51
|
Martin MA, Lee HH, Landa J, Minier M, Avenetti D, Sandoval A. Formative research implications on design of a randomized controlled trial for oral health promotion in children. Pilot Feasibility Stud 2018; 4:155. [PMID: 30305918 PMCID: PMC6171134 DOI: 10.1186/s40814-018-0344-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/17/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The COordinated Oral health Promotion (CO-OP) Chicago trial will test the efficacy of a community health worker (CHW) intervention to improve oral health behaviors for children at high risk for early childhood caries. Before implementing the cluster-randomized controlled trial, we conducted a formative assessment to determine the final design. We used qualitative methods to assess the feasibility and acceptability of the proposed recruitment, data collection, and intervention plan. METHODS Key informant interviews (N = 37) and site observations were conducted at 10 pediatric primary care clinics and 10 Special Supplemental Nutrition Program for Women Infant and Children (WIC) centers to gain insight from providers and administrators at the locations where recruitment and intervention will occur. Eight focus groups (N = 68) were conducted with caregivers of children to capture the parent perspective. Conceptual coding methods from grounded theory were applied to organize the data into the final themes. RESULTS Families, clinics, and WIC centers were all very interested in additional supports for oral health and were enthusiastic about CHWs. Challenges included competing family priorities that might interfere in study enrollment and intervention efficacy. Physical space for enrollment and intervention delivery was a major barrier for some sites. Home visits for data collection and intervention delivery would be unacceptable for some families. These challenges and barriers prompted us to make major changes in our trial design. We opened the option for data collection to occur in multiple locations. We eliminated the home-only arm of the trial. Clinics and WIC centers that are randomized to the non-intervention arm will now have CHWs available at the study conclusion. Finally, we aligned the CHW oral health topics to the needs of families. CONCLUSIONS We conducted this comprehensive formative assessment to determine the feasibility and acceptability of the CO-OP Chicago trial. While overall acceptance of the trial was high, the results highlighted specific issues with the proposed trial implementation plan and led to several critical design changes. This type of formative work requires a significant upfront investment but we expect it will translate into savings through better recruitment, retention, intervention implementation and adherence, and result dissemination.
Collapse
Affiliation(s)
- Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago, 840 South Wood Street, Chicago, IL 60612 USA
| | - Helen H Lee
- Department of Anesthesiology, University of Illinois at Chicago, 1740 West Taylor Street, Suite 3200, Chicago, IL 60612 USA
| | - Jazmin Landa
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558 M/C 275, Chicago, IL 60608 USA
| | - Mark Minier
- Department of Pediatrics, University of Illinois at Chicago, 840 South Wood Street, Chicago, IL 60612 USA
| | - David Avenetti
- College of Dentistry, University of Illinois at Chicago, 801 S. Paulina, Chicago, IL 60612 USA
| | - Anna Sandoval
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Room 558 M/C 275, Chicago, IL 60608 USA
| |
Collapse
|
52
|
Abstract
Orofacial growth and development is a complex process spanning the life course. This article provides an oral health overview in the context of overall growth, physical and social development from infancy through adolescence. It reviews oral health-specific developmental milestones during childhood (0-12 years) and adolescence (≥13 years). It examines issues particular to each age category or spanning multiple ages (eg, pediatric overweight and obesity, tobacco use, and dental trauma) in relation to oral health and development. In addition, the oral microbiome and its potential role in informing personalized oral health care across the life course is discussed.
Collapse
Affiliation(s)
- Bhavna T Pahel
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina at Chapel Hill, 4501B Koury Oral Health Sciences Building, CB# 7450, Chapel Hill, NC 27599-7450, USA; Private Practice: Village Family Dental, 510 Hickory Ridge Drive, Suite 101, Greensboro, NC 27409-9779, USA.
| | - Anne Rowan-Legg
- Department of Pediatrics, University of Ottawa and Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - Rocio B Quinonez
- Departments of Pediatric Dentistry and Academic Affairs, School of Dentistry, The University of North Carolina at Chapel Hill, 1611 Koury Oral Health Sciences Building, CB# 7450, Chapel Hill, NC 27599-7450, USA
| |
Collapse
|
53
|
Fisher-Owens SA, Mertz E. Preventing Oral Disease: Alternative Providers and Places to Address This Commonplace Condition. Pediatr Clin North Am 2018; 65:1063-1072. [PMID: 30213349 DOI: 10.1016/j.pcl.2018.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Oral health disease in young children has not decreased, despite adequate modalities for treatment and prevention. Because many children may not see a dentist before oral disease has begun, disease progression can be expected, affecting short-term and long-term oral health. However, most children are seen by other health professionals frequently in their youngest years, providing a unique opportunity to help weave a safety net of oral health care until they are established in a dental home. This article details ways primary care providers can promote oral health, including ways to integrate ancillary dental professionals into the primary care home.
Collapse
Affiliation(s)
- Susan A Fisher-Owens
- Department of Pediatrics, UCSF School of Medicine, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue/MS6E37, San Francisco, CA 94110, USA; Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Elizabeth Mertz
- Faculty, Healthforce Center for Research and Leadership Development, 3333 California Street, Suite 410, San Francisco, CA 94143, USA
| |
Collapse
|
54
|
Okah A, Williams K, Talib N, Mann K. Promoting Oral Health in Childhood: A Quality Improvement Project. Pediatrics 2018; 141:peds.2017-2396. [PMID: 29802117 DOI: 10.1542/peds.2017-2396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics recommends periodic oral health risk assessments (OHRAs) for young children to prevent early childhood caries and promote oral health. The objective of this quality improvement project was to incorporate OHRAs, including documentation of the oral screening examination, into well-child visits for patients aged 12 to 47 months to drive (1) improved rates of preventive fluoride varnish (FV) application and (2) improved dental referrals for children at high risk for caries. METHODS We identified a quality gap in our OHRAs, oral examination completion, FV application rates, and dental referral rates via retrospective data collection. Plan-Do-Study-Act cycles targeted modification of electronic medical record templates, oral health education, and standardization of work processes. Process and outcome measures were analyzed with statistical process control charts. RESULTS At baseline, OHRAs and oral screening examinations were documented in <2% of patients. Of eligible children, 42% had FV applied. Routine dental referrals before age 3 years were uncommon. After multiple Plan-Do-Study-Act cycles, documentation of OHRAs and oral screening examinations (process measures) improved to 45% and 73%, respectively. The primary outcome measure, FV rates, improved to 86%. Referral of high-risk patients to a dentist improved to 54%. CONCLUSIONS A systematic, evidence-based approach to improving oral health, including electronic medical record-based interventions, resulted in improved documentation of oral health risks and oral screening, improved rates of FV application in young children, and increased identification and referral of high-risk patients.
Collapse
Affiliation(s)
- Abiye Okah
- Department of General Academic Pediatrics, Children's Mercy Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Kristi Williams
- Department of General Academic Pediatrics, Children's Mercy Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Nasreen Talib
- Department of General Academic Pediatrics, Children's Mercy Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Keith Mann
- Department of General Academic Pediatrics, Children's Mercy Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| |
Collapse
|
55
|
Karasz A, Bonuck K. Reducing pediatric caries and obesity risk in South Asian immigrants: randomized controlled trial of common health/risk factor approach. BMC Public Health 2018; 18:680. [PMID: 29855352 PMCID: PMC5984363 DOI: 10.1186/s12889-018-5317-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/14/2018] [Indexed: 11/28/2022] Open
Abstract
Background This paper describes the design and methods of a multi-phase study to reduce early childhood caries and obesity in vulnerable South Asian (SA) immigrants in the United States. Early childhood caries and obesity are the most common diseases of early childhood. Risk factors for both diseases are rooted in early childhood feeding practices such as bottle feeding and intake of sweets and sweetened beverages. The Common Health/Risk Factor Approach to addressing oral health is widely promoted by the WHO and other policy makers. This approach recognizes links between oral health and other diseases of modernity. Our CHALO! (“Child Health Action to Lower Obesity and Oral health risk”--from a Hindi word meaning "Let's go!") study targets SA families at high risk for early childhood caries and obesity. CHALO! addresses common risk factors associated with these two common diseases of childhood. Methods This two part project includes a randomized controlled trial, and a Knowledge Translation campaign. A randomized controlled trial will enroll n = 360 families from pediatric practices serving South Asians in the New York metro area. The intervention group will receive home visits by SA community health workers at 6, 8, 10, 12, 14, and 16 months of age. Controls will receive culturally tailored educational material. Primary outcomes-- cariogenic and obesogenic feeding practices at 6, 12, and 18 months-- will be assessed with the MySmileBuddy iPad based tool. Secondary outcomes include: oral hygiene practices, anthropometrics, and caries incidence at 18 months. A public education campaign will focus on both families and health care providers. Discussion There are few Common Health/Risk Factor Approach published studies on obesity and oral health risk in children, despite health morbidity and costs associated with both conditions. CHALO! comprises a multi-level interventions designed to promote culturally competent, sustainable change. Trial registration ClinicalTrials.govNCT03077425. Electronic supplementary material The online version of this article (10.1186/s12889-018-5317-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alison Karasz
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, 10461, USA.
| | - Karen Bonuck
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| |
Collapse
|
56
|
Oral health training, knowledge, attitudes and practices of primary care paediatricians: a European survey. Eur J Pediatr 2018; 177:675-681. [PMID: 29404716 DOI: 10.1007/s00431-018-3108-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Oral health is an essential component of children's general health. The aim of this study is to evaluate the training, knowledge, attitudes and practices of primary care paediatricians in oral health in Europe. Paediatricians were invited to complete a survey on the web. There was a 54.3% response rate. The oral health education of the responders was received mainly through continuing medical education and practical experience (51%) rather than in medical school or during paediatric residency training (33%). Twenty-four percent of the responders did not know that the first signs of caries were white spots on the surfaces of teeth. Although 98.8% of paediatricians check the oral health status of children, only 52% feel confident enough to identify dental caries. A large proportion of the paediatricians (43%) recommended a first dental visit for children above the age of 3 years and only 7% under 1 year of age. CONCLUSIONS Paediatricians are familiar with some aspects of the oral health but are not confident in identifying the risk factors. The current postgraduate curriculum in Paediatrics should incorporate training on basic oral healthcare. In addition, continuous educational programmes are needed to keep the knowledge of the paediatrician up to date. What is Known: • Oral health is an essential component of general health that influences the functional, psychological and social dimensions of a child's well-being. • Paediatricians are the leading providers of primary healthcare for children. What is New: • Paediatricians are familiar with some aspects of the oral health of children but are not confident in identifying the risk factors responsible for oral disease. • The current postgraduate curriculum in Paediatrics should incorporate training on basic oral healthcare in children.
Collapse
|
57
|
Influence of fluoride varnish on shear bond strength of a universal adhesive on intact and demineralized enamel. Odontology 2018; 106:460-468. [DOI: 10.1007/s10266-018-0363-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/07/2018] [Indexed: 11/27/2022]
|
58
|
Abstract
Despite improvements in the oral health status of the US population as a whole, a disproportionately higher burden of oral diseases and disorders are borne by those individuals from low-income and racial and ethnic minority groups. These differences in health status, health outcomes, or health care use between distinct socially disadvantaged and advantaged groups are well documented and known as health disparities. It is vital that members of the dental profession understand the distribution of oral health and disease across different populations and the life span and participate in developing innovative and sustainable approaches to eliminate oral health disparities.
Collapse
Affiliation(s)
- Michelle M Henshaw
- Office of Global and Population Health, Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, 3rd Floor, Boston, MA 02118, USA; Department of Health Policy & Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, 3rd Floor, Boston, MA 02118, USA; Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, Boston, MA 02118, USA.
| | - Raul I Garcia
- Department of Health Policy & Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, 3rd Floor, Boston, MA 02118, USA; Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, Boston, MA 02118, USA
| | - Jane A Weintraub
- UNC School of Dentistry, The University of North Carolina at Chapel Hill, Koury Oral Health Sciences Building, Room 4508, Chapel Hill, North Carolina 27599-7450
| |
Collapse
|
59
|
Zou J, Meng M, Law CS, Rao Y, Zhou X. Common dental diseases in children and malocclusion. Int J Oral Sci 2018; 10:7. [PMID: 29540669 PMCID: PMC5944594 DOI: 10.1038/s41368-018-0012-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 11/09/2022] Open
Abstract
Malocclusion is a worldwide dental problem that influences the affected individuals to varying degrees. Many factors contribute to the anomaly in dentition, including hereditary and environmental aspects. Dental caries, pulpal and periapical lesions, dental trauma, abnormality of development, and oral habits are most common dental diseases in children that strongly relate to malocclusion. Management of oral health in the early childhood stage is carried out in clinic work of pediatric dentistry to minimize the unwanted effect of these diseases on dentition. This article highlights these diseases and their impacts on malocclusion in sequence. Prevention, treatment, and management of these conditions are also illustrated in order to achieve successful oral health for children and adolescents, even for their adult stage.
Collapse
Affiliation(s)
- Jing Zou
- State Key Laboratory of Oral Diseases& National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Mingmei Meng
- State Key Laboratory of Oral Diseases& National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Clarice S Law
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, University of California, Los Angeles, CA, USA
| | - Yale Rao
- Victoria General Hospital, Victoria, BC, Canada
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases& National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China School of Stomatology, Sichuan University, Chengdu 610041, China.
| |
Collapse
|
60
|
Murphy J, Moore R. Maximising paediatricians' roles in improving children's oral health: lessons from Leicester. Arch Dis Child 2018; 103:181-185. [PMID: 28611067 DOI: 10.1136/archdischild-2017-312726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 11/04/2022]
Abstract
AIMS To provide an overview of steps taken to improve oral health in one UK city and to review factors relevant to maximising the contribution that paediatricians (and potentially other health professionals) can make to improving oral health. METHODS The article provides information on the strategic approach taken in Leicester, one of the most ethnically diverse cities in England, and also one of the most deprived. Over a third of children aged 3 years, and half of those aged 5 years, have experience of obvious dental decay. The collaborative strategic approach taken includes implementing a comprehensive evidence-based early intervention programme from birth (Healthy Teeth, Happy Smiles!) and a focus on professional education and engagement. In order to ensure sustainability and further improvement, wider engagement with paediatricians and other primary care providers is essential and is increasingly recognised by professional bodies.Literature relevant to the factors which inhibit engagement with paediatricians and others is reviewed and highlights issues of knowledge and competency, policies and guidelines, time and capacity and referral and access. CONCLUSION Children's oral health in England has improved over the last 30 years, but inequalities persist, with those living in areas of higher deprivation experiencing a substantially higher burden of dental disease. The article highlights several potential barriers which can be reduced. Collaboration is encouraged between medical and dental professionals as well as commissioners and providers at both the national and local level in order for oral health to be fully integrated within general health. Such collaboration requires appropriate leadership in order to develop policies that support curriculum changes, drive the implementation of associated guidelines, design integrated healthcare service provision and develop the partnership relationships to support this work.
Collapse
Affiliation(s)
- Jasmine Murphy
- Consultant in Dental Public Health, Public Health England Midlands and East Region, Nottingham, UK
| | - Rod Moore
- Consultant in Public Health, Leicester City Council. Honorary Senior Lecturer, University of Leicester, Leicester, UK
| |
Collapse
|
61
|
Ahmad MS, Abuzar MA, Razak IA, Rahman SA, Borromeo GL. Educating medical students in oral health care: current curriculum and future needs of institutions in Malaysia and Australia. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2017; 21:e29-e38. [PMID: 27273317 DOI: 10.1111/eje.12211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 06/06/2023]
Abstract
Poor oral health has been associated with compromised general health and quality of life. To promote comprehensive patient management, the role of medical professionals in oral health maintenance is compelling, thus indicating the need for educational preparation in this area of practice. This study aimed to determine the extent of training in oral health in Malaysian and Australian medical schools. An audio-recorded semi-structured phone interview involving Academic Programme Directors in Malaysian (n = 9, response rate=81.8%) and Australian (n = 7, response rate = 35.0%) medical schools was conducted during the 2014/2015 and 2014 academic years, respectively. Qualitative data was analysed via thematic analysis, involving coding and grouping into emerging themes. Quantitative data were measured for frequencies. It was found that medical schools in Malaysia and Australia offered limited teaching of various oral health-related components that were mostly integrated throughout the curriculum, in the absence of structured learning objectives, teaching methodologies and assessment approaches. Barriers to providing oral health education included having insufficient expertise and overloaded curriculum. As medical educators demonstrated support for oral health education, collaboration amongst various stakeholders is integral to developing a well-structured curriculum and practice guidelines on oral health management involving medical professionals.
Collapse
Affiliation(s)
- M S Ahmad
- University of Melbourne, Melbourne, VIC, Australia
- Universiti Teknologi MARA, Shah Alam, Malaysia
| | - M A Abuzar
- University of Melbourne, Melbourne, VIC, Australia
| | - I A Razak
- University of Malaya, Kuala Lumpur, Malaysia
| | - S A Rahman
- Universiti Teknologi MARA, Shah Alam, Malaysia
| | - G L Borromeo
- University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
62
|
Roos LL, Dragan R, Schroth RJ. Pediatric ambulatory care sensitive conditions: Birth cohorts and the socio-economic gradient. Canadian Journal of Public Health 2017; 108:e257-e264. [PMID: 28910247 DOI: 10.17269/cjph.108.5935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/17/2017] [Accepted: 03/03/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study examines the socio-economic gradient in utilization and the risk factors associated with hospitalization for four pediatric ambulatory care sensitive conditions (dental conditions, asthma, gastroenteritis, and bacterial pneumonia). Dental conditions, where much care is provided by dentists and insurance coverage varies among different population segments, present special issues. METHODS A population registry, provider registry, physician ambulatory claims, and hospital discharge abstracts from 28 398 children born in 2003-2006 in urban centres in Manitoba, Canada were the main data sources. Physician visits and hospitalizations were compared across neighbourhood income groupings using rank correlations and logistic regressions. RESULTS Very strong relationships between neighbourhood income and utilization were highlighted. Additional variables - family on income assistance, mother's age at first birth, breastfeeding - helped predict the probability of hospitalization. Despite the complete insurance coverage (including visits to dentists and physicians and for hospitalizations) provided, receiving income assistance was associated with higher probabilities of hospitalization. CONCLUSIONS We found a socio-economic gradient in utilization for pediatric ambulatory care sensitive conditions, with higher rates of ambulatory visits and hospitalizations in the poorest neighbourhoods. Insurance coverage which varies between different segments of the population complicates matters. Providing funding for dental care for Manitobans on income assistance has not prevented physician visits or intensive treatment in high-cost facilities, specifically treatment under general anesthesia. When services from one type of provider (dentist) are not universally insured but those from another type (physician) are, using rates of hospitalization to indicate problems in the organization of care seems particularly difficult.
Collapse
Affiliation(s)
- Leslie L Roos
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
| | - Roxana Dragan
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
| | - Robert J Schroth
- Department of Preventive Dental Science, College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
63
|
Sanguino SM, Dhepyasuwan N, Church A, Dabrow S, Serwint JR, Bernstein HH. Oral Health Promotion During Well Visits. Clin Pediatr (Phila) 2017; 56:894-901. [PMID: 28516799 DOI: 10.1177/0009922817709552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Training pediatric residents in Bright Futures and oral health concepts is critical to improving oral health. This study's objective was to determine the skill level of pediatric residents in integrating oral health promotion during health supervision visits of 12- to 35-month-old children. One hundred forty-three pediatric residents participated in an evaluation of the effectiveness of a Bright Futures oral health curriculum. Competencies assessed preintervention included partnership building, communication, and integration of oral health concepts. Pediatric residents' abilities to integrate oral health promotion into health supervision visits varied considerably. Residents demonstrated greater skill in communication and partnership building compared with oral health promotion behaviors and performance of an oral examination. Further education is needed at a national level if we are to meet Healthy People 2020 goals.
Collapse
Affiliation(s)
- Sandra M Sanguino
- 1 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Sharon Dabrow
- 4 Morsani College of Medicine, Department of Pediatrics, University of South Florida Tampa, FL, USA
| | - Janet R Serwint
- 5 Deparment of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Henry H Bernstein
- 6 Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | | |
Collapse
|
64
|
Lewis CW, Jacob LS, Lehmann CU, Krol D, Gereige R, Karp J, Fisher-Owens S, Braun P, Jacob L, Segura A. The Primary Care Pediatrician and the Care of Children With Cleft Lip and/or Cleft Palate. Pediatrics 2017; 139:peds.2017-0628. [PMID: 28557774 DOI: 10.1542/peds.2017-0628] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Orofacial clefts, specifically cleft lip and/or cleft palate (CL/P), are among the most common congenital anomalies. CL/P vary in their location and severity and comprise 3 overarching groups: cleft lip (CL), cleft lip with cleft palate (CLP), and cleft palate alone (CP). CL/P may be associated with one of many syndromes that could further complicate a child's needs. Care of patients with CL/P spans prenatal diagnosis into adulthood. The appropriate timing and order of specific cleft-related care are important factors for optimizing outcomes; however, care should be individualized to meet the specific needs of each patient and family. Children with CL/P should receive their specialty cleft-related care from a multidisciplinary cleft or craniofacial team with sufficient patient and surgical volume to promote successful outcomes. The primary care pediatrician at the child's medical home has an essential role in making a timely diagnosis and referral; providing ongoing health care maintenance, anticipatory guidance, and acute care; and functioning as an advocate for the patient and a liaison between the family and the craniofacial/cleft team. This document provides background on CL/P and multidisciplinary team care, information about typical timing and order of cleft-related care, and recommendations for cleft/craniofacial teams and primary care pediatricians in the care of children with CL/P.
Collapse
Affiliation(s)
- Charlotte W. Lewis
- Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, Washington
| | - Lisa S. Jacob
- Georgetown Pediatric Dentistry and Orthodontics, Georgetown, Texas; and
| | - Christoph U. Lehmann
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | | | | | | |
Collapse
|
65
|
Blackburn J, Morrisey MA, Sen B. Outcomes Associated With Early Preventive Dental Care Among Medicaid-Enrolled Children in Alabama. JAMA Pediatr 2017; 171:335-341. [PMID: 28241184 PMCID: PMC5470412 DOI: 10.1001/jamapediatrics.2016.4514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/14/2016] [Indexed: 11/14/2022]
Abstract
Importance There is a recommendation for children to have a dental home by 6 months of age, but there is limited evidence supporting the effectiveness of early preventive dental care or whether primary care providers (PCPs) can deliver it. Objective To investigate the effectiveness of preventive dental care in reducing caries-related treatment visits among Medicaid enrollees. Design, Setting, and Participants High-dimensional propensity scores were used to address selection bias for a retrospective cohort study of children continuously enrolled in coverage from the Alabama Medicaid Agency from birth between 2008 and 2012, adjusting for demographics, access to care, and general health service use. Exposures Children receiving preventive dental care prior to age 2 years from PCPs or dentists vs no preventive dental care. Main Outcome and Measures Two-part models estimated caries-related treatment and expenditures. Results Among 19 658 eligible children, 25.8% (n = 3658) received early preventive dental care, of whom 44% were black, 37.6% were white, and 16.3% were Hispanic. Compared with matched children without early preventive dental care, children with dentist-delivered preventive dental care more frequently had a subsequent caries-related treatment (20.6% vs 11.3%, P < .001), higher rate of visits (0.29 vs 0.15 per child-year, P < .001), and greater dental expenditures ($168 vs $87 per year, P < .001). Dentist-delivered preventive dental care was associated with an increase in the expected number of caries-related treatment visits by 0.14 per child per year (95% CI, 0.11-0.16) and caries-related treatment expenditures by $40.77 per child per year (95% CI, $30.48-$51.07). Primary care provider-delivered preventive dental care did not significantly affect caries-related treatment use or expenditures. Conclusions and Relevance Children with early preventive care visits from dentists were more likely to have subsequent dental care, including caries-related treatment, and greater expenditures than children without preventive dental care. There was no association with subsequent caries-related treatment and preventive dental care from PCPs. We observed no evidence of a benefit of early preventive dental care, regardless of the provider. Additional research beyond administrative data may be necessary to elucidate any benefits of early preventive dental care.
Collapse
Affiliation(s)
- Justin Blackburn
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham
| | - Michael A. Morrisey
- Department of Health Policy and Management, Texas A&M School of Public Health, College Station
| | - Bisakha Sen
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham
| |
Collapse
|
66
|
Flood S, Asplund K, Hoffman B, Nye A, Zuckerman KE. Fluoride Supplementation Adherence and Barriers in a Community Without Water Fluoridation. Acad Pediatr 2017; 17:316-322. [PMID: 27876586 DOI: 10.1016/j.acap.2016.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND To prevent early childhood caries, the American Dental Association recommends oral fluoride supplementation for children in communities lacking water fluoridation who are at high caries risk. However, patient adherence to oral fluoride supplementation has not been studied in this population. This study assessed adherence to oral fluoride and barriers to adherence in a community lacking water fluoridation. METHODS A self-administered survey was completed in a systematic sample of 209 parents of children aged 6 months to 4 years, during a primary care visit in an urban academic medical center. Participants reported frequency of administering oral fluoride to their children, as well as agreement or disagreement with proposed barriers to supplementation. Bivariate and multivariate analyses were used to assess adherence with oral supplementation and the association of barriers to supplementation and child receipt of fluoride on the day before. RESULTS More than half of parents either had not or did not know if their child had received fluoride on the day before. Approximately 1 in 4 of parents had given fluoride in 0 of the previous 7 days. Difficulty remembering to give fluoride and agreeing that the child does not need extra fluoride were associated with not receiving fluoride on the day before. CONCLUSIONS Adherence to oral fluoride supplementation in the primary care setting is low. Difficulty remembering to give fluoride daily is the greatest barrier to adherence. Further research on interventions to reduce common barriers is needed to increase fluoride administration and reduce early childhood caries in communities lacking water fluoridation.
Collapse
Affiliation(s)
- Shannon Flood
- School of Medicine, Oregon Health and Science University, Portland, Ore.
| | - Karin Asplund
- School of Medicine, Oregon Health and Science University, Portland, Ore
| | | | - Allison Nye
- School of Medicine, Oregon Health and Science University, Portland, Ore
| | | |
Collapse
|
67
|
Janem WF, Scannapieco FA, Sabharwal A, Tsompana M, Berman HA, Haase EM, Miecznikowski JC, Mastrandrea LD. Salivary inflammatory markers and microbiome in normoglycemic lean and obese children compared to obese children with type 2 diabetes. PLoS One 2017; 12:e0172647. [PMID: 28253297 PMCID: PMC5333807 DOI: 10.1371/journal.pone.0172647] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/07/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is emerging evidence linking diabetes with periodontal disease. Diabetes is a well-recognized risk factor for periodontal disease. Conversely, pro-inflammatory molecules released by periodontally-diseased tissues may enter the circulation to induce insulin resistance. While this association has been demonstrated in adults, there is little information regarding periodontal status in obese children with and without type 2 diabetes (T2D). We hypothesized that children with T2D have higher rates of gingivitis, elevated salivary inflammatory markers, and an altered salivary microbiome compared to children without T2D. METHODS Three pediatric cohorts ages 10-19 years were studied: lean (normal weight-C), obese (Ob), and obese with T2D (T2D). Each subject completed an oral health survey, received a clinical oral examination, and provided unstimulated saliva for measurement of inflammatory markers and microbiome analysis. RESULTS The diabetes group was less likely to have had a dental visit within the last six months. Body mass index (BMI) Z-scores and waist circumference/height ratios were similar between Ob and T2D cohorts. The number of carious lesions and fillings were similar for all three groups. The gingival index was greater in the T2D group compared to the Ob and C groups. Although salivary microbial diversity was minimal between groups, a few differences in bacterial genus composition were noted. CONCLUSIONS Obese children with T2D show a trend toward poorer oral health compared to normal weight and obese children without T2D. This study characterizes the salivary microbiome of children with and without obesity and T2D. This study supports a modest link between T2D and periodontal inflammation in the pediatric population.
Collapse
Affiliation(s)
- Waleed F. Janem
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Frank A. Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, Buffalo, NY, United States of America
| | - Amarpeet Sabharwal
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, Buffalo, NY, United States of America
| | - Maria Tsompana
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States of America
| | - Harvey A. Berman
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Elaine M. Haase
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, Buffalo, NY, United States of America
| | - Jeffrey C. Miecznikowski
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States of America
| | - Lucy D. Mastrandrea
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
- * E-mail:
| |
Collapse
|
68
|
Garcia RI, Gregorich SE, Ramos-Gomez F, Braun PA, Wilson A, Albino J, Tiwari T, Harper M, Batliner TS, Rasmussen M, Cheng NF, Santo W, Geltman PL, Henshaw M, Gansky SA. Absence of Fluoride Varnish-Related Adverse Events in Caries Prevention Trials in Young Children, United States. Prev Chronic Dis 2017; 14:E17. [PMID: 28207379 PMCID: PMC5313125 DOI: 10.5888/pcd14.160372] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Fluoride varnish is an effective prevention intervention for caries in young children. Its routine use in clinical care is supported by meta-analyses and recommended by clinical guidelines, including the US Preventive Services Task Force (B rating). This report is the first prospective systematic assessment of adverse events related to fluoride varnish treatment in young children. Methods We determined the incidence of adverse events related to fluoride varnish treatment in 3 clinical trials on the prevention of early childhood caries, conducted under the auspices of the Early Childhood Caries Collaborating Centers, an initiative sponsored by the National Institute of Dental and Craniofacial Research. Each trial incorporated use of fluoride varnish in its protocol and systematically queried all children’s parents or legal guardians about the occurrence of acute adverse events after each fluoride varnish treatment. Results A total of 2,424 community-dwelling, dentate children aged 0 to 5 years were enrolled and followed for up to 3 years. These children received a cumulative total of 10,249 fluoride varnish treatments. On average, each child received 4.2 fluoride varnish treatments. We found zero fluoride varnish–related adverse events. Conclusion Fluoride varnish was not associated with treatment-related adverse events in young children. Our findings support its safety as an effective prevention intervention for caries in young children.
Collapse
Affiliation(s)
- Raul I Garcia
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Steven E Gregorich
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco.,Department of Medicine, School of Medicine, University of California, San Francisco
| | | | - Patricia A Braun
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anne Wilson
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Judith Albino
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maya Harper
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Terrence S Batliner
- Center for Native Oral Health Research, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Margaret Rasmussen
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco
| | - Nancy F Cheng
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco
| | - William Santo
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco
| | - Paul L Geltman
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Michelle Henshaw
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts
| | - Stuart A Gansky
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco
| |
Collapse
|
69
|
Ramírez-Puerta BS, Escobar-Paucar G, Franco-Cortés ÁM, Ochoa-Acosta EM, Otálvaro-Castro GJ, Agudelo-Suárez AA. Caries dental en niños de 0-5 años del municipio de Andes, Colombia. Evaluación mediante el sistema internacional de detección y valoración de caries - ICDAS. REVISTA FACULTAD NACIONAL DE SALUD PÚBLICA 2017. [DOI: 10.17533/udea.rfnsp.v35n1a10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
70
|
Bernabé E, MacRitchie H, Longbottom C, Pitts NB, Sabbah W. Birth Weight, Breastfeeding, Maternal Smoking and Caries Trajectories. J Dent Res 2016; 96:171-178. [PMID: 27834298 DOI: 10.1177/0022034516678181] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Evidence for the effects of low birth weight, breastfeeding and maternal smoking on childhood caries is mainly cross-sectional. We examined the association of these 3 putative early life factors with caries increment over a 4-y period among young children. We used data from a 4-y longitudinal caries-risk assessment study carried out among Scottish children. Early life factors were measured when children were aged 1 y (baseline). Caries assessment was repeated annually from ages 1 to 4, and the number of decayed, missing and filled primary tooth surfaces (dmfs) were used as a repeated outcome measure. The associations of low birth weight, breastfeeding and maternal smoking with dmfs at baseline and over time (trajectories) were assessed in linear mixed models. A total of 1,102 children were included in this analysis. Birth weight, breastfeeding and maternal smoking were not associated with dmfs at baseline. However, low birth weight and maternal smoking were associated with the rate of change in dmfs. By wave 4, the predicted mean difference in dmfs was 1.86 between children with low and normal birth weight, and 1.66 between children of smoking and non-smoking mothers. Children with low birth weight and smoking mothers had greater caries increments than those with normal weight and non-smoking mothers, respectively. There was no association between breastfeeding duration and childhood caries, either at baseline or over time.
Collapse
Affiliation(s)
- E Bernabé
- 1 Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, London, UK
| | - H MacRitchie
- 2 National Health Service (NHS) Tayside, Dundee, UK
| | - C Longbottom
- 3 Dental Innovation and Translation Centre, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, London, UK
| | - N B Pitts
- 3 Dental Innovation and Translation Centre, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, London, UK
| | - W Sabbah
- 1 Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, London, UK
| |
Collapse
|
71
|
Abstract
As soon as teeth are present, dental care should be discussed at every pediatric well-child visit. Many parents do not ask their pediatricians about dental care, assuming that it is the dentists' domain, but some families do ask lots of questions. Either way, pediatricians should discuss dental care at well visits, answering any questions and offering anticipatory guidance, especially on how to prevent caries. There are many questions from parents about dental care: how to brush, what kind of toothpaste to use, how to stop their child from grinding his or her teeth, whether or not pacifiers are bad for tooth development, and other inquiries that are addressed in the article. This article acts as a quick reference guide for pediatricians, so they are prepared to answer common questions about oral health. [Pediatr Ann. 2016;45(11):e379-e381.].
Collapse
|
72
|
Hendaus MA, Jama HA, Siddiqui FJ, Elsiddig SA, Alhammadi AH. Parental preference for fluoride varnish: a new concept in a rapidly developing nation. Patient Prefer Adherence 2016; 10:1227-33. [PMID: 27471379 PMCID: PMC4948695 DOI: 10.2147/ppa.s109269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate parental preference for fluoride varnish in a country where the average percentage of dental caries in young children is up to ~73%. Consequently, the aim of this study, despite being a pilot, was to create a nationwide project in the State of Qatar to promote oral health in children. METHODS A cross-sectional perspective study was conducted at Hamad Medical Corporation in Qatar. Parents of children aged ≤5 years were offered an interview survey. A total of 200 questionnaires were completed (response rate =100%). The study was conducted between December 1, 2014 and March 30, 2015, and included all children aged >1 year and <5 years who came to the outpatient clinics for well-child and sick visits. We also included children who were admitted to the inpatient wards. RESULTS The mean age of participant children was 2.8±1.1 years. When inquiring regarding parents' knowledge and awareness of dental health, we found that >90% of families were aware that dental health affects the health of the whole body. The study showed that ~70% of parents were not aware of the existence of fluoride varnish, but would allow a health provider to apply fluoride varnish. Furthermore, ~80% of parents would not stop brushing their child's teeth and would not skip dentist appointments if varnish was to be applied. Approximately 40% of parents conveyed some concerns regarding the safety of fluoride varnish, despite being considered as a new concept. The main concern was that the child might swallow some of the fluoride. Another important concern expressed by parents was the availability of the fluoride varnish in all clinics. CONCLUSION The robust positive attitude of parents in this sample suggests that introducing fluoride varnish is feasible and acceptable in our community. Actions to augment fluoride varnish acceptability in the developing world, such as focusing on safety, could be important in the disseminated implementation of fluoride varnish.
Collapse
Affiliation(s)
- Mohamed A Hendaus
- Department of Pediatrics, General Academic Pediatrics Section, Hamad Medical Corporation, Doha
- Department of Clinical Pediatrics, Weill Cornell Medical College
| | - Hibaq A Jama
- Department of Pediatrics, General Academic Pediatrics Section, Hamad Medical Corporation, Doha
| | - Faisal J Siddiqui
- Department of Pediatrics, General Academic Pediatrics Section, Hamad Medical Corporation, Doha
- Pediatric Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Sohair A Elsiddig
- Department of Pediatrics, General Academic Pediatrics Section, Hamad Medical Corporation, Doha
| | - Ahmed H Alhammadi
- Department of Pediatrics, General Academic Pediatrics Section, Hamad Medical Corporation, Doha
- Department of Clinical Pediatrics, Weill Cornell Medical College
| |
Collapse
|
73
|
Moscicki AB, Yao TJ, Ryder MI, Russell JS, Dominy SS, Patel K, McKenna M, Van Dyke RB, Seage GR, Hazra R. The Burden of Oral Disease among Perinatally HIV-Infected and HIV-Exposed Uninfected Youth. PLoS One 2016; 11:e0156459. [PMID: 27299992 PMCID: PMC4907464 DOI: 10.1371/journal.pone.0156459] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/13/2016] [Indexed: 01/27/2023] Open
Abstract
Objective To compare oral health parameters in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected youth (PHEU). Methods In a cross-sectional substudy within the Pediatric HIV/AIDS Cohort Study, participants were examined for number of decayed teeth (DT), Decayed, Missing, and Filled Teeth (DMFT), oral mucosal disease, and periodontal disease (PD). Covariates for oral health parameters were examined using zero-inflated negative binomial regression and ordinal logistic regression models. Results Eleven sites enrolled 209 PHIV and 126 PHEU. Higher DT scores were observed in participants who were PHIV [Adjusted Mean Ratio (aMR) = 1.7 (95% CI 1.2–2.5)], female [aMR = 1.4 (1.0–1.9)], had no source of regular dental care [aMR = 2.3 (1.5–3.4)], and had a high frequency of meals/snacks [≥5 /day vs 0–3, aMR = 1.9 (1.1–3.1)] and juice/soda [≥5 /day vs 0–3, aMR = 1.6 (1.1–2.4)]. Higher DMFT scores were observed in participants who were older [≥19, aMR = 1.9 (1.2–2.9)], had biological parent as caregiver [aMR = 1.2 (1.0–1.3)], had a high frequency of juice/soda [≥5 /day vs 0–3, aMR = 1.4 (1.1–1.7)] and a low saliva flow rate [mL/min, aMR = 0.8 per unit higher (0.6–1.0)]. Eighty percent had PD; no differences were seen by HIV status using the patient-based classifications of health, gingivitis or mild, moderate, or severe periodontitis. No associations were observed of CD4 count and viral load with oral health outcomes after adjustment. Conclusions Oral health was poor in PHIV and PHEU youth. This was dismaying since most HIV infected children in the U.S. are carefully followed at medical health care clinics. This data underscore the need for regular dental care. As PHIV youth were at higher risk for cavities, it will be important to better understand this relationship in order to develop targeted interventions.
Collapse
Affiliation(s)
- Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mark I. Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California, United States of America
| | - Jonathan S. Russell
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Stephen S. Dominy
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Kunjal Patel
- Department of Epidemiology, Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Matt McKenna
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Russell B. Van Dyke
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - George R. Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Rohan Hazra
- Maternal and Pediatric Infectious Disease Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California, United States of America
| |
Collapse
|
74
|
Berdahl T, Hudson J, Simpson L, McCormick MC. Annual Report on Children's Health Care: Dental and Orthodontic Utilization and Expenditures for Children, 2010-2012. Acad Pediatr 2016; 16:314-26. [PMID: 27154430 DOI: 10.1016/j.acap.2016.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 02/09/2016] [Accepted: 02/18/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. METHODS Nationally representative data from the Medical Expenditure Panel Survey (2010-2012) provided data on insurance status, public health insurance eligibility, and visits to dental providers for both general dental care and orthodontic care. RESULTS Overall, 41.9% of US children reported an annual dental office-based visit for general (nonorthodontic) dental care. Fewer Hispanic (34.7%) and non-Latino black children (34.8%) received dental care compared to non-Hispanic whites (47.3%) and Asians (40.3%). Children living in families with the lowest income were also the least likely to have a visit (32.9%) compared to children in the highest-income families (54.7%). Among children eligible for public coverage, Medicaid-eligible children had the lowest percentage of preventive dental visits (29.2%). Socioeconomic and racial/ethnic disparities in use and expenditures for orthodontic care are much greater than those for general and preventive dental care. Average expenditures for orthodontic care were $1,823, of which 56% ($1,023) was paid out of pocket by families. CONCLUSIONS Our findings provide a baseline assessment for examining trends in the future, especially as coverage patterns for children may change as the Affordable Care Act is implemented and the future of the State Child Health Insurance Program remains uncertain beyond 2017.
Collapse
Affiliation(s)
- Terceira Berdahl
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Md.
| | - Julie Hudson
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Md
| | | | - Marie C McCormick
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Mass
| |
Collapse
|
75
|
Bernstein J, Gebel C, Vargas C, Geltman P, Walter A, Garcia RI, Tinanoff N. Integration of Oral Health Into the Well-Child Visit at Federally Qualified Health Centers: Study of 6 Clinics, August 2014-March 2015. Prev Chronic Dis 2016; 13:E58. [PMID: 27126556 PMCID: PMC4856482 DOI: 10.5888/pcd13.160066] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Early childhood caries, the most common chronic childhood disease, affects primary dentition and can impair eating, sleeping, and school performance. The disease is most prevalent among vulnerable populations with limited access to pediatric dental services. These same children generally receive well-child care at federally qualified health centers. The objective of this study was to identify facilitators and barriers to the integration of oral health into pediatric primary care at health centers to improve problem recognition, delivery of preventive measures, and referral to a dentist. METHODS We collected and analyzed background data and data from structured observations and 39 interviews with administrators and staff at 6 clinics in 2 states, Maryland and Massachusetts. RESULTS Participants valued oral health across professional roles but cited limited time, lack of training and expertise, low caregiver literacy, and lack of shared medical and dental electronic records as barriers to cooperation. Facilitators included an upper-level administration with the vision to see the value of integration, designated team leaders, and champions. An administration's vision, not structural determinants, patient characteristics, or geographic location, predicted the level of integration. Interviewees generated multilevel recommendations to promote delivery of oral health preventive measures and services during a well-child visit. CONCLUSION Poor oral health contributes to health care disparities. Barriers to integrating dental care into pediatric medical practice at health centers must be overcome to improve oral health for children living in poverty, with a disability, at a rural address, or any combination of these. Implementation will require adapting delivery systems to support multidisciplinary collaboration. Strategies suggested here may point the way to enhancing children's oral health.
Collapse
Affiliation(s)
- Judith Bernstein
- Dept of Community Health Sciences, Boston University, 801 Massachusetts Ave 431B, Boston, MA 02118.
| | | | - Clemencia Vargas
- Boston University and University of Maryland School of Dentistry, Baltimore, Maryland
| | | | | | | | - Norman Tinanoff
- Boston University and University of Maryland School of Dentistry, Baltimore, Maryland
| |
Collapse
|
76
|
Arthur T, Rozier RG. Provision of Preventive Dental Services in Children Enrolled in Medicaid by Nondental Providers. Pediatrics 2016; 137:e20153436. [PMID: 26801913 DOI: 10.1542/peds.2015-3436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Aims of this study are to determine (1) the association of oral health services (OHS) provided by nontraditional providers with the percentage of Medicaid children 0 to 5 years of age who receive ≥1 preventive services from all provider types in the United States; and (2) characteristics of state Medicaid policies associated with provision of OHS. METHODS We conducted a time-series cross-sectional study of preventive services provided by nontraditional (OHS) and dental (PDS) providers for Medicaid-enrolled children from birth to 5 years of age in all states during 2010 to 2013 (204 observations). We applied panel data multiple regression analysis techniques to exploit year and state variation in aggregate data available in Centers for Medicare and Medicaid Services reports (form CMS-416). Total preventive dental services (TPDS =OHS + PDS) was predicted by months since state enactment of a policy to reimburse medical providers for OHS. RESULTS The 44 states with a policy reported 4.3% of children per state per year with any OHS. For all states, an average of 30.1% received PDS and 34.5% TPDS. The delivery of OHS was associated with a small increase in percentage with TPDS. One year of Medicaid OHS availability was associated with an increase of 1.5% in the percentage of children with TPDS per state per year. CONCLUSIONS Implementation of policies by Medicaid programs to support integration of OHS into primary care is associated with increases in overallTPDS use, but efforts are needed to improve implementation in practice to achieve national impact on access.
Collapse
Affiliation(s)
- Tania Arthur
- NYU Lutheran Department of Dental Medicine, Dental Public Health Residency Program, Brooklyn, New York; and
| | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
77
|
Kranz AM, Preisser JS, Rozier RG. Effects of Physician-Based Preventive Oral Health Services on Dental Caries. Pediatrics 2015; 136:107-14. [PMID: 26122805 PMCID: PMC4485004 DOI: 10.1542/peds.2014-2775] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most Medicaid programs reimburse nondental providers for preventive dental services. We estimate the impact of comprehensive preventive oral health services (POHS) on dental caries among kindergarten students, hypothesizing improved oral health among students with medical visits with POHS. METHODS We conducted a retrospective study in 29,173 kindergarten students by linking Medicaid claims (1999-2006) with public health surveillance data (2005-2006). Zero-inflated regression models estimated the association between number of visits with POHS and (1) decayed, missing, and filled primary teeth (dmft) and (2) untreated decayed teeth while adjusting for confounding. RESULTS Kindergarten students with ≥4 POHS visits averaged an adjusted 1.82 dmft (95% confidence interval: 1.55 to 2.09), which was significantly less than students with 0 visits (2.21 dmft; 95% confidence interval: 2.16 to 2.25). The mean number of untreated decayed teeth was not reduced for students with ≥4 POHS visits compared with those with 0 visits. CONCLUSIONS POHS provided by nondental providers in medical settings were associated with a reduction in caries experience in young children but were not associated with improvement in subsequent use of treatment services in dental settings. Efforts to promote oral health in medical settings should continue. Strategies to promote physician-dentist collaborations are needed to improve continuity of care for children receiving dental services in medical settings.
Collapse
Affiliation(s)
| | | | - R. Gary Rozier
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|