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Understanding avoidance and non-attendance among adolescents in dental care: an integrative review
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Public Dental Service, Region Örebro County, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0002-4226-6064
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Public Dental Service, Region Örebro County, Örebro, Sweden.
2016 (English)In: Community Dental Health, ISSN 0265-539X, Vol. 33, no 3, p. 195-207Article in journal (Refereed) Published
Abstract [en]

Objective: To review articles exploring manifestations of avoidance of or non-attendance to dental care, to identify background and concomitant factors specifically associated with dental avoidance among adolescents.

Methods: PubMed, CINAHL and PsychINFO were searched using MeSH terms and keywords covering dental avoidance, non-attendance and non-utilization. Searches were limited to peer-reviewed studies in English, published in 1994– 2014. Twenty-one research articles were included. Data were extracted, ordered, coded, categorized, and summarized according to the integrative review method.

Results: The identified factors formed three common major themes: Environmental, Individual and Situational factors. Only seven studies, all from Sweden or Norway, investigated factors associated with dental avoidance. The remaining 14 studies were geographically widespread. Regarding avoidance, the main focus was found to be on individual and situational factors, while environmental factors were more often investigated for the outcome non-attendance.

Conclusions: Although a wide variety of environmental, individual and situational factors could be summarized in this review, factors specifically associated with dental avoidance in a context of free dental care still need to be investigated. The possible impacts of cultural background, of tobacco, alcohol or drug use and of psycho-social circumstances deserve further research. Clinical implications of today’s knowledge may be to pay attention to the adolescents’ individual background and everyday life situation, to offer agreed and individualized treatment, taking fears and attitudes into consideration, to avoid painful treatments, and to be alert for early signs of avoidance.

Place, publisher, year, edition, pages
Suffolk, United Kingdom: FDI World Dental Press Ltd., 2016. Vol. 33, no 3, p. 195-207
Keywords [en]
Dental health services, health care utilization, adolescent, review
National Category
Dentistry
Identifiers
URN: urn:nbn:se:oru:diva-47374DOI: 10.1922/CDH_3829Fagerstad13ISI: 000390932100005OAI: oai:DiVA.org:oru-47374DiVA, id: diva2:892587
Note

Funding Agency:

Public Dental Service, Region Orebro County, Sweden

Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2019-10-28Bibliographically approved
In thesis
1. No-shows in dental care: perspectives on adolescents' attendance pattern
Open this publication in new window or tab >>No-shows in dental care: perspectives on adolescents' attendance pattern
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

All children and adolescents living in Sweden have free dental care with regular check-ups. Yet, missed and cancelled dental appointments are not unusual. The overall aim was to explore potential explanatory factors associated with non-regular dental care and to seek a deeper understanding of why some adolescents fail to attend their dental appointments.

An integrative review (Paper I) identified and summarized different sets of environmental, individual and situational factors that could be associated with dental avoidance or non-attendance. Paper II found similar levels of dental fear between children and adolescents (8-19 yrs) with a Swedish or a non-Swedish background. The occurrence and patterns of missed dental appointments among 16–19-year-olds were investigated in Paper III, where we report that 13.1% of 23 522 booked dental appointments were missed in 2012. Boys had more missed appointments than girls, while no age differences were found. In a case-control design, adolescents with missed appointments more often had sociodemographic load, dental fear or dental behaviour management problems, poor oral health, emergency visits, tooth extractions, operative treatments, and over the past years, more missed and cancelled appointments. A history of missed and cancelled dental appointments predicted future missed and cancelled appointments. Twelve adolescent girls with missed appointments were interviewed in Paper IV and described several potential barriers or facilitators to accessing dental care. They highlighted that knowing what will happen during the dental visit was decisive to whether or not they would attend their appointments.

In conclusion, factors specifically associated with dental avoidance still need to be investigated. Dental fear should still be seen as potential causal factor for dental avoidance. Missed and cancelled dental appointments should never be ignored since they could predict future missed and cancelled appointments. The results indicate that missed dental appointments among adolescents remain a challenge for Swedish dental care.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 96
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 202
Keywords
Adolescents, avoidance, dental attendance, dental care, dental fear, dental health services, oral health, utilization
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-76141 (URN)978-91-7529-307-3 (ISBN)
Public defence
2019-11-22, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-10-29Bibliographically approved

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Fägerstad, AnidaWindahl, JennyArnrup, Kristina

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