Home Free Lab ReportsDeterminants of Delay in Presentation of Patients with Dental Problems 1

Determinants of Delay in Presentation of Patients with Dental Problems 1

Determinants of Delay in Presentation of Patients with Dental Problems
1.Fatima Saleem, 2. Sara Ashraf, 3. Farhan Javed, 4. Navid Rafiq 1.House Surgeon Periodontology Dep, 2. House Surgeon Periodontology Dep, 3. Head & Asst Professor Periodontology Dep CMH Medical College and institute of dentistry Lahore. 4. MPhil Student Post-Graduate Medical Institute Lahore.

Abstract
Background: Oral health is always ignored and taken as less important as compared to the general health but in contrast both types of health are linked to each other. Study shows that determinants affecting general health are also causing oral health problems and poor oral health leads to many diseases. Therefore, it is said to be important having oral health always kept at higher priority and focused.

Objective: The aim of this study was to examined the factor which decisively affects individuals delaying treatments of their dental problems (Oral Health).

Material/Methods: This research was based on the sample of 126 patients (men and women) who reported at outdoor of CMH LMC & IOD. A descriptive cross sectional study was conducted from April 2017 to September 2017. Convenient sampling design was presented. Survey was conducted only on patients who arrived at outpatient first time with past oral treatment history. Patients showed interest was given questionnaire to answer.

Results: Only 150 participants were approached to participate in this survey and 126 answered successfully (response rate=84%) with age ranges from 15-80 years, 79 were males and 47 were females. Majority of them responded that they avoid visiting the dentist due to lack of time (63.5%), people said that appointments are delayed to months (55.60%), respondents had financial issues (43.70%) and people were afraid of going to the dentist (38.90%).

Conclusion: It is concluded that most of patients complaint that they do not have enough time for oral treatment due to various reasons. Other major factors are delayed appointment and financial barriers. These factors are common around the region and also discussed in this report with comparison of current results.

Keywords: Oral health, Dental Problems, Factors, Delay Treatment.

Introduction: Oral health defined as people can eat, speak, and socialize without discomfort or embarrassment and without active disease in their mouth 1. There are very small numbers in a certain society aware of oral health and make visits to their selected doctors frequently. However, the majority still required to be highlighted and notify the awareness of the severity of oral health as stated that “clinical dental services also play an important role in maintaining and improving oral health and wellbeing.1 To overcome the factors causing delays many steps were adopted at different levels. The approach was taken in the most of the countries trying and simplifying their system to minimize socioeconomic differences among their population but these differences still exist among adults.2 Goettems stated in journal that dental anxiety and fear was found out to be one of the major reasons for delaying dental visits.3 Indian community was also contributed by 180 victims aged 15-65 years and reported that oral distresses made their way for treatment (35.3%), less severity dental problems (43.1%). It was concluded that problematic oral visitors were more than preventive visitors.4 On the other side, regular preventive dental visits always help to diagnosis early and treatment of oral diseases can be provided. But it was seen that patients who often needed dental care services did not receive dental treatment properly.5 Australians 1 out of 3 patients do not seek oral treatment due to higher cost.6, 7 Also household incomes contributing vital part since insurances are covering general health but not oral health. Data showed 45.4% avoided due to cost, 30.3%, 20.3% constraint of time, not getting around to it (31.9%, 21.35% of an entire sample). Other reasons were disliking dentist 18.1%, fear 17.8%, inconvenience 8.5%and some lack of interest.7 , Tanzania 365 sufferers aging range 15-55 years mentioned their opinion that was concluded as 79% only pursue until toothache, negligence 71%, fear 12.3% and financial constraints 9.3%. It was also noted that 43.8% adopt traditional medicine remedies rather than taking proper treatment.8
In Pakistan, there is no any research done on factors associated with delaying oral treatments unfortunately. However, it gives opportunity in this study to find out the delays occurred to perform oral treatment and reasons to improve the system.

Method: This research was based on the sample of 126 patients (men and women) who reported at outdoor of CMH LMC & IOD. A descriptive cross sectional study was conducted from April 2017 to September 2017. Convenient sampling design was presented. Survey was conducted only on patients who arrived at outpatient first time with past oral treatment history. Patients showed interest was given questionnaire to answer.
Participants ranged in age from 15-80 years. Mean age of sample was 40.10(S.D=16.289). There were 62.7% males and 37.7% females. Participants were asked a structured series of questions that took only less than five minutes to answer all questions. Questionnaire consisted of 15 questions addressing the following aspects, sociodemographic characteristics, dental visit history and reasons for not visiting the dentist. Sociodemographic variables include age, gender, level of education.
Results: Only 150 participants were approached to participate in this survey and 126 answered successfully (response rate=84%) with age ranges from 15-80 years, 79 were males and 47 were females. The graph below was developed to compare reasons causing delays and response from the participants. Some participants selected more than one reason and percentage was calculated accordingly.

Majority of them responded that they avoid visiting the dentist due to lack of time (63.5%), people said that appointments are delayed to months (55.60%), respondents had financial issues (43.70%) andpeople were afraid of going to the dentist (38.90%).

Some other reasons were also noted with such as respondents took self-medication (34.0%), people were asymptomatic(33.30%) and low response was commonly cited with conveyance issues (23.80%) of entire sample, not giving importance to treatment (22.20%),fear of getting infection were (21.40%), lack of knowledge (11.90%), visited non-qualified dentist were (10.30%) and people who thought teeth are not important and those who gave preference to alternative treatments were (8.70%).

Table.1 completed questionnaire data requested and filled by patients

characteristics Lack of time Delayed appointments (55.60%) Financial issues (43.70%) Fear and anxiety (38.90%) Self-medication(34%)
63.50% Gender          
Male 69.62% 62.02% 46.83% 40.50% 31.64%
Female 53.19% 44.68% 38.29% 36.17% 38.29%
Age          
15-24yrs 71.40% 61.90% 33.33% 33.33% 28.57%
25-39yrs 57.60% 61.53% 34.61% 34.61% 32.69%
40-64yrs 64.10% 43.58% 64.10% 38.46% 28.20%
65+ 71.42% 57.14% 35.71% 64.28% 64.28%
Income/month          
>25K 57.14% .42.85% 57.14% 35.71% 71.42%
26K-50K 64.70% 61.76% 38.23% 47.05% 20.58%
50K-75K 60.71% 60.71% 64.28% 53.57% 53.57%
75K-1Lac 37.50% 25% 25% 37.50% 37.50%
>1Lac 78.57% 64.28% 21.42% 17.85% 57.14%
Level of education          
<Matriculation 55.55% 66.67% 44.44% 16.66% 22.22%
Intermediate 38.88% 61.11% 27.77% 33.33% 16.66%
Graduation 69.20% 46.15% 69.23% 38.46% 30.76%
Masters 72.85% 51.42% 42.85% 48.57% 38.57%
P.H.D 42.85% 71.42% 42.85% 14.28% 71.42%
Visiting frequency          
<6 months 41.93% 48.38% 51.61% 32.25% 25.80%
6months-1 yr 86.20% 51.72% 37.93% 51.72% 24.13%
1-2 yrs 63.63% 57.57% 63.63% 33.33% 39.39%
>2 yrs 63.63% 63.63% 21.21% 39.39% 45.45%
The mean age of sample was 40.10(SD=16.289) and there were 62.7%males and
37.7% females. Adult aged 25-35 years were significantly more likely to avoid dental visiting due to lack of time (72.85%) and delayed appointments (62.48%) were most common among people. Moreover the data collected from the completed questionnaire requested and filled by patients arrived at outdoor first time with history of oral treatment shown in Table 1.

Discussion: The need of this research was significant to focus why people find other ways rather than consulting proper treatment for oral health. . In Pakistan no study was ever done on this particular important issue. It is very much required to address people about the importance of the oral treatment targeting from highest level of victims to lowest level. Since oral treatment is a very serious and common issue, therefore it is important to discuss essential results comparatively. According to this study subjects only visit doctor when pain or discomfort is unbearable(Goettems, 2014), Pakistan (50%),India (35.3%), Kuwait (35.1%) Tanzania (79%). This factor is common in commonwealth and higher in developed countries such as Tanzania(Kusekwa, M. and E. Kikwilu. 2011), due to homemade remedies and medication purchased at the counter. In Pakistan majority responded to survey that they have no time to cure oral treatments. This result is very much impacting as compared to other region. When comparing Pakistan response 63.50% with Kuwait 40.4%(Al-Shammari, 2007) and Australia 20.3%(Spencer & Harford, 2001).It is clearly indicating that Pakistan populations ignore oral treatment at highest. This factor is more common in young age and older age. Cost as financial barrier contributing significant role in Pakistan as well as in some developed countries such as Australia. In contrast Malaysia eliminated this barrier by covering oral treatment through governmental schemes such as insurances. Pakistan having cost barrier 43.70% is forcing determinants to seek alternatives in the first priority. However, Australia also showing figure 45.9%(Harford, J., A.C. Ellershaw. 2011. Similarly in Canada with higher level of dental disease are being concentrated among those with lower incomes and lower socio-economic status (Duncan, L. and A. Bonner. 2014). So it is proven that visiting frequency delayed from 1-2 years due to financial barrier is higher 63.63% revealed from this study. fear and anxiety, from this research 38.90% population divert their attention to alternative treatments and delay visitation until required by critical oral symptoms. According to Australian study 29.2%of people were “very afraid” of going to the dentist(Armfield, Stewart & Spencer. 2007). in this study fear is more prevalent in older age groups (64.28%) another reason for this higher percentage is limitation in conducting survey due to convenient sampling method followed by age group 40-64 years to 38.4%. This research has limitations and further studies could highlight better understanding and trends. Nonetheless, these results do lead to areas of concerns and continues improvements described in recommendations.
Conclusion: It is concluded that most of patients complaint that they do not have enough time for oral treatment due to various reasons. Other major factors are delayed appointment and financial barriers. These factors are common around the region and also discussed in this report with comparison of current results.

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