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Milgrom PM, Horst JA. The Effect of New Oral Care Technologies on the Need for Dentists in 2040. J Dent Educ 2017; 81:eS126-eS132. [DOI: 10.21815/jde.017.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/16/2017] [Indexed: 11/20/2022]
Affiliation(s)
| | - Jeremy A. Horst
- Department of Biochemistry and Biophysics; University of California; San Francisco
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Riedy CA, Weinstein P, Mancl L, Garson G, Huebner CE, Milgrom P, Grembowski D, Shepherd-Banigan M, Smolen D, Sutherland M. Dental attendance among low-income women and their children following a brief motivational counseling intervention: A community randomized trial. Soc Sci Med 2015; 144:9-18. [PMID: 26372934 DOI: 10.1016/j.socscimed.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 08/19/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study tested a behavioral intervention to increase dental attendance among rural Oregonian low-income women and their children. It utilized a multi-site, single-blind, randomized trial design. Four hundred women were randomized into one of four conditions to receive prenatal or postpartum motivational interviewing/counseling (MI) or prenatal or postpartum health education (HE). Counselors also functioned as patient navigators. Primary outcomes were dental attendance during pregnancy for the mother and for the child by age 18 months. Attendance was obtained from the Oregon Division of Medical Assistance Programs and participant self-report. Statewide self-reported utilization data were obtained from the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS). Maternal attendance was 92% in the prenatal MI group and 94% in the prenatal HE group (RR = 0.98; 95% CI = 0.93-1.04). Children's attendance was 54% in postpartum MI group and 52% in the postpartum HE group (RR = 1.03; 95% CI = 0.82-1.28). Compared to statewide PRAMS, attendance was higher during pregnancy for study mothers (45% statewide; 95% CI = 40-50%) and for their children by 24 months (36% statewide; 95% CI = 27-44%). MI did not lead to greater attendance when compared to HE alone and cost more to implement. High attendance may be attributable to the counselors' patient navigator function. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01120041.
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Affiliation(s)
- Christine A Riedy
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Philip Weinstein
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Lloyd Mancl
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Gayle Garson
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Colleen E Huebner
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Peter Milgrom
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - David Grembowski
- University of Washington School of Public Health, Box 357660, 1959 NE Pacific St, Seattle, WA 98195-7660, USA.
| | - Megan Shepherd-Banigan
- University of Washington School of Public Health, Box 357660, 1959 NE Pacific St, Seattle, WA 98195-7660, USA.
| | - Darlene Smolen
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Marilynn Sutherland
- Klamath County Department of Public Health, 305 Main Street, Klamath Falls, OR 97601, USA.
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Abstract
Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of family's competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.
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Affiliation(s)
- Clemencia M Vargas
- Department of Health Promotion and Policy, University of Maryland Dental School, Baltimore, MD 21201, USA
| | - Cynthia R Ronzio
- Center for Health Services and Community Research, Children's National Medical Center/George Washington University Medical Center, Washington, DC 20010, USA
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Grembowski D, Spiekerman C, del Aguila MA, Anderson M, Reynolds D, Ellersick A, Foster J, Choate L. Randomized pilot study to disseminate caries-control services in dentist offices. BMC Oral Health 2006; 6:7. [PMID: 16670027 PMCID: PMC1513219 DOI: 10.1186/1472-6831-6-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2005] [Accepted: 05/03/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.). METHODS In 1999, 53 dental offices in Washington Dental Service's capitation dental plan were invited to participate in the study, and consenting offices were randomized to intervention (n = 9) and control (n = 10) groups. Offices recruited 689 capitation children aged 6-14 and at risk for caries, who were followed for 2 years. Intervention offices received provider education and fee-for-service reimbursement for delivering fluoride varnish and sealants. Insurance records were used to calculate office service rates for fluoride, sealants, and restorations. Parents completed mail surveys after follow-up to measure their children's dental utilization, dental satisfaction, dental fear and oral health status. Regression models estimated differences in service rates between intervention and control offices, and compared survey measures between groups. RESULTS Nineteen offices (34%) consented to participate in the study. Fluoride and sealant rates were greater in the intervention offices than the control offices, but the differences were not statistically significant. Restoration rates were lower in the intervention offices than the control offices. Parents in the intervention group reported their children had less dental fear than control group parents. CONCLUSION Due to low dentist participation the study lacked power to detect an intervention effect on dentists' delivery of caries-control services. The intervention may have reduced children's dental fear.
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Affiliation(s)
- David Grembowski
- Department of Dental Public Health Sciences, Box 357475, University of Washington, Seattle, WA, 98195, USA
- Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195, USA
| | - Charles Spiekerman
- Department of Dental Public Health Sciences, Box 357475, University of Washington, Seattle, WA, 98195, USA
| | | | - Maxwell Anderson
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
| | - Debra Reynolds
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
| | - Allison Ellersick
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
| | - James Foster
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
| | - Leslie Choate
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
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Kaakko T, Skaret E, Getz T, Hujoel P, Grembowski D, Moore CS, Milgrom P. An ABCD program to increase access to dental care for children enrolled in Medicaid in a rural county. J Public Health Dent 2004; 62:45-50. [PMID: 14700089 DOI: 10.1111/j.1752-7325.2002.tb03420.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The Access to Baby and Child Dentistry (ABCD) Program addresses the needs of families in obtaining dental care. In this study, the program was evaluated in rural Stevens County, Washington. Aims were to assess utilization of dental services, average dental expenditures per child, and oral health status. METHODS Medicaid-enrolled children aged 1-4 years were randomly assigned to the ABCD program (n=216) or to regular benefits (n=221). An outreach worker contacted each ABCD family and provided an orientation. Dental care utilization and expenditures were calculated from claims. A posttest-only design was used to evaluate oral health status. RESULTS An enrollment effect was seen in ABCD, but the difference between groups was not sustained. There was a doubling of utilization between groups for the youngest cohort, while the others showed no differences. In the first year the rate was higher for the entire ABCD group than for the children not in ABCD (34.0% vs 24.7%). Thirty-three percent of ABCD children (70/212) who had visited the dentist had >1 appointment compared to 21.5 percent (47/219) for the children not in ABCD who had visited the dentist. There was no overall difference in expenditures, while expenditures for preventive services were greater for ABCD. ABCD children had fewer teeth with initial caries. The average incremental cost per child per initial lesion prevented was 31.44 dollars. CONCLUSION ABCD most benefited the youngest cohort of children and improved health.
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Affiliation(s)
- Tarja Kaakko
- Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle 98195, USA
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Dasanayake AP, Li Y, Wadhawan S, Kirk K, Bronstein J, Childers NK. Disparities in dental service utilization among Alabama Medicaid children. Community Dent Oral Epidemiol 2002; 30:369-76. [PMID: 12236828 DOI: 10.1034/j.1600-0528.2002.00001.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Access to oral health care and utilization of available services are important factors in minimizing the oral health disparities among underserved minorities. Our objective was to evaluate the racial and other factors related to 'realized access' to oral health care among Alabama Medicaid children. METHODS Data were obtained from 308 538 Alabama Medicaid claims submitted in 1995-96 and analyzed using regression analyses. RESULTS A lower proportion of Blacks (24%) and other racial groups (22%) compared to Whites (31%) and a lower proportion of 15-19-year-olds (15%) compared to younger age groups (30%) obtained dental services (P < 0.05). Odds of males obtaining care were slightly lower compared to females (OR = 0.96; 95% CI = 0.94-0.99). However, there was a significant interaction of race with other factors in determining service utilization. Subjects who were continuously eligible for Medicaid throughout the fiscal year were more likely to obtain care (OR = 2.86; 95% CI = 2.78-2.93). About one-fourth of the visits had an emergency procedure included in the treatment rendered. Availability of a participating dentist within the county of residence and the lower reimbursement-to-charge ratio were among the other related factors for underutilization of services. CONCLUSIONS There is a significant racial disparity in utilization of dental services even among the Medicaid-eligible children. However, this was not a simple function of race, but a complex interaction of race with other factors such as age, gender, and location. ACKNOWLEDGMENT Supported by CDC grant #U48/CCU 409679.
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Affiliation(s)
- Ananda P Dasanayake
- Department of Oral Biology, School of Dentistry, University of Alabama, Birmingham, AL 35294, USA.
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Abstract
Tremendous strides have been made in reducing the incidence of tooth decay, periodontal diseases, and associated loss of teeth in adults and children since the inception of community water fluoridation programs. Yet the disadvantaged and poor have not fully shared in the benefits. Other challenges to oral health remain. Oral cancer and related smoking and smokeless tobacco use remain major public health problems. Access to preventive and therapeutic dental care is far from universal. Public health programs similar in commitment to the approach of community water fluoridation programs initiated in the 1950s and 1960s are needed to address neglected oral health needs of underserved and high-risk populations in the United States.
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Affiliation(s)
- P Milgrom
- Department of Dental Public Health Sciences, University of Washington, Seattle 98195-7475, USA.
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Grembowski D, Milgrom PM. Increasing access to dental care for medicaid preschool children: the Access to Baby and Child Dentistry (ABCD) program. Public Health Rep 2000; 115:448-59. [PMID: 11236017 PMCID: PMC1308601 DOI: 10.1093/phr/115.5.448] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Washington State's Access to Baby and Child Dent stry (ABCD) Program, first implemented in Spokane County in 1995, offers extended dental benefits to participating Medicaid-enrolled children and higher fees for certified providers. This study aimed to determine the program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge. METHODS The study used a posttest-only comparison group design. Trained interviewers conducted telephone interviews with 465 parents of chi dren ages 13 to 36 months (49% ABCD, 51% Medicaid-enrolled children not in ABCD). One year later, 282 of 465 parents completed a follow-up survey. Utilization and expenditures were calculated from Medicaid claims. RESULTS Forty-three percent of children in the ABCD Program visited a dentist in the follow-up year, compared with 12% of Medicaid-enrolled children not in the ABCD Program. An ABCD child was 5.3 times as likely to have had at least one dental visit as a child not in the program. ABCD children were 4 to 13 times as likely to have used specific dental services. Parents of ABCD children were more likely to report having ever tried to make a dental appointment, less likely to report that their children were fearful of the dentist, and were more satisfied, compared to parents of non-ABCD children. CONCLUSION The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction.
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Affiliation(s)
- D Grembowski
- Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle 98195-7660, USA.
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Milgrom P, Hujoel P, Grembowski D, Fong R. A community strategy for Medicaid child dental services. Public Health Rep 1999; 114:528-32. [PMID: 10670620 PMCID: PMC1308536 DOI: 10.1093/phr/114.6.528] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The authors present second-year utilization data and first- and second-year cost data for a community-based program in Spokane County, Washington, designed to increase access to dental care for Medicaid-enrolled children from birth to 60 months of age. METHODS The authors used Medicaid eligibility and claims data for 18,727 children 5 years of age and younger to determine utilization of dental care from January 15, 1996, through January 15, 1997. They also used accounting records from the agencies involved to calculate the first- and second-year costs of the program. RESULTS A child in the ABCD program was 7.2 times as likely to have at least one dental visit as a Medicaid-enrolled child not in the program. Estimated costs per child with at least one dental visit (in 1995 dollars) were $54.30 for the first year and $44.38 for the second year, or $20.09 per enrolled child for the first year and $18.77 for the second year. CONCLUSION Public-private joint efforts are effective in improving access to dental care for Medicaid-enrolled children.
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Affiliation(s)
- P Milgrom
- Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle 98195-7660, USA
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Milgrom P. Response to Reisine & Douglass: psychosocial and behavioral issues in early childhood caries. Community Dent Oral Epidemiol 1998; 26:45-8. [PMID: 9671199 DOI: 10.1111/j.1600-0528.1998.tb02093.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The behaviors that are fundamental in early childhood caries are those that initiate and maintain the conditions for transmission of the cariogenic bacteria and block prevention of the disease in the presence of an unfavorable diet. These behaviors have not been the focus of interdisciplinary research involving clinicians, microbiologists, pharmacologists, and behavioral scientists. The current "health promotion product" is not selling. The problem is the "product", not the potential buyer. Evidence suggests that positive interactions with the dental care system do lead to mothers taking preventive steps. However, dentist's attitudes, knowledge, skills and experience with babies and toddlers are deficient. Primary prevention of early childhood caries will fail unless it begins in the prenatal period and addresses the health of both mother and child.
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Affiliation(s)
- P Milgrom
- Department of Dental Public Health Sciences, University of Washington, Seattle 98195-7475, USA.
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Abstract
Early childhood caries (ECC) is primarily a disease of poor, minority population children who generally have limited access to dental services. Public health dental clinics have not made the prevention and control of ECC a priority, and the services provided have not controlled ECC. New training and early screening are recommended. Additionally, repeated accessing of mothers and children through prenatal and postnatal medical visits is recommended. At such visits behavioral and chemotherapeutic strategies need to be utilized. Examples from a demonstration project in the Commonwealth of Northern Marianas are presented.
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Affiliation(s)
- P Weinstein
- Dental Public Health Sciences, University of Washington, Seattle 98195-7475, USA.
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