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Crystal YO, Luo YL, Duangthip D, Tantawi ME, Benzian H, Schroth RJ, Feldens CA, Virtanen JI, Al-Batayneh OB, Diaz ACM, Vukovic A, Pavlic V, Mfolo T, Daryanavard HA, Gaffar BO, Shamala A, Foláyan MO. A scoping review of the links between early childhood caries and clean water and sanitation: the Sustainable Development Goal 6. BMC Oral Health 2024; 24:769. [PMID: 38982426 PMCID: PMC11234638 DOI: 10.1186/s12903-024-04535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION The United Nation's Sustainable Development Goal (SDG) 6 calls for universal access to clean water, sanitation and hygiene (WASH), which are crucial elements of health and well-being and fundamental for a life in dignity. Early childhood caries (ECC) is a preventable disease affecting health and quality of life of millions of young children worldwide. This scoping review aims to explore the connection between ECC and access to clean water and sanitation. METHODS This scoping review, registered on the Open Science Framework and following PRISMA-ScR guidelines, conducted a thorough search in databases (PubMed, Web of Science, Embase, Google Scholar, SciELO) and websites (via Google) in November 2023. The search, without date limitations, targeted studies in English and Spanish linking ECC to SDG6. Exclusions were made for studies solely focusing on ECC without a direct connection to clean water and sanitation. Descriptive statistics summarized the retrieved papers. RESULTS The initial search yielded 303 articles. After removing duplicates, 264 articles remained for title and abstract screening after which 244 were excluded and one report was added through citation searching. The 21 remaining articles underwent full text review. There were no studies on a direct association between access to clean water and sanitation and the prevalence of ECC. There were nine studies that showed indirect associations between ECC and access to clean water and sanitation through the links of: water and sanitation access as a marker for poverty (n = 1), water consumption as a feeding practice (n = 4), and the effectiveness of water fluoridation (n = 4). These were used to develop a conceptual model. CONCLUSIONS While it is conceivable that a direct link exists between ECC and access to clean water and sanitation, the available body of research only offers evidence of indirect associations. The exploration of potential pathways connecting water access to ECC warrants further investigation in future research.
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Affiliation(s)
- Yasmi O Crystal
- Early Childhood Caries Advocacy Group, Winnipeg, Canada.
- Department of Pediatric Dentistry, College of Dentistry, New York University, 234 24th Street, New York, NY, 10010, USA.
| | - Yuanyuan Laura Luo
- Department of Pediatric Dentistry, College of Dentistry, New York University, 234 24th Street, New York, NY, 10010, USA
| | - Duangporn Duangthip
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Maha El Tantawi
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Habib Benzian
- Department of Epidemiology & Health Promotion and WHO Collaborating Center Quality Improvement & Evidence-Based Dentistry, College of Dentistry, New York University, New York, NY, USA
- Stellenbosch Institute of Advanced Study, Stellenbosch, South Africa
| | - Robert J Schroth
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carlos Alberto Feldens
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Pediatric Dentistry, Universidade Luterana Do Brasil, Canoas, Brazil
| | - Jorma I Virtanen
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ola B Al-Batayneh
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Orthodontics, Pediatric and Community Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Aida Carolina Medina Diaz
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Pediatric Dentistry and Orthodontics Department, Pediatric Dentistry and Orthodontics Department, Universidad Central de Venezuela, Centro Medico Docente, Caracas, Venezuela
| | - Ana Vukovic
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Clinic for Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Verica Pavlic
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Periodontology and Oral Medicine, Medical Faculty University of Banja Luka, 78000, Banja Luka, Bosnia and Herzegovina
| | - Tshepiso Mfolo
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Community Dentistry, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Hamideh A Daryanavard
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Dental Department, Dubai Health, Dubai, United Arab Emirates
| | - Balgis O Gaffar
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Preventive Dental Sciences, College of Dentistry - Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Anas Shamala
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Preventive and Biomedical Sciences, Faculty of Dentistry, University of Science & Technology, Aden, Yemen
| | - Morẹ́nikẹ́ Oluwátóyìn Foláyan
- Early Childhood Caries Advocacy Group, Winnipeg, Canada
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Goodwin M, Henshaw M, Borrelli B. Inequities and oral health: A behavioural sciences perspective. Community Dent Oral Epidemiol 2023; 51:108-115. [PMID: 36753398 DOI: 10.1111/cdoe.12826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The importance of tackling ongoing dental health inequities, observed both within and across countries, cannot be overstated. Alarmingly, health inequities in some areas are widening, resulting in an urgent need to act. The objective of this commentary is to explore oral health inequities through the lens of behavioral science and discuss adapting evidence based interventions for populations experiencing health inequities. METHOD/RESULTS The first section of this paper aims to describe the role of health disparities and inequities within oral health, with a specific focus on behaviours. The determinants, from upstream to downstream, and the interplay between these levels of intervention are discussed. This is followed by an overview of oral health promotion interventions, again with a focus on behaviours, which could potentially improve oral health while also taking into account oral health inequities. It is essential to translate evidence-based interventions (EBIs) to populations that have the greatest burden of disease. The second section of this paper discusses the rationale for cultural adaption of EBIs, criteria to justify EBIs and considers different cultural adaptation strategies necessary for the development and testing of effective, engaging, equitable and culturally relevant interventions. CONCLUSIONS We conclude with future directions for the development of theory-based multi-level interventions, guided by extent evidence-based interventions, and transdisciplinary approaches to science and key stakeholders such as patients, providers and payers.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Michelle Henshaw
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Belinda Borrelli
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,The University of Manchester, Manchester, UK
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Burgette JM, Dahl ZT, Yi JS, Weyant RJ, McNeil DW, Foxman B, Marazita ML. Mothers' Sources of Child Fluoride Information and Misinformation From Social Connections. JAMA Netw Open 2022; 5:e226414. [PMID: 35363267 PMCID: PMC8976236 DOI: 10.1001/jamanetworkopen.2022.6414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/20/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Fluoride delivered either topically (eg, fluoride varnish) or systemically (eg, water fluoridation, prescription fluoride supplements) is widely used as a caries preventive agent in children. The widespread existence of misinformation, including inaccurate information that attaches negative values or suspicion to fluoride treatments, raises concerns that misinformation will lead to underutilization of fluoride and contribute to avoidable increases in caries prevalence. Objective To describe the social relationships from which mothers obtain child fluoride information and misinformation. Design, Setting, and Participants This qualitative study analyzed 126 mothers with children aged 3 to 5 years to explore how their social networks were associated with their child's oral health. Mothers were recruited from community-based sites in Pittsburgh, Pennsylvania, and throughout the state of West Virginia from 2018 to 2020. In-person, semi-structured qualitative interviews were conducted. Data were transcribed, coded, and analyzed using Nvivo 12. Three investigators analyzed data using template analysis, a qualitative technique that combines inductive and deductive approaches to identify patterns until primary themes are identified. Main Outcomes and Measures Sources of information regarding fluoride from the mother's social relationships. Results Of the 126 mothers with children aged 3 to 5 years in Pittsburgh and West Virginia, 120 (95%) identified as non-Hispanic White and 5 (4%) identified as Hispanic White; 38 (30%) had a bachelor's degree, 77 (61%) had private dental insurance for their child, and 52 (41%) had an income less than $50 000; 82 (65%) reported that they discussed child fluoride information with members of their social network. Mothers described that they obtained fluoride information from family members, health care clinicians, and community members. The receipt of inconsistent child fluoride information from multiple sources resulted in confusion and difficulty assessing whether fluoride information was accurate. Conclusions and Relevance This qualitative study found that mothers received inconsistent child fluoride information from multiple sources, which resulted in confusion and difficulty assessing the accuracy of the fluoride information. These findings suggest that social relationships can be a potential target for interventions to communicate fluoride information related to children.
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Affiliation(s)
- Jacqueline M. Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Oral Health Research in Appalachia, Pittsburgh, Pennsylvania
| | - Zelda T. Dahl
- Center for Oral Health Research in Appalachia, Pittsburgh, Pennsylvania
- Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Janice S. Yi
- Center for Oral Health Research in Appalachia, Pittsburgh, Pennsylvania
- Department of Dental Hygiene, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert J. Weyant
- Center for Oral Health Research in Appalachia, Pittsburgh, Pennsylvania
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel W. McNeil
- Center for Oral Health Research in Appalachia, Pittsburgh, Pennsylvania
- Department of Psychology, Eberly College of Arts & Sciences, West Virginia University, Morgantown
- Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown
| | - Betsy Foxman
- Center for Molecular and Clinical Epidemiology of Infectious Disease, School of Public Health, University of Michigan, Ann Arbor
| | - Mary L. Marazita
- Center for Oral Health Research in Appalachia, Pittsburgh, Pennsylvania
- Department of Oral and Craniofacial Sciences, Center for Craniofacial and Dental Genetics, School of Dental Medicine, Pittsburgh, Pennsylvania
- Department of Human Genetics, Graduate School of Public Health, Pittsburgh, Pennsylvania
- Clinical and Translational Science, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Meyer J, Margaritis V, Jacob M. The Impact of Water Fluoridation on Medicaid-Eligible Children and Adolescents in Alaska. JOURNAL OF PREVENTION (2022) 2022; 43:111-123. [PMID: 35048263 DOI: 10.1007/s10935-021-00656-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
Juneau, Alaska, ceased community water fluoridation (CWF) in 2007, and previous research found a substantial increase in dental caries-related procedures and treatment costs for children from low-income families in Juneau between 2003 and 2012. We collected comparable dental caries-related procedures and treatment cost data for the same years for children in Anchorage, Alaska, where CWF has been continuously maintained. This retrospective study analyzed all Medicaid dental claims records in two separate years for caries-related procedures and associated costs among children (aged 0 to 18 years) residing in Anchorage's 99502 zip code and compared these records to data from Juneau. We obtained descriptive statistics and conducted bivariate analyses and binomial logistic regression. Between 2003 and 2012, children in Anchorage experienced a nonsignificant modest decrease in the mean number of caries-related procedures and only small, statistically nonsignificant changes to the mean inflation-adjusted service costs of caries-related restorative care. The lack of significant change in child dental caries-related procedures and treatment costs in Anchorage between 2003 and 2012 contrasted with the substantial increase in caries-related procedures and treatment costs over the same period in Juneau. Our results are consistent with previous research that has demonstrated a significant protective effect of CWF against dental caries.
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Affiliation(s)
- Jennifer Meyer
- Assistant Professor of Public Health, College of Health, Division of Population Health Sciences, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, Alaska, 99508, USA.
| | - Vasileios Margaritis
- Senior Core (FT) Faculty Member, School of Health Sciences, College of Health Sciences, Walden University, 100 Washington Ave. South. Suite 900, Minneapolis, MN, 55401, USA
| | - Matt Jacob
- Jacob Strategies LLC, 2311 Connecticut Avenue NW #205, Washington, DC, 20008, USA
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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 J, Margaritis V, Mendelsohn A. Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska. BMC Oral Health 2018; 18:215. [PMID: 30545358 PMCID: PMC6293551 DOI: 10.1186/s12903-018-0684-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/30/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The general aim of this research was to determine whether cessation of community water fluoridation (CWF) increased oral health disparities, as measured by dental caries procedures and restoration costs for children and adolescents. METHODS The analysis was based on all Medicaid dental claims records of 0- to 18-year-old patients residing in zip code 99801 (Juneau, Alaska) during an optimal CWF year (2003, n = 853) compared to all claims for the same age group from 2012 (n = 1052), five years after cessation of CWF. A bivariate analysis (Mann-Whitney U test) of the mean number of caries procedures performed per client was conducted in the study groups under both independent CWF conditions. Furthermore, logistic regression was performed using the dependent variables of caries procedures and the cost of caries-related procedures, with adjustments for CWF group, gender, and race. RESULTS The statistically significant results included a higher mean number of caries-related procedures among 0- to 18-year-old and < 7-year-old patients in the suboptimal CWF group (2.35 vs. 2.02, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). The mean caries-related treatment costs per patient were also significantly higher for all age groups, ranging from a 28 to 111% increase among the suboptimal CWF cohorts after adjusting for inflation. The binary logistic regression analysis results indicated a protective effect of optimal CWF for the 0- to 18-year-old and < 7-year-old age groups (OR = 0.748, 95% CI [0.62, 0.90], p = 0.002; OR = 0.699, 95% CI [0.52, 0.95], p = 0.02, respectively). Additionally, the age group that underwent the most dental caries procedures and incurred the highest caries treatment costs on average were those born after CWF cessation. CONCLUSIONS These results expand our understanding of caries epidemiology under CWF cessation conditions and reaffirm that optimal CWF exposure prevents dental decay. These findings can offer fiscal estimates of the cost burden associated with CWF cessation policies and help decision-makers advance oral health, prevent dental caries, and promote equity in oral health outcomes.
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Affiliation(s)
- Jennifer Meyer
- Health Sciences, University of Alaska Anchorage, College of Health, 3211 Providence Drive, Anchorage, AK 99508 USA
| | - Vasileios Margaritis
- Public Health Programs, School of Health Sciences, College of Health Sciences, Walden University, 100 Washington Ave. South, Suite 900, Minneapolis, MN 55401 USA
| | - Aaron Mendelsohn
- Public Health Programs, School of Health Sciences, College of Health Sciences, Walden University, 100 Washington Ave. South, Suite 900, Minneapolis, MN 55401 USA
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Abstract
Oral health is a fundamental component of health and physical and mental well-being. Oral health is influenced by an individual's physiologic and psychosocial attributes and cumulative oral health experiences. The perinatal period is a critical time when health and oral health determinants set in and thus an important time for intervention. Recognition of the importance of oral health intervention during pregnancy and oral health infrastructures have substantially grown over the last several years. This article reviews the current state of knowledge and practice of oral health intervention during pregnancy with a focus on individual- and population-based strategies, and summarizes key agendas for advancing prenatal oral health.
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Affiliation(s)
- Hiroko Iida
- New York State Oral Health Center of Excellence, 259 Monroe Avenue, Rochester, NY 14607, USA.
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O'Connell J, Rockell J, Ouellet J, Tomar SL, Maas W. Costs And Savings Associated With Community Water Fluoridation In The United States. Health Aff (Millwood) 2018; 35:2224-2232. [PMID: 27920310 DOI: 10.1377/hlthaff.2016.0881] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most comprehensive study of US community water fluoridation program benefits and costs was published in 2001. This study provides updated estimates using an economic model that includes recent data on program costs, dental caries increments, and dental treatments. In 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. Savings associated with dental caries averted in 2013 as a result of fluoridation were estimated to be $32.19 per capita for this population. Based on 2013 estimated costs ($324 million), net savings (savings minus costs) from fluoridation systems were estimated to be $6,469 million and the estimated return on investment, 20.0. While communities should assess their specific costs for continuing or implementing a fluoridation program, these updated findings indicate that program savings are likely to exceed costs.
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Affiliation(s)
- Joan O'Connell
- Joan O'Connell is an associate professor in the Department of Community and Behavioral Health at the Colorado School of Public Health, in Aurora
| | - Jennifer Rockell
- Jennifer Rockell is a research associate in the Department of Community and Behavioral Health at the Colorado School of Public Health
| | - Judith Ouellet
- Judith Ouellet is a senior professional research assistant in the Division of Health Care Policy and Research at the University of Colorado Denver School of Medicine, in Aurora
| | - Scott L Tomar
- Scott L. Tomar is a professor in the Department of Community Dentistry and Behavioral Science at the College of Dentistry, University of Florida, in Gainesville
| | - William Maas
- William Maas is a dental consultant at William Maas, LLC, in Rockville, Maryland
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