Variation in prices for an evidence-based pediatric preventive service

Knowledge of and Attitude Toward Preventive Care Among Iraqi Dentists and Senior Dental Students: A Cross-Sectional Study

OBJECTIVES

Acquiring knowledge and maintaining a positive mindset are essential for dental care providers to offer optimal dental services. Dental professionals are expected to follow preventive dentistry principles to ensure the best oral health maintenance for their patients, as prevention is a key component of public health initiatives. This study aims to assess the knowledge and attitudes toward preventive dental care among Iraqi dentists and senior dental students.

METHODOLOGY

A cross-sectional study, conducted from June to August 2023, involved 876 Iraqi dentists and 587 senior dental students in Baghdad, utilizing a physically paper-based self-administered questionnaire. Participants' level of knowledge was assessed based on a 5-point Likert scale to 12 statements on preventive dental care. Their attitudes were inquired by selecting one option from a 7-point Likert scale on four pairs of bipolar adjectives describing preventive dentistry. Higher scores were considered more accurate knowledge and more positive attitudes. Statistical evaluation included the Chi-square test and regression analysis.

RESULTS

In total, data from 841 dentists and 567 students were analyzed (response rate: 96%). Around 90% of dentists (N=745) and students (N=502) acknowledged the impact of sugar, sealant, and water fluoridation on dental caries, but about 80% of dentists (N=662) and students (N=446) undervalued the role of fluoridated toothpaste. Women (OR=1.4, 95% CI: 1.02-2.1) and dentists, within one year of their graduation (OR=1.9, 95% CI: 1.1-3.5), exhibited higher levels of knowledge. More favorable attitudes towards preventive dentistry were associated with a higher level of knowledge among dentists (OR=1.6, 95% CI: 1.2-2.3). Regarding dental students, those from private dental schools showed higher scores of knowledge than their counterparts from public schools (OR=2.1, 95% CI: 1.3-3.4). The majority of participants held the belief that preventive dentistry is beneficial for the community but just about 60% of dentists (N=477) and students (N=300) exhibited a positive attitude toward the economic advantages of preventive dentistry for dentists, as well as the ease of engaging in preventive dental practices.

CONCLUSIONS

The dentists and dental students in this study demonstrated satisfactory knowledge and a favorable attitude toward most aspects of preventive dentistry. However, deficiencies were noted in certain areas, such as the application of topical fluoride for preventing dental caries, as well as a substantial proportion of individuals who lacked a positive perspective on the economic benefits of preventive dentistry. Hence, there is a clear need for educational interventions during their undergraduate training and postgraduate continuing education to enhance their knowledge levels and cultivate a more positive attitude towards preventive dentistry.

Five-year follow-up of an interdisciplinary oral health education program: Clinical practice behaviors in working pediatric nurse practitioners

ABSTRACT

Many interdisciplinary oral health education programs have been implemented for pediatric primary care providers (e.g., pediatric nurse practitioner [PNP]) to raise awareness and gain skills related to the prevention of early childhood caries (ECC). However, no studies have evaluated if these educational programs provided to PNPs during their training resulted in clinical practice behavior changes. A 33-item survey was designed on a web-based platform (Survey Monkey) and distributed to 71 PNP graduates. The survey included demographics, current clinical practice, clinical practice behaviors, and perceived barriers to practice. Descriptive statistics were used to assess the survey items and thematic analyses on the open-ended questions. The survey response rate was 70% (50/71 PNPs). Most practicing PNPs were in acute care or specialty clinics (n = 33; 66%) where oral health was not part of the focused visit. Majority used knowledge learned in assessment and anticipatory guidance skills. However, only 14% of primary care providers were applying fluoride varnish with 10% billing for this procedure. Barriers to application were time, available supplies, COVID protocols, lack of support staff, or not billing due to minimal reimbursement. Many primary care-trained PNPs were practicing in acute or subspecialty areas where prevention of ECC is not viewed as part of their focused visit. Pediatric nurse practitioners working in primary care demonstrated some clinical practice changes. However, areas for improvement are time to perform a risk assessment and application of fluoride varnish, access to these supplies, and standard billing and insurance reimbursement for these preventable services.

Association Between Insurance Type and Fluoride Varnish Application During Well-Child Visits in Massachusetts

OBJECTIVE

To compare rates of fluoride varnish (FV) applications during well-child visits for children covered by Medicaid and private medical insurance in Massachusetts.

METHODS

This cross-sectional study analyzed well-child visits for children aged 1 to 5 years paid by Medicaid and private insurance during 2016.Çô18 in Massachusetts. Multivariate regression models, with all covariates interacting with insurance type, were used to calculate odds ratios and adjusted predicted probabilities of fluoride varnish during well-child visits by calendar year and age.

RESULTS

Across 957,551 well-child visits, 40.0% were paid by private insurers. Unadjusted rates of fluoride varnish were significantly lower among well-child visits paid by private insurers (6.6%) than visits paid by Medicaid (14.2%). In the fully interacted regression model, the odds of a visit including fluoride varnish were significantly lower for older children than for children aged 1 for visits paid by both insurance types. Adjusted rates of fluoride varnish increased significantly from 2016 to 2018 for both insurance types. Moreover, rates were higher among visits for children covered under Medicaid than privately insured children in all years, and the differences by insurance type declined over time (2016: 8.0% points, 95% confidence interval.á=.á.êÆ8.7 to .êÆ7.3, 2018: 5.3% points, 95% confidence interval.á=.á.êÆ6.6 to .êÆ3.9).

CONCLUSIONS

Rates of fluoride varnish applications during well-child visits were low for both Medicaid and private insurance despite growth from 2016 to 2018 in Massachusetts. Low rates are concerning because this is a recommended service with the potential to help address racial, geographic, and income-based disparities in access and oral health outcomes.

Variation in prices for an evidence-based pediatric preventive service

OBJECTIVE

To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive.

DATA SOURCES

Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016-2018).

STUDY DESIGN

We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid.

DATA COLLECTION/EXTRACTION METHODS

Private claims for fluoride varnish during medical visits for children aged 1-5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics.

PRINCIPAL FINDINGS

Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers.

CONCLUSIONS

Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.