The level of education, the VEGFR type of insurance, and number of dental visits appeared as the main explanatory factors for subjects�� dental check-ups in the final logistic regression analysis (Table 4), which simultaneously controls for all factors included. The model indicated that those with a medium (OR=2.6) or high (OR=3.3) level of education, and with commercial insurance (OR=2.4) were more likely to go to a dentist for a check-up. The model fitted the data well (P=0.62). Table 4 Factors related to reporting that a check-up was the reason for most recent dental visit, as explained by means of a logistic regression model fitted to the data on adults reporting a dental visit (n=1019) in Tehran, Iran. DISCUSSION Only 16% of our respondents gave a check-up as the reason for their most recent dental visit.

In comparison with developed countries, this is far from the recommended way to use dental services. In Netherlands, almost all insured patients (92%), both public and private, reported that they had visited a dentist for a check-up within the past 12 months.20 High or moderate check-up rates have been reported for the USA, 78%,8 Finland, 57%,35 Australia, 53%37 and Japan, 46%.13 In the UK, 62% of adults report having had a dental check-up within the previous 12 months, the figures being clearly higher for those under the NHS (46%) compared to 14% for the non-NHS subjects.38 The behavior of visiting a dentist regularly for check-ups has its origins in one��s childhood. In addition, the health policy and the characteristics of the oral health care system in a community create and maintain circumstances favorable to such behavior.

One important and effective way to promote this behavior has been school-based dental care, where children visit a dentist for check-ups at regular intervals. Studies have shown that this preventive behavior seems to continue into adulthood.29,39�C40 Consequently, in those countries with higher rates for dental check-ups, school-based dental care programs have long dominated.41 In Iran, the public health services offer dental care to school children up to 12 years of age.42 The fact that this care does not include regular dental check-ups is probably reflected in the present adults�� check-up behavior as well. Those insurance health systems with prevention-oriented features and an obligation to regular dental check-ups have resulted into higher rates of check-ups.

7 The very low rates of checkups in the present study certainly reflect the nature of the health delivery system. Unfortunately, Iran has a treatment-oriented health care system where patients usually make a dental visit when they have trouble with their teeth or gums. The policies of either public or commercial insurance include no obligation to attend regular dental check-ups. In our study, having a commercial insurance had Brefeldin_A a strong impact on attendance at dental checkups.