Exploring the relationship between oral healthcare service choice, treatment needs and oral health-related quality of life

Abstract

Background: Irregular use of oral healthcare is associated with oral disease burden, leading to poorer oral health-related quality of life (OHRQoL). There is evidence suggesting an association between dental care visits or access and OHRQoL. However, no studies have assessed the relationship of use of oral healthcare services on OHRQoL in countries where universal health coverage, including oral health, has been prioritized. Therefore, this study aimed to evaluate whether choosing either public or private oral healthcare service mediates the association between oral health treatment need and OHRQoL. Another aim was to compare the difference in treatment need between two cohorts born 20 years apart. Methods: This study utilized the data of two birth cohorts from the two northernmost provinces of Finland, the Northern Finland Birth Cohort 1966 (NFBC1966) and the Northern Finland Birth Cohort 1986 (NFBC1986). A clinical oral examination was conducted when NFBC1966 were 45–46-year-olds (n = 1964), and NFBC1986 were 33–35-year-olds (n = 1807). Participants in both cohorts were asked to complete an oral health-related questionnaire before their clinical examination. A Structural Equation Model was employed to examine the impact of choosing either public or private oral healthcare services. Results: Almost half of the study participants in the older cohort and almost two-thirds of the participants in the younger cohort used private oral healthcare services. The younger cohort had a greater need for restorative treatment than the older cohort. In contrast, the need for extensive periodontal treatment was higher in the older cohort than in the younger cohort. Oral health treatment needs had a direct association with OHRQoL (β = 0.432, p < 0.001). Additionally, choosing public oral healthcare services also had a direct association with OHRQoL (β = 0.057, p = 0.014). There was no indirect association between choice of oral healthcare service and oral health treatment need and OHRQoL (β = 0.008, 95% CI: -0.022 to 0.029). Conclusion: The association between oral health treatment needs and OHRQoL persisted, independent of the relationship with Oral Healthcare Service choice. Additionally, younger cohorts exhibited a greater need for restorative treatment compared to older cohorts.