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Theriault H, Bridge G. Oral health equity for rural communities: where are we now and where can we go from here? Br Dent J 2023; 235:99-102. [PMID: 37500855 DOI: 10.1038/s41415-023-6058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 07/29/2023]
Abstract
Oral health is embedded in overall health and contributes to physical, social and mental wellbeing. Most diseases are preventable, and yet, oral diseases pose a significant public health problem and an economic burden globally. Poor oral health is a risk factor for certain systemic diseases, such as cardiovascular disease, diabetes and lung pathologies. Rural populations are disproportionately affected by oral disease, with higher levels of periodontal disease, caries and the loss of teeth. These issues are worsened by barriers in access to oral healthcare services and minimal promotion of healthy behaviours in rural communities. Certain interventions, including mobile dental clinics, teledentistry, dental outreach camps and educational initiatives, have been successful in addressing rural challenges. Policies and action plans should be considered by public health officials to reduce the disparities in oral health among rural communities, reduce the overall burden of oral health and promote health equity.
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Cruz S, Kerr D, Patiño Nguyen D, Carlyle A, Chi DL. Qualitative evaluation of the pre-implementation phase of a rural dental clinic co-located within a health center in the Pacific Northwest of the United States. Community Dent Oral Epidemiol 2023; 51:256-264. [PMID: 35261055 DOI: 10.1111/cdoe.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The development of a dental clinic within an existing Rural Health Clinic (RHC) was proposed to improve access to dental care for Medicaid enrollees in Washington. This qualitative study assessed the implementation of a co-located dental clinic in a rural community during the pre-implementation phase. Additionally, we sought to determine the needs and expectations of community members living in this rural Washington county. METHODS This study took place in Jefferson County, Washington, a Dental Health Professional Shortage Area. Semi-structured interviews were conducted with 42 participants, consisting of administrators (n = 9), health providers (n = 9) and community members (n = 24). Administrators and health providers were interviewed by phone. Community members were interviewed in-person at Jefferson Healthcare primary care clinics or by phone. Interview data were deductively coded, and thematic analysis with a hybrid inductive-deductive approach was used to analyse coded data. RESULTS Five themes were identified regarding local needs and expectations: dental care as a major need in the community, persisting barriers to dental care access, expecting more than a 'Medicaid experience', visions for a clinic that serves the community, and solutions outside the clinic to improve community oral health. CONCLUSIONS By improving access to dental care, a co-located dental clinic is helping to address general dental care needs in rural communities. Policy-level solutions that address housing and food insecurity, improve public transportation, and retain and expand low-income adult Medicaid dental benefits may be needed to overcome persisting barriers to oral health.
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Affiliation(s)
- Stephanie Cruz
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Darragh Kerr
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Adi Carlyle
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Chandel T, Alulaiyan M, Farraj M, Riedy CA, Barrow JR, Brennan L, Thompson L, Bass MB, Chamut S. Training and educational programs that support geriatric dental care in rural settings: A scoping review. J Dent Educ 2022; 86:792-803. [DOI: 10.1002/jdd.12885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/08/2022] [Indexed: 12/18/2022]
Affiliation(s)
- Tejasvita Chandel
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Mohammed Alulaiyan
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Malik Farraj
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Christine A. Riedy
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Jane R. Barrow
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Leonard Brennan
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Lisa Thompson
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Michelle B. Bass
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Steffany Chamut
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
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Simon L, Ahern J, Fox K, Barrow J, Palmer N. Variation in dental services by rurality among privately insured adults in the United States. J Public Health Dent 2020; 81:50-56. [PMID: 32918758 DOI: 10.1111/jphd.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/30/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Rurality is associated with reduced dental access and worse oral health outcomes. It is unknown whether there is variation in dental services received by rural adults who visit a dentist. METHODS This was a retrospective analysis of claims data from a large private insurer. All individuals who had at least one dental visit in 2018 were included. Patient demographics, whether or not a patient's ZIP code was rural as defined by the Federal Office of Rural Health Policy, as well as ZIP code demographics were collected. Differences in the frequency of dental services received were evaluated using χ2 tests. Multilevel logistic regressions were used to evaluate the individual and ZIP code-level correlates of receiving a preventive dental procedure, a tooth extraction, or a denture-related dental procedure. RESULTS Rates of preventive, oral and maxillofacial surgery, and denture-related procedures were higher among rural adults. Accounting for individual age and gender, and ZIP code average income and dentist density, rural dwellers were more likely to receive a preventive procedure [odds ratio (OR) 1.15, P < 0.0001] or tooth extraction (OR 1.08, P < 0.0001), and less likely to have a denture-related procedure (OR 0.94, P = 0.015) compared to nonrural dwellers. Female gender was the strongest predictor of receiving a preventive procedure (OR 1.30, P < 0.0001). CONCLUSIONS Even among privately insured individuals with known access to dental care, rurality was associated with significant differences in the frequency of various dental procedures. Rural dental patients may have higher needs for oral surgical procedures, even when they have access to preventive care.
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Affiliation(s)
- Lisa Simon
- Harvard School of Dental Medicine, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - John Ahern
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Kathe Fox
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Jane Barrow
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Nathan Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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Foiles Sifuentes AM, Castaneda-Avila MA, Lapane KL. The relationship of aging, complete tooth loss, and having a dental visit in the last 12 months. Clin Exp Dent Res 2020; 6:550-557. [PMID: 32737945 PMCID: PMC7545228 DOI: 10.1002/cre2.309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/13/2020] [Accepted: 06/18/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To evaluate the extent to which dental health care visits in the past year differed among older adults with and without edentulism. MATERIAL AND METHODS We conducted a cross-sectional study using the 2017 Medical Expenditure Panel Survey among participants aged ≥50 years (n = 10,480, weighted = 112,116,641). Two self-reported outcome variables were used: loss of all teeth from upper and lower jaws (yes/no) and dental visit in the last 12 months (yes/no). Logistic models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS Overall, 11.4% of the non-institutionalized U.S. population aged ≥50 years were edentulous; the prevalence was higher in those with advanced age. Adherence to annual oral health visits was 16% among those with edentulism, 52% among those without. The prevalence of dental care visits in the past year was higher among those with advanced age without edentulism, but for those with edentulism, the odds of visiting a dental care provider was lower in all age groups compared to those 50-59 years ((60-69 years): aOR: 0.58, CI:0.36-0.95; (70-79 years): aOR: 0.51, CI: 0.30-0.88; (≥ 80 years): aOR: 0.45, CI: 0.26-0.80)). CONCLUSION Although the prevalence of edentulism was higher in those with advanced age, oral health visits during the last 12 months were less frequent in older adults with edentulism. Interventions to improve adherence to dental care recommendations in the growing aging population are warranted.
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Affiliation(s)
- Andriana M Foiles Sifuentes
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Maira A Castaneda-Avila
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Fingar KR, Smith MW, Davies S, McDonald KM, Stocks C, Raven MC. Medicaid dental coverage alone may not lower rates of dental emergency department visits. Health Aff (Millwood) 2017; 34:1349-57. [PMID: 26240249 DOI: 10.1377/hlthaff.2015.0223] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medicaid was expanded to millions of individuals under the Affordable Care Act, but many states do not provide dental coverage for adults under their Medicaid programs. In the absence of dental coverage, patients may resort to costly emergency department (ED) visits for dental conditions. Medicaid coverage of dental benefits could help ease the burden on the ED, but ED use for dental conditions might remain a problem in areas with a scarcity of dentists. We examined county-level rates of ED visits for nontraumatic dental conditions in twenty-nine states in 2010 in relation to dental provider density and Medicaid coverage of nonemergency dental services. Higher density of dental providers was associated with lower rates of dental ED visits by patients with Medicaid in rural counties but not in urban counties, where most dental ED visits occurred. County-level Medicaid-funded dental ED visit rates were lower in states where Medicaid covered nonemergency dental services than in other states, although this difference was not significant after other factors were adjusted for. Providing dental coverage alone might not reduce Medicaid-funded dental ED visits if patients do not have access to dental providers.
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Affiliation(s)
- Kathryn R Fingar
- Kathryn R. Fingar is a research leader at Truven Health Analytics in Sacramento, California
| | - Mark W Smith
- Mark W. Smith is a director in the Federal Government Division of Truven Health Analytics in Bethesda, Maryland
| | - Sheryl Davies
- Sheryl Davies is a research associate in the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University, in California
| | - Kathryn M McDonald
- Kathryn M. McDonald is executive director of and a senior scholar at the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University
| | - Carol Stocks
- Carol Stocks is a senior research analyst in the Center for Delivery, Organization, and Markets at the Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Maria C Raven
- Maria C. Raven is an associate professor of emergency medicine at the University of California, San Francisco
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Cunningham TJ, Eke PI, Ford ES, Agaku IT, Wheaton AG, Croft JB. Cigarette Smoking, Tooth Loss, and Chronic Obstructive Pulmonary Disease: Findings From the Behavioral Risk Factor Surveillance System. J Periodontol 2015; 87:385-94. [PMID: 26537367 DOI: 10.1902/jop.2015.150370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cigarette smoking and tooth loss are seldom considered concurrently as determinants of chronic obstructive pulmonary disease (COPD). This study examines the multiplicative effect of self-reported tooth loss and cigarette smoking on COPD among United States adults aged ≥18 years. METHODS Data were taken from the 2012 Behavioral Risk Factor Surveillance System (n = 439,637). Log-linear regression-estimated prevalence ratios (PRs) are reported for the interaction of combinations of tooth loss (0, 1 to 5, 6 to 31, or all) and cigarettes smoking status (never, former, or current) with COPD after adjusting for age, sex, race/ethnicity, marital status, educational attainment, employment, health insurance coverage, dental care utilization, and diabetes. RESULTS Overall, 45.7% respondents reported having ≥1 teeth removed from tooth decay or gum disease, 18.9% reported being current cigarette smokers, and 6.3% reported having COPD. Smoking and tooth loss from tooth decay or gum disease were associated with an increased likelihood of COPD. Compared with never smokers with no teeth removed, all combinations of smoking status categories and tooth loss had a higher likelihood of COPD, with adjusted PRs ranging from 1.5 (never smoker with 1 to 5 teeth removed) to 6.5 (current smoker with all teeth removed) (all P <0.05). CONCLUSIONS Tooth loss status significantly modifies the association between cigarette smoking and COPD. An increased understanding of causal mechanisms linking cigarette smoking, oral health, and COPD, particularly the role of tooth loss, infection, and subsequent inflammation, is essential to reduce the burden of COPD. Health providers should counsel their patients about cigarette smoking, preventive dental care, and COPD risk.
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Affiliation(s)
- Timothy J Cunningham
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Paul I Eke
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Earl S Ford
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Israel T Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Guo Y, Logan HL, Dodd VJ, Muller KE, Marks JG, Riley JL. Health literacy: a pathway to better oral health. Am J Public Health 2014; 104:e85-91. [PMID: 24832423 DOI: 10.2105/ajph.2014.301930] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We examined whether health literacy was associated with self-rated oral health status and whether the relationship was mediated by patient-dentist communication and dental care patterns. METHODS We tested a path model with data collected from 2 waves of telephone surveys (baseline, 2009-2010; follow-up, 2011) of individuals residing in 36 rural census tracts in northern Florida (final sample size n = 1799). RESULTS Higher levels of health literacy were associated with better self-rated oral health status (B = 0.091; P < .001). In addition, higher levels of health literacy were associated with better patient-dentist communication, which in turn corresponded with patterns of regular dental care and better self-rated oral health (B = 0.003; P = .01). CONCLUSIONS Our study showed that, beyond the often-reported effects of gender, race, education, financial status, and access to dental care, it is also important to consider the influence of health literacy and quality of patient-dentist communication on oral health status. Improved patient-dentist communication is needed as an initial step in improving the population's oral health.
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Affiliation(s)
- Yi Guo
- Yi Guo and Keith E. Muller are with the Department of Health Outcomes and Policy, College of Medicine, and Henrietta L. Logan, Virginia J. Dodd, John G. Marks, and Joseph L. Riley III are with the Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville
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Krunić N, Kostić M, Aleksov L, Višnjić A, Igić M, Petrović M. ASSESSMENT OF PREVALENCE OF TOOTH LOSS AMONG PROSTHETICALLY TREATED PATIENTS IN THREE HEALTH CENTERS OF SOUTHERN SERBIA IN THE PERIOD 2002–2011. ACTA MEDICA MEDIANAE 2013. [DOI: 10.5633/amm.2013.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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