REPORTED HEALTH OF DENTISTS IN AN UNDER-SERVED AREA: A CASE-CONTROL STUDY

Abstract

Background: The uneven distribution of dentists in a geographical area creates disparities in access to dental care. Long distances and delays for appointments impact on patients’ health. But what about the health of dental professionals?

Aim: The purpose of this study was to estimate the physical and psychological health of the dentists practicing in poorly served areas.

Methods: A case-control study was carried out comparing two French departments: Orne (under-served by dentists) and Morbihan (normal number of dentists). Questionnaires were distributed between June 1st and July 31st, 2015. The study population encompassed 95 dentists in the test group (Orne) and 204 in the control group (Morbihan). Statistical analysis was carried out with XLSTAT software. Type I error was set at 0.05.

Results: The response rate was 57% (56) in the test population and 54% (101) in the control population. The age and gender profiles of the test and control populations were not significantly different (48.45 and 45.14 years; p=0.061 for age) and (58% men and 42% women; p=0.125 for gender). The age when they started working in their own dental office was higher in the test group (33 years vs 29 years; p=0.040). In the test group 41% practiced alone as opposed to 23% in the control group (p=0.019) and they employed more staff per dentist (1.14 vs 0.93; p=0.027). The number of days of activity per week, (4.02 days vs 4.04 days) and the number of hours of activity per day (8.94 hours) were similar. The test dentists (Orne) saw more patients a day (21.23 vs 17.97; p=0.006), the percentage of a two month wait for an appointment was above 40% (vs 17%; p=0.002) with a higher rate of missed appointments per week (3.87 vs 2.98; p=0.030) and a higher rate of emergency appointments with a seven day delay (9% vs 0%; p=0.002). In under-served areas dentists more frequently reported that they had routine work (34.7% vs 19.9% p=0.025). The test and control dentists considered themselves healthy but the test practitioners had more activity interruptions for professional reasons in the last years 6 (11%) vs 3 (3%), p=0.046, they were more likely to suffer from hearing disorders13 (23%) vs 9 ( 3%), p=0.013 and from being overweight 6 (11%) vs3( 3%), p=0.046. The prevalence of stress was not significantly different 26 (46.43%) vs 41(40.59%); p=0.479, but the test practitioners reported more suffering from overwork 9 (16%) vs 6 (6%), p=0.039, burn-out 5 (9%) vs 2 (2%), p=0.043 and suicidal thoughts 5 (9%) vs 1 (1%), p=0.045. Similarly, the test group had less sleep hours (7.16 hours vs 7.54 hours; p=0.0022), and were consuming more sleeping drugs (8.93% vs 0%; p=0.002).

Conclusion: The activity in under-served areas involves higher rates of work for the dentists and some reported impacts on their physical and psychological health. Fighting for adequate provision of dental care is an issue for the population’s health but also for the health of dentists.