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  • 1.
    Fägerstad, Anida
    Örebro University, School of Health Sciences.
    No-shows in dental care: perspectives on adolescents' attendance pattern2019Doctoral 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.

    List of papers
    1. Understanding avoidance and non-attendance among adolescents in dental care: an integrative review
    Open this publication in new window or tab >>Understanding avoidance and non-attendance among adolescents in dental care: an integrative review
    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
    Keywords
    Dental health services, health care utilization, adolescent, review
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:oru:diva-47374 (URN)10.1922/CDH_3829Fagerstad13 (DOI)000390932100005 ()
    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
    2. Dental fear among children and adolescents in a multicultural population: a cross-sectional study
    Open this publication in new window or tab >>Dental fear among children and adolescents in a multicultural population: a cross-sectional study
    2015 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 39, no 2, p. 109-120Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to explore dental fear in a multicultural population of child and adolescent dental patients, with background, gender, age, and socioeconomic status taken into account. A specific aim was to investigate whether the level of DF differed between patients with a non- Swedish background and patients with a Swedish background.

    In conjunction with a routine visit to the dental clinic, 301 patients (8-19 years old) assessed their dental fear on the Children's Fear Survey Schedule - Dental Subscale, using self-ratings. Following an interview protocol, patients' and their parents' country of birth, and parents' education and occupation/employment were registered. An interpreter was present when needed.

    Self-rated dental fear was almost equal among patients coming from a non-Swedish background and patients with a Swedish background. Girls scored higher than boys and younger children scored slightly higher compared to older children, but the pattern of dental fear variation was inconsistent. Socioeconomic status differed between the groups with a non- Swedish vs. a Swedish background, but no impact on dental fear was revealed. When children and adolescents with a non-Swedish vs. a Swedish background were modelled separately, female gender and younger age had an impact on dental fear only in the group with a Swedish background.

    No differences in dental fear were found between children and adolescents from non-Swedish vs. Swedish backgrounds. Dental fear variations according to gender and age were more pronounced in the group with a Swedish background compared to the group with a non-Swedish background. No impact of socioeconomic status could be revealed.

    Place, publisher, year, edition, pages
    Stockholm: Swedish Dental Journal, 2015
    Keywords
    Dental fear, questionnaires, cultural diversity
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:oru:diva-51417 (URN)000377057900006 ()26529836 (PubMedID)2-s2.0-84937907216 (Scopus ID)
    Note

    Funding Agency:

    Public Dental Service of Örebro County Council, Örebro, Sweden

    Available from: 2016-07-27 Created: 2016-07-19 Last updated: 2019-10-28Bibliographically approved
    3. Dental avoidance among adolescents: a retrospective case–control study based on dental records in the public dental service in a Swedish county
    Open this publication in new window or tab >>Dental avoidance among adolescents: a retrospective case–control study based on dental records in the public dental service in a Swedish county
    2019 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 1, p. 1-8Article in journal (Refereed) Published
    Abstract [en]

    Objective: This study aimed to investigate the occurrence of missed dental appointments among 16–19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.

    Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009–2012.

    Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.

    Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents’ individual situation and be observant of early signs of avoidance.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2019
    Keywords
    Dental care, utilization, adolescent
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:oru:diva-68444 (URN)10.1080/00016357.2018.1489978 (DOI)000455890400001 ()30022701 (PubMedID)2-s2.0-85050359378 (Scopus ID)
    Note

    Funding Agencies:

    Public Dental Service, Region Örebro County, Örebro University, Örebro  

    Swedish Dental Hygienist Association (SDHA), Sweden 

    Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-10-28Bibliographically approved
    4. Barriers and facilitators for adolescent girls to take on adult responsibility for dental care: a qualitative study
    Open this publication in new window or tab >>Barriers and facilitators for adolescent girls to take on adult responsibility for dental care: a qualitative study
    2019 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1678971Article in journal (Refereed) Published
    Abstract [en]

    Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county.

    Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis.

    Results: The study findings could be summed into the theme ?Triggers for adolescent girls to take on or not take on adult responsibility for dental care?. The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories.

    Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2019
    Keywords
    Dental care, dental attendance, adolescent, content analysis
    National Category
    Nursing Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:oru:diva-77601 (URN)10.1080/17482631.2019.1678971 (DOI)000490054100001 ()31608818 (PubMedID)2-s2.0-85073161662 (Scopus ID)
    Note

    Funding Agencies:

    Public Dental Service, Region Örebro County, Sweden  

    Örebro University, Örebro, Sweden 

    Available from: 2019-10-25 Created: 2019-10-25 Last updated: 2019-10-29Bibliographically approved
  • 2.
    Fägerstad, Anida
    et al.
    Örebro University, School of Health Sciences. Public Dental Service, Örebro County Council, Örebro, Sweden.
    Lundgren, Jesper
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Public Dental Service, Örebro County Council, Örebro, Sweden.
    Dental fear among children and adolescents in a multicultural population: a cross-sectional study2015In: Swedish Dental Journal, ISSN 0347-9994, Vol. 39, no 2, p. 109-120Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore dental fear in a multicultural population of child and adolescent dental patients, with background, gender, age, and socioeconomic status taken into account. A specific aim was to investigate whether the level of DF differed between patients with a non- Swedish background and patients with a Swedish background.

    In conjunction with a routine visit to the dental clinic, 301 patients (8-19 years old) assessed their dental fear on the Children's Fear Survey Schedule - Dental Subscale, using self-ratings. Following an interview protocol, patients' and their parents' country of birth, and parents' education and occupation/employment were registered. An interpreter was present when needed.

    Self-rated dental fear was almost equal among patients coming from a non-Swedish background and patients with a Swedish background. Girls scored higher than boys and younger children scored slightly higher compared to older children, but the pattern of dental fear variation was inconsistent. Socioeconomic status differed between the groups with a non- Swedish vs. a Swedish background, but no impact on dental fear was revealed. When children and adolescents with a non-Swedish vs. a Swedish background were modelled separately, female gender and younger age had an impact on dental fear only in the group with a Swedish background.

    No differences in dental fear were found between children and adolescents from non-Swedish vs. Swedish backgrounds. Dental fear variations according to gender and age were more pronounced in the group with a Swedish background compared to the group with a non-Swedish background. No impact of socioeconomic status could be revealed.

  • 3.
    Fägerstad, Anida
    et al.
    Örebro University, School of Health Sciences. Public Dental Service, Region Örebro County, Örebro, Sweden.
    Lundgren, Jesper
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Carlsson, Eva
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Barriers and facilitators for adolescent girls to take on adult responsibility for dental care: a qualitative study2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1678971Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county.

    Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis.

    Results: The study findings could be summed into the theme ?Triggers for adolescent girls to take on or not take on adult responsibility for dental care?. The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories.

    Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.

  • 4.
    Fägerstad, Anida
    et al.
    Örebro University, School of Health Sciences. Public Dental Service, Dental research Department, Örebro County Council, Örebro, Sweden.
    Lundgren, Jesper
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Windahl, Jenny
    Örebro University, School of Health Sciences.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Public Dental Service, Dental research Department, Örebro, Sweden.
    Dental avoidance among adolescents: a retrospective case–control study based on dental records in the public dental service in a Swedish county2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to investigate the occurrence of missed dental appointments among 16–19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.

    Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009–2012.

    Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.

    Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents’ individual situation and be observant of early signs of avoidance.

  • 5.
    Fägerstad, Anida
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Public Dental Service, Region Örebro County, Örebro, Sweden.
    Windahl, Jenny
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Public Dental Service, Region Örebro County, Örebro, Sweden.
    Understanding avoidance and non-attendance among adolescents in dental care: an integrative review2016In: Community Dental Health, ISSN 0265-539X, Vol. 33, no 3, p. 195-207Article in journal (Refereed)
    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.

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