摘要：Objectives. We examined rationales for behaviors related to dental care among persons receiving public assistance in Montreal, Quebec. Methods. Fifty-seven persons receiving public assistance participated in 8 focus groups conducted in 2002. Sessions were recorded on audiotape and transcribed; analyses included debriefing sessions and coding and interpreting transcribed data. Results. In the absence of dental pain and any visible cavity, persons receiving public assistance believed they were free of dental illness. However, they knew that dental pain signals a pathological process that progressively leads to tooth decay and, therefore, should be treated by a dentist. However, when in pain, despite recognizing that they needed professional treatment, they preferred to wait and suffer because of a fear of painful dental treatments and a reluctance to undertake certain procedures. Conclusions. Persons receiving public assistance have perceptions about dental health and illness that prevent them from receiving early treatment for tooth decay, which may lead to disagreements with dentists when planning dental treatments. Although the oral health of Canadian and American populations has improved overall during the past 3 decades, oral diseases remain a significant problem in our societies. Indeed, there are profound socioeconomic disparities, and the burden of oral diseases is high among underprivileged people. 1 In the province of Quebec, Canada, approximately 25% of adults aged 35 to 44 years who earned less than $25 000 in 1993 were already edentulous. 2 In Harlem (New York City), Zabos 3 found teeth and gum problems to be the main health complaints made by adults. Additionally, Vargas 4 reported that American adults of low socioeconomic status were more likely to report tooth pain and were more likely to endure their pain without the benefit of dental care. Despite a high occurrence of tooth pain, and despite public dental coverage, Medicaid recipients rarely consult a dentist. 1 , 5 Use of dental services is also very low among Quebecois receiving public assistance. 6 , 7 Yet, in contrast to the rest of the Quebecois adult population, persons receiving public assistance benefit from public dental insurance that covers diagnostic, preventive (prophylactic), and routine restorative services and emergency visits, extractions, and dentures; however, root canal therapies and fixed pros-theses are excluded. 6 Although researchers have recently identified different impediments to accessing dental care by persons receiving public assistance—in particular, difficult relationships with dentists—we have little information on what motivates persons receiving public assistance to seek dental care. 8 , 9 Thus, we do not know how they interpret symptoms, how they differentiate the normal from the pathological, and how they evaluate their need for treatment. Researchers have shown that illness and behavior are mediated by various factors, such as culture and education, and that symptoms are not necessarily interpreted by individuals as an indicator of illness. 10 – 12 In the 1950s, Koos observed that back pain was not considered symptomatic of any specific disorder among lower-class women; rather, they viewed it as a natural and unavoidable condition. 13 Furthermore, researchers have shown that working-class adults value their capacity to endure symptoms, an ability perceived to be an indicator of strength or good health. 14 – 18 Thus, we hypothesized that Medicaid recipients may not consider tooth pain as an indicator of need for professional treatment and that this capacity to endure tooth pain may fill them with a sense of pride or the belief that they are healthy. To better understand why Medicaid recipients in the United States and persons receiving public assistance in Quebec rarely seek dental care, it was important to determine how they define oral health and illness and how they interpret oral symptoms. Therefore, the objective of our study was to understand the rationale behind the behavior of persons receiving public assistance when tooth pain occurs and to identify their indicators of dental health and illness.
