Search

Objectives To critically review the oral health care systems of four countries with a universal public health care system in terms of structure, scope and delivery and their impact on oral health outcomes. Methods A comparative review on the oral health care systems from Brazil, New Zealand, Canada and Sweden was performed between August 2017 and January 2018 using PubMed/MEDLINE and the key words ‘universal’ AND ‘dental OR oral’ AND ‘care OR access’ AND ‘outcome’. This is a critical essay based on evidence available in the literature and interactive conversations with key informants in all four countries. Results Although all four countries provide universal health care, the administration, funding and delivery of oral health care varied. About 6% of oral health care expenditure in Canada are publicly-funded. Brazil provides free oral health care at the point of use via salaried dental professionals, while Sweden offers a high-cost protection plan favouring those with greater needs, and New Zealand delivers free oral health care to children only up to their 18th birthday. With service utilization varying from 44% to more than 80%, sixty-one percent of Canadian children, 67% of Swedish children, 50% of Brazilian children and 45% of New Zealand children are caries-free at age 12 while 6.4%, 0.8%, 6.5%, and 9.6% of adults between the ages of 20 and 79 years are edentulous, respectively. Conclusions All countries have some form of publicly-funded oral health care, but a wide spectrum of salary-based and private-practice delivery models exists. Services utilization and oral health outcomes differ in each country.

To evaluate whether the oral hygiene of institutionalized older people differs significantly between groups of participants with different degrees of hand function.Cross-sectional study.Residents of a long-term institution of Porto Alegre, Brazil.Forty-nine institutionalized older people. Subjects restricted to bed or with Mini-Mental State Examination (MMSE) scores less than 15 were excluded.Dental (Silness and Löe Index) and denture plaque (Modified Ambjornsen Plaque Index) scores were assessed as a measure of oral hygiene. Hand functions were assessed using the Jebsen-Taylor and the Purdue pegboard tests. Participants were grouped according to their levels of hand function (regarded as good if test values were at the median or higher in the case of Purdue pegboard test and below the median in the case of Jebsen-Taylor test). Existence of differences between groups was checked using univariate analysis of variance, adjusting for age, sex and cognitive status according to MMSE.Dentate participants with poor hand function according to the Dominant Hand Purdue test harbored significantly more dental plaque after adjustment for age, sex, and cognitive status. Complete denture wearers with poor hand function according to the Dominant Hand and Sum of Three Steps Purdue tests and the total Jebsen-Taylor test also had significantly more denture plaque after adjustment.The results support the notion that hand function plays a central role in oral hygiene, mainly removal of dental and denture plaque, in institutionalized older people.