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Peng J, Gorham TJ, Meyer BD. Predicting Dental General Anesthesia Use among Children with Behavioral Health Conditions. JDR Clin Trans Res 2024:23800844241252817. [PMID: 38877718 DOI: 10.1177/23800844241252817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVES To evaluate how different data sources affect the performance of machine learning algorithms that predict dental general anesthesia use among children with behavioral health conditions. STUDY DESIGN Observational study using claims data. METHODS Using Medicaid claims from Partners For Kids (2013-2019), electronic medical record data, and the Ohio Child Opportunity Index, we conducted a retrospective cohort study of 12,410 children with behavioral health diagnoses. Four lasso-regularized logistic regression models were developed to predict dental general anesthesia use, each incorporating different data sources. Lift scores, or the ratio of positive predictive value to base case prevalence, were used to compare models, and a lift score of 2.5 was considered minimally acceptable for risk prediction. RESULTS Dental general anesthesia use ranged from 3.2% to 3.9% across models, which made it difficult for the machine learning models to achieve high positive predictive value. Model performance was best when either the electronic medical record (lift = 2.59) or Ohio Child Opportunity Index (lift = 2.56), but not both (lift = 2.34) or neither (lift = 1.87), was used. CONCLUSIONS Incorporating additional data sources improved machine learning model performance, and 2 models achieved satisfactory performance. The model using electronic medical record data could be applied in hospital-based settings, and the model using the Ohio Child Opportunity Index could be more valuable in community-based settings. KNOWLEDGE TRANSFER STATEMENT Machine learning was applied to satisfactorily predict which children with behavioral health diagnoses would require dental treatment under general anesthesia. Incorporating electronic medical record data or area-level social determinants of health data, but not both, improved the performance of the machine learning predictions. The 2 highest performing models could be applied by hospitals using medical record data or by organizations using area-level social determinants of health data to risk stratify the pediatric behavioral health population.
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Affiliation(s)
- J Peng
- IT Research & Innovation, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T J Gorham
- IT Research & Innovation, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - B D Meyer
- Division of Pediatric Dentistry, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
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Patel S, Fantauzzi AJ, Patel R, Buscemi J, Lee HH. Childhood caries and dental surgery under general anesthesia: an overview of a global disease and its impact on anesthesiology. Int Anesthesiol Clin 2023; 61:21-25. [PMID: 36480646 PMCID: PMC9752176 DOI: 10.1097/aia.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Children’s oral health is influenced, negatively and positively, but modifiable social determinants. For high-risk populations, severe disease burden leads to dental treatment under general anesthesia (DGA), which represents a costly and futile use of scarce resources. These clinical events, at the intersection of medicine and dentistry, often involve anesthesiologists to facilitate care. However, clinical interventions do not address the etiology of disease, which are largely rooted in health behaviors. In this review, we will summarize the scope of severe disease on a global scale and its impact on individual and population health and health systems. We will also provide insight into factors that influence DGA utilization from perspectives of families, providers, health systems, policy, and community-level environment. A child’s need for DGA may represent missed prevention opportunities at several levels. However, the surgical period may serve as a prime window to change a family’s oral health behaviors and reduce chance of recurrent disease amongst the highest risk families.
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Affiliation(s)
- Shiragi Patel
- Department of Anesthesiology, Ann & Robert H. Lurie Children's Hospital, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Andrés J Fantauzzi
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois
| | - Raj Patel
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, Illinois
| | - Helen H Lee
- Department of Anesthesiology, Institute for Health Policy and Research, University of Illinois at Chicago, Chicago, Illinois
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Kranz AM, Opper IM, Stein BD, Ruder T, Gahlon G, Sorbero M, Dick AW. Medicaid Payment and Fluoride Varnish Application During Pediatric Medical Visits. Med Care Res Rev 2022; 79:834-843. [PMID: 35130771 PMCID: PMC9357861 DOI: 10.1177/10775587221074766] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
All Medicaid programs pay for fluoride varnish applications during medical visits for infants and toddlers, but receipt of care varies considerably across states. Using 2006-2014 Medicaid data from 22 states, this study examined the association between Medicaid payment and receipt of fluoride varnish during pediatric medical visits. Among 3,393,638 medical visits, fewer than one in 10 visits included fluoride varnish. Higher Medicaid payment was positively associated with receipt of fluoride varnish during pediatric medical visits. As policymakers consider strategies for increasing young children's access to preventive oral health services, as well as consider strategies for balancing budgets, attention should be paid to the effects of provider payment on access to pediatric oral health services.
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Neighbors CJ, Choi S, Yerneni R, Forthal S, Morgenstern J. Effects of Medicaid Health Homes among people with substance use disorder and another chronic condition on health care utilization and spending: Lessons from New York State. J Subst Abuse Treat 2022; 132:108503. [PMID: 34098212 PMCID: PMC8628019 DOI: 10.1016/j.jsat.2021.108503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION New York State implemented a Health Homes (HH) care management program to facilitate access to health services for Medicaid enrollees with multiple chronic conditions. This study assessed the impact of HH on health care utilization outcomes among enrollees who have substance use disorder (SUD). METHODS Using HH enrollment data and Medicaid claims data 1 year before and after enrollment, this study compared HH enrollees who enrolled between 2012 and 2014 to a statistically matched comparison group created with propensity score methods. Analyses used generalized gamma models, logistic regression models, and difference-in-differences analyses to assess the impact of HH on general (all-cause) health care and SUD-related outpatient, emergency department (ED), hospitalization, and detoxification utilization as well as total Medicaid cost. RESULTS The sample consisted of 41,229 HH enrollees and a comparison group of 39,471 matched patients. HH-enrolled patients who had SUD utilized less SUD-related ED services (average marginal effect (AME) = -1.85; 95% CI = -2.45, -1.24), SUD-related hospitalizations (AME = -1.28; 95% CI: -1.64, -0.93), and detoxification services (AME = -1.30; 95% CI = -1.64, -0.96), relative to the comparison group during the 1 year post-HH enrollment. SUD-related outpatient visits did not change significantly (AME = -0.28; 95% CI = -0.76, 0.19) for enrollees, but general health care outpatient visits increased (AME = 1.63; 95% CI = 1.33, 1.93). CONCLUSION These findings provide preliminary evidence that care management programs can decrease ED visits and hospitalizations among people with SUD.
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Affiliation(s)
- Charles J Neighbors
- Partnership to End Addiction, Formerly Center on Addiction, 711 Third Avenue, New York, NY 10017, United States of America; New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, United States of America.
| | - Sugy Choi
- Partnership to End Addiction, Formerly Center on Addiction, 711 Third Avenue, New York, NY 10017, United States of America; Boston University School of Public Health, 715 Albany St, Boston, MA 02118, United States of America
| | - Rajeev Yerneni
- Partnership to End Addiction, Formerly Center on Addiction, 711 Third Avenue, New York, NY 10017, United States of America
| | - Sarah Forthal
- Partnership to End Addiction, Formerly Center on Addiction, 711 Third Avenue, New York, NY 10017, United States of America
| | - Jon Morgenstern
- Northwell Health, 1010 Northern Blvd, Suite 311, Great Neck, NY 11021, United States of America
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Lee HH, LeHew CW, Avenetti D, Cory M, Buscemi J, Koerber A. A qualitative analysis of caregiver perceptions of pediatric dental surgery under general anesthesia. Int J Paediatr Dent 2021; 31:311-317. [PMID: 32558011 DOI: 10.1111/ipd.12684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dental surgery under general anesthesia (GA) is a common treatment for severe childhood caries and thus may serve as an event to motivate behavior change. The frequency of recurrent caries, however, indicates opportunities within current practice to change a child's oral health behaviors. AIM To assess caregiver experiences related to their child's dental surgery to inform development of a behavioral intervention. DESIGN Semi-structured interviews with caregivers of children receiving GA for dental surgery. Transcripts (n = 19) were analyzed using qualitative thematic methods. RESULTS Children were 2-5 years of age, mean 3.8 years. Limited access to GA services was a source of caregiver frustration and a barrier to caries treatment. Surgical events elicited emotional reactions including guilt, anxiety, and a sense of caregiver accountability for development of severe caries. There was variation in caregiver awareness and/or motivation to change oral health behaviors. CONCLUSIONS A child's dental surgery under GA is an emotionally challenging event yet may inspire hope and expectations for improvement. Surgery offers an opportunity to implement interventions at a time when caregivers may be open to assistance with behavior change, though stress and anxiety may create barriers. Behavioral interventions should be tailored to individual caregiver needs/barriers and stage of developmental readiness.
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Affiliation(s)
- Helen H Lee
- Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Charles W LeHew
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - David Avenetti
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Molly Cory
- Department of Psychology, College of Science and Health, DePaul University, Chicago, IL, USA
| | - Joanna Buscemi
- Department of Psychology, College of Science and Health, DePaul University, Chicago, IL, USA
| | - Anne Koerber
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
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Griffin S, Thornton-Evans G, Wei L, Griffin P. Disparities in Dental Use and Untreated Caries Prevalence by Income. JDR Clin Trans Res 2021; 6:234-241. [PMID: 32585114 PMCID: PMC10996343 DOI: 10.1177/2380084420934746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Untreated dental caries (UC), although preventable, is the most prevalent disease in the United States. UC diminishes quality of life and lowers productivity for millions of Americans and is notably higher among lower-income compared to higher-income persons. OBJECTIVE This study examines changes in disparities by income in past-year dental use (DU) and UC in 4 life stages (2-5, 6-19, 20-64, and ≥65 y) between 1999-2004 and 2011-2016. We also examined changes in dental safety net policies during this time. METHODS We obtained data on dependent variables, UC and DU, from cross-sectional, nationally representative surveys for 1999-2004 and 2011-2016. We used multivariable regression models with 3 main-effect explanatory variables: income (<200% or ≥200% federal poverty level), life stage, and survey period (1999-2004 or 2011-2016) and sociodemographic variables. We included 2-way interaction terms among main-effect variables to test whether disparities had changed over time in each life stage and a 3-way term to test changes in disparities differed across life stages. RESULTS Model-adjusted disparities in DU decreased for both preschool-age and school-age children, and disparities in UC decreased for school-age children. Changes in DU and UC disparities were not detectable for working-age adults and increased for retirement-age adults. Changes in DU and UC among preschool and school-age children were not significantly different from one another and were significantly different from changes among retirement-age adults. Compared to working-age adults, changes in disparities for DU and UC were significantly different for school-age children, and changes in DU were significantly different for preschool-age children. Between surveys, the dental safety net was expanded for youth but remained largely unchanged for adults. CONCLUSIONS Expanding the dental safety net for youth could have contributed to increased access to dental care among children relative to adults and contributed to the decrease in disparities in DU and UC among youth. KNOWLEDGE TRANSFER STATEMENT Between 1999-2004 and 2011-2016, the dental safety net was expanded for youth but remained largely unchanged for adults. Using national survey data to compare changes in disparities in past-year dental use and untreated dental caries by income between adults and youth sheds light on the potential impact of expanding the dental safety net.
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Affiliation(s)
- S.O. Griffin
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - G. Thornton-Evans
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - L. Wei
- DB Consulting Group, Inc., Atlanta, GA, USA
| | - P.M. Griffin
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
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Peng J, Zeng X, Townsend J, Liu G, Huang Y, Lin S. A Machine Learning Approach to Uncovering Hidden Utilization Patterns of Early Childhood Dental Care Among Medicaid-Insured Children. Front Public Health 2021; 8:599187. [PMID: 33537275 PMCID: PMC7848156 DOI: 10.3389/fpubh.2020.599187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Early childhood dental care (ECDC) is a significant public health opportunity since dental caries is largely preventable and a prime target for reducing healthcare expenditures. This study aims to discover underlying patterns in ECDC utilization among Ohio Medicaid-insured children, which have significant implications for public health prevention, innovative service delivery models, and targeted cost-saving interventions. Methods: Using 9 years of longitudinal Medicaid data of 24,223 publicly insured child members of an accountable care organization (ACO), Partners for Kids in Ohio, we applied unsupervised machine learning to cluster patients based on their cumulative dental cost curves in early childhood (24–60 months). Clinical validity, analytical validity, and reproducibility were assessed. Results: The clustering revealed five novel subpopulations: (1) early-onset of decay by age (0.5% of the population, as early as 28 months), (2) middle-onset of decay (3.0%, as early as 35 months), (3) late-onset of decay (5.8%, as early as 44 months), (4) regular preventive care (67.7%), and (5) zero utilization (23.0%). Patients with early-onset of decay incurred the highest dental cost [median annual cost (MAC) = $9,499, InterQuartile Range (IQR): $7,052–$11,216], while patients with regular preventive care incurred the lowest dental cost (MAC = $191, IQR: $99–$336). We also found a plausible correlation of early-onset of decay with complex medical conditions diagnosed at 0–24 months. Almost one-third of patients with early-onset of decay had complex medical conditions diagnosed at 0–24 months. Patients with early-onset of decay also incurred the highest medical cost (MAC = $7,513, IQR: $4,527–$12,546) at 0–24 months. Conclusion: Among Ohio Medicaid-insured children, five subpopulations with distinctive clinical, cost, and utilization patterns were discovered and validated through a data-driven approach. This novel discovery promotes innovative prevention strategies that differentiate Medicaid subpopulations, and allows for the development of cost-effective interventions that target high-risk patients. Furthermore, an integrated medical-dental care delivery model promises to reduce costs further while improving patient outcomes.
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Affiliation(s)
- Jin Peng
- Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Xianlong Zeng
- Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Janice Townsend
- Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, GA, United States.,Department of Dentistry, Nationwide Children's Hospital, Columbus, OH, United States
| | - Gilbert Liu
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Yungui Huang
- Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Simon Lin
- Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
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Kopczynski K, Meyer BD. Examining Parental Treatment Decisions Within a Contemporary Pediatric Dentistry Private Practice. Patient Prefer Adherence 2021; 15:645-652. [PMID: 33790544 PMCID: PMC8007596 DOI: 10.2147/ppa.s300684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/22/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The primary objective of this study was to compare relationships between child, parent, and clinical factors with patient-level treatment decisions for early childhood caries. A secondary objective was to describe children that received silver diamine fluoride (SDF) as interim versus long-term treatment. PATIENTS AND METHODS Parents of 2-6-year-old children seeking care at a multi-center pediatric dentistry private practice were enrolled in this cross-sectional study. Demographic data and dental anxiety data according to the Modified Corah's Dental Anxiety Scale were collected via questionnaire. A dental visit behavior rating and decayed, missing, and filled tooth (dmft) index were recorded from the child's dental record. The primary outcome was treatment decision categorized into three groups: (1) treatment with SDF (n=25), (2) conventional restorative treatment under local anesthesia (n=32), and (3) restorative treatment under general anesthesia (n=33). Analyses included descriptive statistics, bivariate analysis, and ordered logistic regression. RESULTS Child age, parent education level, family income, dental insurance status, dental visit behavior rating, and dmft were significantly different across treatment groups in bivariate comparisons. However, when included in multivariable, ordered logistic regression, child dental anxiety was the only significant covariate associated with treatment decisions (Odds Ratio=5.01, 95% confidence interval: 1.51 to 16.63). In secondary analysis, two distinct subgroups were identified within the SDF group: one as long-term treatment (n=9) and one as interim treatment prior to general anesthesia (n=16). The long-term group was younger (mean=3.2 versus 3.7), had lower dmft (mean=4 versus 11.1), and had lower frequency of very high dental anxiety (0% versus 15%). CONCLUSION The present study identified child dental anxiety as the primary factor associated with treatment decisions at this private practice. The characterization of two subgroups of children treated with SDF has meaningful implications for studies evaluating the economic and public health impacts of SDF.
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Affiliation(s)
- Kayla Kopczynski
- Adams School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Beau D Meyer
- Division of Pediatric Dentistry, College of Dentistry, Ohio State University, Columbus, OH, USA
- Correspondence: Beau D Meyer The Ohio State University, College of Dentistry, Division of Pediatric Dentistry, Columbus, OH, USA Email
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Lee HH, Faundez L, Nasseh K, LoSasso AT. Does Preventive Care Reduce Severe Pediatric Dental Caries? Prev Chronic Dis 2020; 17:E136. [PMID: 33119483 PMCID: PMC7665577 DOI: 10.5888/pcd17.200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Tertiary oral health services (caries-related surgery, sedation, and emergency department visits) represent high-cost and ineffective ways to improve a child's oral health. We measured the impact of increased Texas Medicaid reimbursements for preventive dental care on use of tertiary oral health services. METHODS We used difference-in-differences models to compare the effect of a policy change among children (≤9 y) enrolled in Medicaid in Texas and Florida. Linear regression models estimated 4 outcomes: preventive care dental visit, dental sedation, emergency department use, and surgical event. RESULTS Increased preventive care visits led to increased sedation visits (1.7 percentage points, P < .001) and decreased emergency department visits (0.3 percentage points, P < .001) for children aged 9 years or younger. We saw no significant change in dental surgical rates associated with increased preventive dental care reimbursements. CONCLUSION Increased access to preventive dentistry was not associated with improved long-term oral health of Medicaid-enrolled children. Policies that aim to improve the oral health of children may increase the effectiveness of preventive dentistry by also targeting other social determinants of oral health.
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Affiliation(s)
- Helen H Lee
- Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, 1740 W Taylor St, Ste 3200W, MC 515, Chicago, IL 60612.
| | - Luis Faundez
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois
| | - Kamyar Nasseh
- Health Policy Institute, American Dental Association, Chicago, Illinois
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Lee HH, Faundez L, LoSasso AT. A Cross-Sectional Analysis of Community Water Fluoridation and Prevalence of Pediatric Dental Surgery Among Medicaid Enrollees. JAMA Netw Open 2020; 3:e205882. [PMID: 32785633 PMCID: PMC7424407 DOI: 10.1001/jamanetworkopen.2020.5882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Dental surgery under general anesthesia (DGA) is an ineffective, costly treatment for caries. Interventions to reduce the need for DGA are challenging because children's parents may not seek care until surgery is required. Community water fluoridation (CWF) effectively prevents early childhood caries, but its effectiveness in reducing severe early childhood caries is unknown. OBJECTIVE To determine whether access to CWF is associated with the prevalence of DGA. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional analysis of Medicaid claims data from 2011 to 2012. Deidentified data were derived from Medicaid claims and enrollee files for Massachusetts, Texas, Connecticut, Illinois, and Florida for children aged 9 years and younger enrolled in either a fee-for-service or managed care plan through their state's Medicaid program. Linear regression models tested for associations between CWF and covariates. Multivariable linear regression models tested for associations between CWF and outcomes. Regression models included clustered SEs at the county level. Data analysis was performed from December 2018 to March 2020. EXPOSURES Access to CWF was determined by estimating the proportion of a county's total population that had access to a fluoridated public water system. MAIN OUTCOMES AND MEASURES The main outcome was county-level DGA prevalence. Other outcomes were caries-related visit prevalence and patient quality indicators (asthma and diabetes). Covariates included county-level demographic, socioeconomic, and dental practitioner variables. RESULTS A total of 436 counties within 5 states per year (872 county-year observations), were included in the analysis. Adjusted analysis revealed that a 10% increase in the proportion of county's population access to CWF was associated with lower caries-related visit prevalence (-0.45 percentage points; 95% CI, -0.59 to -0.31 percentage points; P < .001). Increasing CWF access in 10% increments was associated with decreased DGA prevalence in unadjusted analysis (-0.39 percentage points; 95% CI, -0.67 to -0.12 percentage points; P = .006) but not in adjusted analysis (-0.23 percentage points; 95% CI, -0.49 to 0.02 percentage points; P = .07). Increasing the proportion of county's access to CWF by 10% was not associated with the prevalence of asthma-related exacerbations (-0.02 percentage points; 95% CI, -0.10 to 0.05 percentage points; P = .53) or diabetes-related exacerbations (-0.0003 percentage points; 95% CI, -0.0014 to 0.0009 percentage points; P = .66). CONCLUSIONS AND RELEVANCE This study extends our understanding of CWF's benefits for children's oral health. Specifically, these findings suggest that increasing a population's access to CWF's is associated with decreased caries-related visits and may also be associated with use of dental surgical services within high-risk populations.
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Affiliation(s)
- Helen H. Lee
- Department of Anesthesiology, University of Illinois at Chicago, Chicago
| | - Luis Faundez
- Department of Economics, University of Illinois at Chicago, Chicago
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Meyer BD, Kelly ER, McDaniel P. Dentists' Adoption of Silver Diamine Fluoride among 1- to 5-Year-Old Children in North Carolina. JDR Clin Trans Res 2020; 6:59-67. [PMID: 32168462 DOI: 10.1177/2380084420913251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A natural experiment was conducted to observe the adoption of silver diamine fluoride (SDF) by Medicaid-enrolled dentists in North Carolina (NC). The purpose of this study was to describe the sociocontextual and community health characteristics where dentists adopted SDF, determine the association between SDF use and general anesthesia (GA) use, and examine the changes in GA utilization following implementing SDF reimbursement. METHODS NC Medicaid initiated SDF reimbursement in 2016 for children ages 1 to 5 y. This cross-sectional time series study used aggregate NC Medicaid claims, including geographic data, from 2014 to 2018. All dentists who provided GA and/or SDF to children ages 1 to 5 y were included. County health ranking data described social and community health indicators. Descriptive statistics, spatial data techniques, and multivariable methods were used. RESULTS From 2016 to 2018, the number of dentists using SDF increased from 35 to 258, or 637%, whereas the number of dentists using GA increased from 179 to 211, or 17%. SDF utilization spread outward from areas of good social and health indicators to areas of poorer indicators. SDF utilization increased from 0.35 to 0.65 per 1,000 children, whereas GA utilization decreased from 2.57 to 2.47 per 1,000 children. GA utilization was positively associated with SDF utilization and poorer county health ranking but did not change before and after SDF implementation. CONCLUSION Early adopters of SDF in NC practiced in areas with positive social and community health indicators. Over time, SDF was adopted in resource-poor communities. It remains too early to determine the public health impacts of SDF treatment on GA utilization. KNOWLEDGE TRANSFER STATEMENT Policy makers and clinicians can use the results of this study to develop geographically targeted interventions that could lead to clinically and cost-effective public health programs.
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Affiliation(s)
- B D Meyer
- Department of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E R Kelly
- Digital Research Services Department, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P McDaniel
- Digital Research Services Department, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Scherrer CR, Naavaal S. Cost-Savings of Fluoride Varnish Application in Primary Care for Medicaid-Enrolled Children in Virginia. J Pediatr 2019; 212:201-207.e1. [PMID: 31253412 DOI: 10.1016/j.jpeds.2019.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/23/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the cost-benefit of fluoride varnish application during pediatric well-visits for the Medicaid/Children's Health Insurance Program population in Virginia (VA) from a Medicaid payer perspective. To provide initial cost estimates from the primary care provider (PCP) perspective. STUDY DESIGN A systematic search of recent literature was completed to obtain input data for a Monte Carlo cost-benefit simulation and for the fluoride varnish application time, labor, and materials costs for PCPs. The analysis was conducted from a Medicaid perspective; costs and savings related to fluoride varnish application in primary dentition through 7.5 years were calculated for all Medicaid-eligible children up to 3 years of age in VA. Sensitivity analysis was performed to mitigate the effects of parameter uncertainty. RESULTS Delivering fluoride varnish to all children <3 years old in VA who annually receive well-visits through Medicaid but did not receive fluoride varnish at those visits would reduce the percent of 7.5 year olds with decay from 63.2% to 39.8%. Accounting for averted restoration cost, PCP fluoride varnish application would save $75.32 per child, or a total population savings of almost $2 million/year for VA Medicaid. From the PCP perspective, the Medicaid reimbursement rate for fluoride varnish is 3.8-12.0 times the direct fluoride varnish application cost (labor and materials). CONCLUSIONS Application of fluoride varnish by a PCP to children under 3 years of age is cost-saving in this study population. Costs to provide fluoride varnish from the PCP perspective are favorable compared with the Medicaid reimbursement, but additional studies on optimizing fluoride varnish application into the well-visit workflow are needed.
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Affiliation(s)
- Christina R Scherrer
- Department of Systems and Industrial Engineering, Kennesaw State University, Marietta, GA.
| | - Shillpa Naavaal
- Department of Oral Health Promotion and Community Outreach, School of Dentistry, Virginia Commonwealth University, Richmond, VA; Oral Health in Childhood and Adolescence Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA
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Meyer BD, Wang R, Steiner MJ, Preisser JS. The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia. JDR Clin Trans Res 2019; 5:146-155. [PMID: 31434532 DOI: 10.1177/2380084419870128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. METHODS We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina (N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. RESULTS Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87-0.99; P = 0.029) and expenditures ($114; CI,-$152.61 to -$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. CONCLUSIONS POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome-treatment under general anesthesia. KNOWLEDGE TRANSFER STATEMENT The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.
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Affiliation(s)
- B D Meyer
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Wang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M J Steiner
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Johhnson B, Serban N, Griffin PM, Tomar SL. Projecting the economic impact of silver diamine fluoride on caries treatment expenditures and outcomes in young U.S. children. J Public Health Dent 2019; 79:215-221. [PMID: 30741498 DOI: 10.1111/jphd.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 01/07/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To quantify the economic impact of using silver diamine fluoride (SDF) to arrest the progression of dental caries in Medicaid-enrolled children (aged 1-5 years) relative to the standard restorative treatment from the Medicaid programs' perspective. METHODS We used Monte Carlo simulation to estimate averted restorative visits and associated expenditures for varying SDF effectiveness and intervention penetration levels. We compared the current standard of care for treating caries to applying SDF. We estimated expenditures from the 2010-2012 Medicaid Analytic Extract files for seven US states and the incremental cost effectiveness ratio for SDF application on averted restorative visits. RESULTS Across the seven states, averted restorative visits ranged from 2,049 (Vermont) to 60,542 (North Carolina), assuming an SDF penetration level of 50%. Averted per-restorative visit costs ranged from $100 to $350 per-visit. There were higher averted per-restorative visit costs in nonmetropolitan counties than metropolitan counties. CONCLUSIONS Providing SDF as a caries management strategy can reduce Medicaid program dental care expenditures by averting expensive caries treatment options. It could also prevent stressful restorative procedures. State Medicaid programs should consider reimbursing for SDF to arrest the progression of dental caries in young children.
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Affiliation(s)
- Ben Johhnson
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Nicoleta Serban
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Paul M Griffin
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
| | - Scott L Tomar
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
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15
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Abstract
Medical management of caries is a distinct treatment philosophy that employs topical minimally invasive therapies that treat the disease and is not merely prevention. This strategy is justified as an alternative or supplement to traditional care by significant disease recurrence rates following comprehensive operative treatment under general anesthesia. Silver diamine fluoride (SDF) is one agent to enable effective noninvasive treatment. The announcement of breakthrough therapy designation by the Food and Drug Administration (FDA) suggests that SDF may become the first FDA-approved drug for treating caries. Since our systematic review performed in April 2015, 4 clinical trials have been completed, which inform an update to the application protocol and frequency regimen. Suggestions from these studies are to skip the rinsing step due to demonstration of safety in young children, start patients with high disease severity on an intensive regimen of multiple applications over the first few weeks, and continue with semiannual maintenance doses as previously suggested. Breakthroughs in elucidating the impact of SDF on the dental plaque microbiome inform potential opportunities for understanding caries arrest. SDF can be added to the set of evidence-based noninvasive methods to treat caries lesions in primary teeth, such as the Hall crown technique and sealing lesions with accessible margins.
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Affiliation(s)
- J A Horst
- 1 Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
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16
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Casamassimo PS, Flaitz CM, Hammersmith K, Sangvai S, Kumar A. Recognizing the Relationship Between Disorders in the Oral Cavity and Systemic Disease. Pediatr Clin North Am 2018; 65:1007-1032. [PMID: 30213346 DOI: 10.1016/j.pcl.2018.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Oral health is integral to general health. The oral cavity may harbor manifestations of systemic disease and can be the harbinger of early onset. Primary care providers (PCPs) can therefore use the oral cavity to support working diagnoses. Conversely, systemic diseases and treatments can affect oral health and require interactions between PCPs and dental providers. Acute oral manifestations of systemic disease may involve teeth and/or gums. This article reviews oral and systemic disease connections for some diseases, identifies issues that benefit patients through medical-dental collaboration, and highlights some nondental oral injuries that might confront PCPs or emergency medical providers.
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Affiliation(s)
- Paul S Casamassimo
- The Ohio State University College of Dentistry, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Catherine M Flaitz
- The Ohio State University College of Dentistry, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kimberly Hammersmith
- The Ohio State University College of Dentistry, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shilpa Sangvai
- The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ashok Kumar
- The Ohio State University College of Dentistry, Nationwide Children's Hospital, Columbus, OH, USA
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17
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Casamassimo PS, Hammersmith K, Gross EL, Amini H. Infant Oral Health: An Emerging Dental Public Health Measure. Dent Clin North Am 2018; 62:235-244. [PMID: 29478455 DOI: 10.1016/j.cden.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Infant oral health (IOH) is a preventive service advocated by major medical and dental organizations. IOH aims to prevent early childhood caries (ECC) and impart health strategies to families for continued oral health and prevention of future caries. IOH reaches across disciplines, is low cost, and is covered by Medicaid and many private dental payers. Increasing evidence points to immediate and long-term positive oral health outcomes of reduced disease, reduction in costly care, and reduction in ECC-associated morbidities.
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Affiliation(s)
- Paul S Casamassimo
- The Ohio State University College of Dentistry, Nationwide Children's Hospital, 305 West 12th Avenue, Columbus, OH 43210, USA.
| | - Kimberly Hammersmith
- The Ohio State University College of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Erin L Gross
- The Ohio State University College of Dentistry, Nationwide Children's Hospital, 305 West 12th Avenue, Columbus, OH 43210, USA
| | - Homa Amini
- The Ohio State University College of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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18
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Abstract
This article explores trends in 3 areas of dental services use for children less than 21 years of age. First, it examines the change in access to prevention, diagnostic, and treatment services over time among Medicaid-enrolled children and how access to care is affected by state-level factors. Second, it evaluates trends and health care costs associated with the treatment of oral health conditions in the operating room of pediatric hospitals. Third, it examines the trends in use of emergency departments for dental needs among children in the United States.
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Affiliation(s)
- Natalia I Chalmers
- Analytics and Publication, DentaQuest Institute, 10320 Little Patuxent Parkway, Suite 214, Columbia, MD 21044, USA.
| | - Joseph S Wislar
- Analytics and Publication, DentaQuest Institute, 10320 Little Patuxent Parkway, Suite 214, Columbia, MD 21044, USA
| | - Matt Hall
- Children's Hospital Association, 600 13th Street NW, Washington, DC 20005, USA
| | - Cary Thurm
- Children's Hospital Association, 600 13th Street NW, Washington, DC 20005, USA
| | - Man Wai Ng
- Department of Pediatric Dentistry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Silver Diamine Fluoride Staining is Acceptable for Posterior Primary Teeth and Is Preferred Over Advanced Pharmacologic Behavior Management by Many Parents. J Evid Based Dent Pract 2018; 18:94-97. [PMID: 29478691 DOI: 10.1016/j.jebdp.2018.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Parental perceptions and acceptance of silver diamine fluoride staining. Crystal YO, Janal MN, Hamilton DS, Niederman R. J Am Dent Assoc 2017; 148(7):510-8. SOURCE OF FUNDING Grant from the National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health; New York University Clinical and Translational Science Award; and National Center for Advancing Translational Science, National Institutes of Health TYPE OF STUDY/DESIGN: Cross-sectional.
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Ramos-Gomez F, Askaryar H, Garell C, Ogren J. Pioneering and Interprofessional Pediatric Dentistry Programs Aimed at Reducing Oral Health Disparities. Front Public Health 2017; 5:207. [PMID: 28856133 PMCID: PMC5557784 DOI: 10.3389/fpubh.2017.00207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
Early Childhood Caries (ECC) is the most chronic childhood disease and more predominant in low-income and underserved children. Although easily transmitted, ECC is entirely preventable. Dr. Ramos-Gomez and his team at the University of California, Los Angeles put together an interprofessional curriculum where both medical and dental knowledge and practice is integrated to prepare dentists and primary care providers to more cost effectively address ECC and thereby reduce disparities in oral health. The curriculum, known as the Strategic Partnership for Interprofessional Collaborative Education in Pediatric Dentistry (SPICE-PD), consists of nine evidence-based training modules: applied statistics and research, community partners, interprofessional education/training, quality improvement, policy and advocacy, disease management/risk assessment, ethics/professionalism, cultural competency and children with special heath-care needs. SPICE aims to prepare pediatric dental residents and primary care providers to provide preventive, culturally competent, and minimally invasive oral care for underserved, low income, and special needs children. Additionally, the Infant Oral Care Program (IOCP), located at a local community health clinic, provides culturally sensitive preventive oral health care for children aged 0–5 years. The medical–dental integration model utilized at IOCP helps reduce oral health disparities by providing a systems-based and cost-effective approach to combat the burden of ECC. To track the progress of SPICE, a comprehensive evaluation framework has been designed, which aligns goals and objectives with program activities, desired outcomes, and measured indicators.
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Affiliation(s)
- Francisco Ramos-Gomez
- Section of Pediatric Dentistry, UCLA School of Dentistry, Los Angeles, CA, United States
| | - Hamida Askaryar
- Section of Pediatrics, UCLA School of Dentistry, Los Angeles, CA, United States
| | - Cambria Garell
- Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jennifer Ogren
- Department of Neurobiology, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
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Nelson S, Slusar MB, Albert JM, Riedy CA. Do baby teeth really matter? Changing parental perception and increasing dental care utilization for young children. Contemp Clin Trials 2017; 59:13-21. [PMID: 28479221 PMCID: PMC5514377 DOI: 10.1016/j.cct.2017.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/21/2017] [Accepted: 05/03/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Parent/caregivers' inability to recognize the importance of baby teeth has been associated with inadequate self-management of children's oral health (i.e. lower likelihood of preventive dental visits) which may result in dental caries and the need for more expensive caries-related restorative treatment under general anesthesia. Health behavior theories aid researchers in understanding the impact and effectiveness of interventions on changing health behaviors and health outcomes. One example is the Common-Sense Model of Self-Regulation (CSM) which focuses on understanding an individual's illness perception (i.e. illness and treatment representations), and subsequently has been used to develop behavioral interventions to change inaccurate perceptions and describe the processes involved in behavior change. METHODS We present two examples of randomized clinical trials that are currently testing oral health behavioral interventions to change parental illness perception and increase dental utilization for young children disproportionately impacted by dental caries in elementary schools and pediatric primary care settings. Additionally, we compared empiric data regarding parent/caregiver perception of the chronic nature of dental caries (captured by the illness perception questionnaire revised for dental: IPQ-RD constructs: identity, consequences, control, timeline, illness coherence, emotional representations) between parent/caregivers who did and did not believe baby teeth were important. RESULTS Caregivers who believed that baby teeth don't matter had significantly (P<0.05) less accurate perception in the majority of the IPQ-RD constructs (except timeline construct) compared to caregivers who believed baby teeth do matter. CONCLUSION These findings support our CSM-based behavioral interventions to modify caregiver caries perception, and improve dental utilization for young children.
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Affiliation(s)
- Suchitra Nelson
- Case Western Reserve University School of Dental Medicine, Department of Community Dentistry, 10900 Euclid Ave., Cleveland, OH 44106-4905, USA.
| | - Mary Beth Slusar
- Case Western Reserve University School of Dental Medicine, Department of Community Dentistry, 10900 Euclid Ave., Cleveland, OH 44106-4905, USA.
| | - Jeffrey M Albert
- Case Western Reserve University School of Medicine, Department of Epidemiology and Biostatistics, 10900 Euclid Ave., Cleveland, OH 44106-4945, USA.
| | - Christine A Riedy
- Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115, USA.
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