18–34 years62.451.9–71.915.09.1–23.8
35–44 years77.973.8–81.612.49.6–15.9
45–54 years82.377.7–86.114.110.4–18.7
55+ years81.765.2–91.49.63.9–21.8
Parent employment#Employed79.175.9–81.910.88.8–13.3
Unemployed70.462.3–77.324.017.4–32.0
Household structure*#Sole adult household62.151.3–71.928.019.0–39.2
2+ adult household79.776.8–82.411.09.1–13.3
Highest level of educationPost-secondary78.074.7–81.012.810.4–15.7
No post-secondary76.369.8–87.713.89.8–19.0
Table Total 77.674.6–80.313.111.0–15.6

For parents who visited a dentist in the previous 12 months, 64.7% of their children visited a dentist in the last 12 months and for parents who avoided or delayed visiting a dentist in the last 12 months due to cost, 82.3% of their children also delayed/avoided visiting the dentist in the previous 12 months due to cost.

Bivariate associations

Bivariate analyses testing the association between children’s use of dental services and various parent, affordability, and parent visiting factors yielded a number of significant findings.

Child visiting related to socio-demographic and need factors (Table 2)

A number of child factors were significantly associated with child’s use of dental services in the previous 12 months. Nearly 90% of children whose parents reported the child did not need dental care had visited in the previous 12 months compared to 72% of children who needed dental care. In addition about 17% of children who needed dental care reported avoiding or delaying visiting because of cost compared to 4.3% of those who reported no need. A greater percentage of children whose oral health was reported to be fair or poor (33.1%) had avoided or delayed their dental visit because of cost compared to those with better oral health (11.9%). A greater proportion of children who had not visited in the last 12 months avoided or delayed visiting in the last 12 months due to cost (28.7% cf 8.5%).

Parental factors significantly related to child visiting were the gender of the parent with a greater proportion of female parents reporting avoiding or delaying visiting because of cost. The age of the parent was also significant with fewer children of younger parents having visited in the previous 12 months (62.4%) compared to older parents (77.9% and 82.4%). Fewer children of parents in sole parent households had visited in the previous 12 months and a greater percentage of parents in sole parent households reported their child had avoided visiting because of cost. For parents who were employed, 10.8% of children had avoided or delayed visiting the dentist in the previous 12 months due to cost, compared to 24% of children of unemployed parents.

Child visiting related to affordability and parental visiting factors (Table 3)
Table 3.   Child visit and child avoided/delayed care in the last 12 months by affordability factors and parent visiting characteristics
  Child last visited dentist in <12 monthsChild avoided/delayed visit in <12 months due to cost
Weighted %95% CIWeighted %95% CI
  1. CI = confidence interval.

  2. *For dependent variable: child last visited dentist in <12 months: statistically significant–non-overlapping confidence intervals.

  3. #For dependent variable: child avoided/delayed visit in <12 months due to cost: statistically significant–non-overlapping confidence intervals.

  4. †Includes ‘Never’ category.

Affordability factors
Private dental insurance*#Yes   84.881.5–87.6    7.25.2–9.8
No69.063.9–73.620.216.4–24.6
Difficulty paying a $150 dental bill*#Yes63.956.1–71.036.329.3–44.0
No81.080.3–85.77.15.5–9.2
Dwelling ownership*#Rented accommodation64.255.5–72.019.613.5–27.6
Other81.879.2–84.111.09.1–13.2
Equivalized income*#<$10 00056.938.9–73.336.921.7–55.2
$10–<$20 00067.257.6–75.526.719.1–36.0
$20–<$35 00076.069.0–81.713.69.7–18.8
$35–<$45 00084.779.8–88.69.06.1 –13.2
$45–<$75 00080.876.4–84.65.43.5–8.3
Cardholder status*#Cardholder59.850.3–68.623.916.7–32.8
Non-cardholder81.278.4–83.810.98.9–13.3
Parent visiting factors
Parent’s perceived need for dental care (for self)*#No86.982.0–90.64.32.6–7.2
Yes74.470.8–77.716.013.3–19.2
Time since parent last visited a dentist*#<12 months84.180.5–87.110.27.9–13.2
1+ years†67.962.9–72.617.313.6–21.7
Parent avoided/delayed dental visit in last 12 months due to cost*#Yes71.566.2–76.228.623.9–33.8
No81.377.7–84.43.72.4–5.7
Parent’s usual reason for dental visit*#Check-up84.180.7–87.08.46.3–11.2
Problem68.062.8–72.819.915.9–24.5
Parent usually goes to a particular dentist*Yes82.681.6–87.111.79.3–14.5
No63.455.0–71.015.610.5–22.6
Table Total 77.674.6–80.313.111.0–15.6

All affordability factors and most parental visiting factors were related to child visiting. Fewer children (69%) whose family had no private dental insurance visited in the previous 12 months compared to children of families with insurance (84.8%) and a higher proportion of children in families without insurance reported avoiding or delaying visiting because of cost (20.2% cf 7.2%). Only about 64% of children whose parents reported difficulty with a $150 bill had visited in the last 12 months compared with 81% of those with no difficulty, but 36.3% of children whose parents reported difficulty had avoided or delayed visiting because of cost compared to 7.1% of those with no difficulty with a $150 bill. Children from families in rental accommodation were less likely to have visited in the previous 12 months and to report cost precluding visiting. Among families with an equivalized income of less than $20 000, fewer children had visited in the previous 12 months and more had avoided visiting because of cost compared to incomes of $35 000 and higher. Child visiting was also significantly related to cardholder status with fewer children of cardholders visiting in the previous 12 month compared to those without cards (59.8% cf 81.2%). In addition, more than twice the proportion of children of cardholders had avoided or delayed visiting because of cost relative to non-cardholders (23.9% cf 10.9%).

Fewer children of parents who had a perceived need for dental care had made a dental visit (74.4%) and more of those children reported avoiding or delaying visiting because of cost (16.0% cf 4.3%). Children of parents who had not made a dental visit in the previous 12 months were less likely to have visited in the same period (67.9% cf 84.1%) and more of them reported avoiding or delaying visiting because of cost (17.3% cf 10.2%). If parents reported avoiding or delaying dental visiting because of cost, fewer of their children visited in the last 12 months (71.5% cf 81.3%) and more reported avoiding or delaying due to cost (28.6% cf 3.7%). Similar results were found for usual reason for parental visiting. The parent having a particular dentist was associated with child’s visiting in the previous 12 months with 82.6% of children visiting in the previous 12 months compared to 63.4% of children of parents who did not have a particular dentist but this variable was not associated with avoiding or delaying because of cost.

Discussion

  1. Top of page
  2. Introduction
  3. Methods
  4. Independent variables
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

This study has found that parental characteristics are associated with child dental visiting patterns. There are some welcome findings in this study and others which are concerning. One of the main positive findings is that although over 40% of adults had not made a dental visit in the previous 12 months, less than one-quarter of children had not made a visit. In addition, although nearly 38% of parents had avoided or delayed dental visiting because of cost this only applied to 13% of children. Many parents are ensuring their children obtain dental care even if they have not made a dental visit themselves.

However, children who had not visited in the past 12 months or who had avoided or delayed dental care because of cost were more likely to come from disadvantaged families. These families were characterized by young parents, sole adult households, families without private dental insurance, those who report difficulty paying a $150 dental bill, those living in rented accommodation, and those on low incomes. Parental visiting patterns are also reflected in the patterns of their children. The analyses within this report showed that differences in child visiting patterns are larger for affordability factors than for parent visiting factors. In examining trends in dental visiting among Australian adults between 1994 and 2008 using previously conducted National Dental Telephone Interview Survey data, it was found that non-cardholders and insured adults consistently reported a higher prevalence of visiting in the last 12 months and visiting for a check-up at their most recent visit than did cardholders and uninsured adults.7 This suggests that the same affordability barriers that affect child dental visiting also affect parent dental visiting.

This study is limited by self report of both oral health need and visiting patterns and may be subject to recall bias. Its strengths lie in the population based survey on which it is based.

This study supports previous findings by Isong et al.4 and by Grembowski et al.5 in the United States where there is no School Dental Service, that parental health-seeking behaviours have an important effect on their children. In an environment in which the utilization of the School Dental Service is declining, and there is a minority of children and a larger proportion of adults having difficulty obtaining timely dental care, what is the appropriate approach to dental care in Australia? It may be time to reconsider a universal child dental scheme and a dental scheme for adults.

Acknowledgements

  1. Top of page
  2. Introduction
  3. Methods
  4. Independent variables
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

This article was prepared by Kaye Roberts-Thomson, Liana Luzzi and Judy Stewart.

References

  1. Top of page
  2. Introduction
  3. Methods
  4. Independent variables
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  • 1
    Ha DH, Roberts-Thomson KF, Armfield JM. The Child Dental Health Surveys Australia, 2005 and 2006. Dental Statistics and Research Series no. 54. Cat. No. DEN 213. Canberra: AIHW, 2011.
  • 2
    Australian Institute of Health and Welfare. Australian Hospital Statistics 2008–09. Health Services Series no. 17. Cat. no. HSE 84. Canberra: AIHW, 2010.
  • 3
    Ellershaw A, Spencer AJ. Trends in access to dental care among Australian children. Dental Statistics and Research Series no. 51. Cat. no. DEN 198. Canberra: AIHW, 2009.
  • 4
    Isong IA, Zuckerman KE, Rao SR, Kuhlthau KA, Winickoff JP, Perrin JM. Association between parents’ and children’s use of oral health services. Pediatrics 2010;125:502508.
  • 5
    Grembowski D, Spiekerman C, Milgrom P. Linking mother access to dental care and child oral health. Community Dent Oral Epidemiol 2009;37:381390.
  • 6
    Australian Bureau of Statistics (ABS) Super CUBE dataset Population estimates by age and sex, Australia, by geographical classification (ASGC 2009) at 30 June 2009, Table 1.
  • 7
    Harford JE, Ellershaw AC, Spencer AJ. Trends in access to dental care among Australian adults 1994–2008. Dental Statistics and Research Series no. 55. Cat. no. DEN 204. Canberra: AIHW, 2011.