1
|
Chou R, Selph SS, Bougatsos C, Nix C, Ahmed A, Griffin J, Schwarz E. Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults: A Systematic Review for the US Preventive Services Task Force. JAMA 2023; 330:1780-1790. [PMID: 37934490 DOI: 10.1001/jama.2023.20685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Importance Dental caries and periodontal disease are common adult oral health conditions and potentially amenable to primary care screening and prevention. Objective To systematically review the evidence on primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force. Data Sources MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023. Study Selection Diagnostic accuracy studies of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions; cohort studies on primary care oral health screening and preventive intervention harms. Data Extraction and Synthesis One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Diagnostic accuracy data were pooled using a bivariate mixed-effects binary regression model. Main Outcomes and Measures Dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy. Results Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies (total 3300 participants) were included. One poor-quality trial (n = 477) found no difference between oral health screening during pregnancy vs no screening in caries, periodontal disease, or birth outcomes. One study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity (0.42 and 0.56) and high specificity (0.84 and 0.87) for periodontal disease and with variable sensitivity (0.33 and 0.83) and high specificity (0.80 and 0.93) for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 (95% CI, 0.57-0.83) and specificity of 0.74 (95% CI, 0.66-0.82) for periodontal disease. For preventive interventions no study evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials; adjusted odds ratio, 0.4 [95% CI, 0.3-0.7]). No trial evaluated primary care-administered preventive interventions. Conclusions and Relevance Screening questionnaires were associated with moderate diagnostic accuracy for periodontal disease. Research is needed to determine benefits and harms of oral health primary care screening and preventive interventions.
Collapse
Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
- Division of General Internal Medicine; Oregon Health & Science University, Portland
| | - Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Christina Bougatsos
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Chad Nix
- School of Medicine; Oregon Health & Science University, Portland
| | - Azrah Ahmed
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Jessica Griffin
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Eli Schwarz
- School of Dentistry, Division of Dental Public Health, Oregon Health & Science University, Portland
| |
Collapse
|
2
|
Callaway Kim K, Khouja T, Burgette JM, Evans CT, Calip GS, Gellad WF, Suda KJ. Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019. Pharmacoepidemiol Drug Saf 2023; 32:625-634. [PMID: 36573575 DOI: 10.1002/pds.5589] [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: 08/13/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Opioids, benzodiazepines and sedatives can manage dental pain, fear and anxiety but have a narrow margin of safety in children. General dentists may inappropriately prescribe gabapentin and stimulants. National evidence on dispensing rates of these high-alert medicines by dentists to children is limited. METHODS We utilize join-point regression to identify changes in fills for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. RESULTS From 2012 to 2019, 3.8 million children filled prescriptions for high-alert drugs from general dentists. National quarterly dispensing of high-alert drugs decreased 63.1%, from 10456.0 to 3858.8 days per million. Opioids accounted for 69.4% of high-alert prescriptions. From 2012 to 2019, fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2% (7651.8 to 2662.7), 43.4% (810.9 to 458.7), 43.6% (785.7 to 442.7) and 89.3% (825.6 to 88.6 days per million), respectively. Gabapentin increased 8.1% (121.8 to 131.7 days per million). A significant decrease in high-alert fills occurred in 2016, (-6.0% per quarter vs. -1.6% pre-2016, P-value<0.001), especially for opioids (-7.0% vs. -1.2%, P-value<0.001). Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in the South were overrepresented among top-prescribing areas in 2019. CONCLUSIONS We found promising national decreases in fills for high-alert medicines to children by general dentists from 2012 to 2019. However, older teenagers and children in some counties continued to receive dental opioids at high rates. Future efforts should address non-evidence-based pain management in these groups.
Collapse
Affiliation(s)
- Katherine Callaway Kim
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Tumader Khouja
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacqueline M Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Charlesnika T Evans
- Department of Preventative Medicine and Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois, USA
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Walid F Gellad
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Center of Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Katie J Suda
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Center of Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Karam SA, Costa FDS, Peres KG, Peres MA, Barros FC, Bertoldi AD, Santos IS, Tovo L, Matijasevich A, B Menezes AM, Gonçalves H, Correa MB, Demarco FF. Two decades of socioeconomic inequalities in the prevalence of untreated dental caries in early childhood: Results from three birth cohorts in southern Brazil. Community Dent Oral Epidemiol 2023; 51:355-363. [PMID: 35362631 DOI: 10.1111/cdoe.12747] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. METHODS The socioeconomic data to this study were collected at the 48-month follow-up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality-SII and Concentration Index-CIX) were used. RESULTS The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro-poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. CONCLUSIONS Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children.
Collapse
Affiliation(s)
- Sarah Arangurem Karam
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Karen G Peres
- National Dental Research Institute Singapore, National Dental Center Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Center Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Fernando C Barros
- Health and Behavior, Universidade Católica de Pelotas, Pelotas, Brazil
| | | | - Iná S Santos
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luciana Tovo
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Faculty of Medicine, Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Ana M B Menezes
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Helen Gonçalves
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Flávio Fernando Demarco
- Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| |
Collapse
|
4
|
Monsalves MJ, Espinoza I, Moya P, Aubert J, Durán D, Arteaga O, Kaufman JS, Bangdiwala SI. Structural determinants explain caries differences among preschool children in Chile's Metropolitan Region. BMC Oral Health 2023; 23:136. [PMID: 36894931 PMCID: PMC9996898 DOI: 10.1186/s12903-023-02778-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To estimate the association between Social Determinants of Health (structural and intermediate) and caries indicators in Chile's Metropolitan Region preschool children. METHODS A multilevel cross-sectional study of Social Determinants of Health (SDH) and caries in children aged 1 to 6 years in Chile's Metropolitan Region was conducted in 2014-2015, with three levels: district, school and child. Caries were assessed by the dmft-index and the prevalence of untreated caries. The structural determinants analyzed were Community Human Development Index (CHDI), urban/rural location, school type, caregiver's education and family income. Poisson multilevel regression models were fit. RESULTS The sample size was 2,275 children from 40 schools in 13 districts. While the highest CHDI district had an untreated caries prevalence of 17.1% (12.3-22.7%), in the most disadvantaged district it was 53.9% (95% CI 46.0-61.6%). As family income increased, the probability of untreated caries prevalence decreased (PR = 0.9 95% CI 0.8-1.0). Rural districts had an average dmft-index of 7.3 (95% CI 7.2-7.4), while in urban districts, it was 4.4 (95% CI 4.3-4.5). Higher probabilities of untreated caries prevalence (PR = 3.0 95% CI 2.3-3.9) were observed in rural children. Greater probabilities of untreated caries prevalence (PR = 1.3 95% CI 1.1-1.6) and prevalence of caries experience (PR = 1.3 95% CI 1.1-1.5) were observed in children whose caregivers had a secondary educational level. CONCLUSIONS A strong association was observed between the social determinants of health, specifically the structural ones, and the caries indicators studied in children of the Metropolitan Region of Chile. There were notable differences in caries between districts according to social advantage. Rurality and caregiver's education were the most consistent predictors.
Collapse
Affiliation(s)
- María José Monsalves
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Lota 2465, 7510157, Santiago, Chile.
| | - Iris Espinoza
- Departamento de Patología y Medicina Oral y Centro de Epidemiología y Vigilancia de Enfermedades Orales (CEVEO), Facultad de Odontología, Universidad de Chile, 380544, Santiago, Chile
| | - Patricia Moya
- Facultad de Odontología, Universidad Finis Terrae, 7501015, Santiago, Chile
| | - Josefina Aubert
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Lota 2465, 7510157, Santiago, Chile
| | - Doris Durán
- Instituto de Investigación en Ciencias Odontológicas (ICOD), Facultad de Odontología, Universidad de Chile, 380544, Santiago, Chile.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, H3A1G1, Canada
| | - Oscar Arteaga
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, 8380453, Santiago, Chile
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, H3A1G1, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton, ON, L8L2X2, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| |
Collapse
|
5
|
Choi SE, Shen Y, Wright DR. Cost-effectiveness of Dental Workforce Expansion Through the National Health Service Corps and Its Association With Oral Health Outcomes Among US Children. JAMA HEALTH FORUM 2023; 4:e230128. [PMID: 36930167 PMCID: PMC10024205 DOI: 10.1001/jamahealthforum.2023.0128] [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] [Received: 11/16/2022] [Accepted: 01/25/2023] [Indexed: 03/18/2023] Open
Abstract
Importance Despite considerable efforts to improve oral health for all, large disparities remain among US children. A dental professional shortage is thought to be among the determinants associated with oral health disparities, particularly for those residing in underserved communities. Objective To evaluate the cost-effectiveness of expanding the dental workforce through the National Health Service Corps (NHSC) and associations with oral health outcomes among US children. Design, Setting, and Participants A cost-effectiveness analysis was conducted to estimate changes in total costs and quality-adjusted life years (QALYs) produced by increasing the NHSC funding for dental practitioners by 5% to 30% during a 10-year period. A microsimulation model of oral health outcomes using a decision analytic framework was constructed based on oral health and dental care utilization data of US children from 0 to 19 years old. Data from the nationally representative National Health and Nutrition Examination Survey (NHANES, 2011-2016) were linked to county-level dentist supply and oral health professional shortage areas (HPSAs) information. Changes in prevalence and cumulative incidence of dental caries were also estimated. Sensitivity analyses were conducted to assess the robustness of results to variation in model input parameters. Data analysis was conducted from August 1, 2021, to November 1, 2022. Exposures Expanding dental workforce through the NHSC program. Main Outcomes and Measures Changes in total QALYs, costs, and dental caries prevalence and cumulative incidence. Results This simulation model informed by NHANES data of 10 780 participants (mean [SD] age, 9.6 [0.1] years; 5326 [48.8%] female; 3337 [weighted percentage, 57.9%] non-Hispanic White individuals) found that when funding for the NHSC program increased by 10%, dental caries prevalence and total number of decayed teeth were estimated to decrease by 0.91 (95% CI, 0.82-1.00) percentage points and by 0.70 (95% CI, 0.62-0.79) million cases, respectively. When funding for the NHSC program increased between 5% and 30%, the estimated decreases in number of decayed teeth ranged from 0.35 (95% CI, 0.27-0.44) to 2.11 (95% CI, 2.03-2.20) million cases, total QALY gains ranged from 75.76 (95% CI, 59.44-92.08) to 450.50 (95% CI, 434.30-466.69) thousand QALYs, and total cost savings ranged from $105.53 (95% CI, $70.14-$140.83) to $508.23 (95% CI, $598.91-$669.22) million among children residing in dental HPSAs from a health care perspective. Benefits of the intervention accrued most substantially among Hispanic children and children in low-income households. Conclusions and Relevance This cost-effectiveness analysis using a decision analytic model suggests that expanding the dental workforce through the NHSC program would be associated with cost savings and a reduced risk of dental caries among children living in HPSAs.
Collapse
Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Ye Shen
- Center for Health Decision Science, Harvard Chan School of Public Health, Boston, Massachusetts
- Interfaculty PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts
| | - Davene R. Wright
- Interfaculty PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| |
Collapse
|
6
|
Jurasic MM, Gibson G, Orner MB, Wehler CJ, Jones JA, Cabral HJ. Topical Fluoride Effectiveness in High Caries Risk Adults. J Dent Res 2022; 101:898-904. [PMID: 35264049 DOI: 10.1177/00220345221081524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This retrospective analysis of longitudinal data was developed to determine which types, combinations, and intensities of topical fluorides more effectively prevent new caries-related restorations and extractions in high caries risk adults. We included data from October 1, 2008, through June 30, 2018, from electronic dental and medical records and pharmacy database from the US Department of Veterans Affairs. Veterans who were eligible for continuing and comprehensive care, met the criteria of high caries risk (received 2 or more caries-related restorations within a 365-d period), and had 3 y of follow-up were included. Multivariable logistic regression models estimated the odds of caries-related treatment during the 1-y observation period, controlling for age, gender, race and ethnicity, illness burden (Selim comorbidity index), use of prescription medications, attendance at dental prophylaxis appointments, number of caries-related restorations during the index year, and time between first and last caries-related restoration during the index year. The study sample included 68,757 veterans, who were primarily male (91.5%), were White (73.6%), had a mean age of 59.2 ± 13.5 y, and had significant medical comorbidity as measured by the Selim index (3.7 ± 2.4 physical and 1.3 ± 1.2 mental diagnoses). They had 10.8 ± 6.3 prescription VA drug classes, took 0.6 ± 0.8 strong anticholinergic medications, and had 3.9 ± 2.6 teeth restored due to caries during the index year. Adjusted multivariable logistic regression models showed veterans who received a varnish or gel/rinse fluoride intervention versus no fluoride had an approximately 29% decreased odds of receiving caries-related treatment during the observation period (gel/rinse adjusted odds ratio [AOR] = 0.72; 95% confidence interval [CI], 0.67-0.76; varnish AOR = 0.71; 95% CI, 0.67-0.75). The receipt of a varnish and gel/rinse did not demonstrate statistically better odds than each intervention alone (AOR = 0.69; 95% CI, 0.64-0.75). A dose-response effect was observed. Two-plus applications of varnish versus none (AOR = 0.73; 95% CI, 0.69-0.77) and 2-plus applications of gel/rinse versus none (AOR = 0.71; 95% CI, 0.67-0.75) were more effective than 1 application of either modality versus none.
Collapse
Affiliation(s)
- M M Jurasic
- General Dentistry and Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA.,VHA Office of Dentistry, Oral Health Quality Group, VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - G Gibson
- Oral Health Quality Group, VHA Office of Dentistry, Fayetteville, AR, USA
| | - M B Orner
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - C J Wehler
- VHA Office of Dentistry, Oral Health Quality Group, VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,General Dentistry, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - J A Jones
- University of Detroit Mercy School of Dentistry, Detroit, MI, USA
| | - H J Cabral
- Biostatistics, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
7
|
Gaskin DJ, Zare H, McCleary R, Kanwar O, Davis AL. Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis. JDR Clin Trans Res 2021; 7:398-406. [PMID: 34323109 DOI: 10.1177/23800844211035669] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. METHOD Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. RESULTS Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. CONCLUSION Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. KNOWLEDGE TRANSFER STATEMENT Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.
Collapse
Affiliation(s)
- D J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Global Health Services and Administration, University of Maryland Global Campus (UMGC), Baltimore, MD, USA
| | - R McCleary
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - O Kanwar
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A L Davis
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|