The dental home: a primary care oral health concept

Perception of nurses applying silver diamine fluoride to children's teeth: A mixed methods study

BACKGROUND

No studies have evaluated the unique potential of nurse-led silver diamine fluoride (SDF) application for children to bridge the gap in interprofessional collaboration.

AIM

To investigate the attitudes, beliefs and perceptions of nurses regarding nurse-led SDF application at the well-child visit and identify possible barriers and make recommendations.

DESIGN

Mixed methods design involving a questionnaire and semi-structured individual interviews were conducted.

RESULTS

All eligible nurses (n = 110) completed the questionnaire, and 16 were interviewed. Questionnaire responses highlighted that nurses were not confident in providing oral health services (score: <3 of 5) beyond oral hygiene advice (score: ≥3.9 of 5) but believed that they should be providing these services for individuals with difficulty accessing care. Interviews reflected that most nurses viewed oral health care as an important part of paediatric health but were limited by knowledge, time and manpower. Most were willing to expand their job scope to include SDF application with formal education and training, competency assessments and approaches to counter time limitations.

CONCLUSION

Where nurses are already providing basic oral healthcare, nurse-led SDF application could be the next step. Findings suggest that systemic changes should include strategies to empower and motivate nurses to apply SDF at the well-child visit.

The Patient-Centered Dental Home: A Framework for Quality Measurement, Improvement, and Integration

OBJECTIVE

This study completed the development of a standardized patient-centered dental home (PCDH) framework to align and integrate with the patient-centered medical home. This study identified measure concepts and specific measures and standards to complete the 4-level measurement framework to implement and evaluate a PCDH. This study built on prior model development, which identified the PCDH definition and characteristics and the components nested within those characteristics.

METHODS

An environmental scan identified existing oral health care quality measure concepts, measures, and standards for rating by the project's National Advisory Committee (NAC). A modified Delphi process, adapted from the RAND appropriateness method, was used to obtain structured feedback from the NAC. NAC members rated measure concepts on importance and, subsequently, specific measures and standards on feasibility, validity, and actionability using a 1 to 9 rating scale. Criteria for model inclusion were based on median ratings and rating dispersion. Open-ended comments were elicited to inform model inclusion as well as identify additional concepts.

RESULTS

We identified more than 500 existing oral health care measures and standards. A structured process was used to identify a subset that best aligned with a PCDH for rating by the NAC. Four Delphi rounds were completed, with 2 rounds to rate measure concepts and 2 rounds to rate measures and standards. NAC quantitative ratings and qualitative comments resulted in a total of 61 measure concepts and 47 measures and standards retained for inclusion in the framework.

CONCLUSIONS

The NAC ratings of measure concepts, and specific measures and standards nested within those concepts, completed the 4-level PCDH measurement framework. The resulting framework allows for the development and implementation of core measure sets to identify and evaluate a PCDH, facilitating quality improvement and dental-medical integration.

KNOWLEDGE TRANSFER STATEMENT

Clinicians, payers, health care systems, and policy makers can use the results of this study to guide and assess implementation of the various components of a patient-centered dental home and to support dental-medical integration.

Awareness and Incorporation of the Dental Home Concept Among General Dentists and Dental Therapists in Malaysia

Background The dental home concept (DHC) refers to an approach in oral healthcare that emphasizes establishing a long-term, comprehensive, and family-centered relationship between a patient and their primary dental care. This study determined the awareness and incorporation of the DHC among general dentists and dental therapists in Malaysia. Methodology A total of 154 general dentists and 137 dental therapists providing oral healthcare services at the Ministry of Health (MOH) primary care facilities throughout Malaysia participated in this cross-sectional study. A self-administered questionnaire was used to measure the respondents' awareness of the DHC and incorporation of the DHC characteristics into their practice. Results Most dentists and dental therapists (61.7% and 67.2%, respectively) had not heard of the term DHC and were unaware of the concept. The respondents' awareness was not associated with their age, sex, years of service, facility location, and percentage of treatment given to children aged five years and below. However, most dentists and dental therapists responded positively about incorporating most DHC characteristics into their current practice. Conclusions Most dentists and dental therapists serving the MOH primary oral healthcare facilities were unaware of the DHC, although most DHC characteristics have already been incorporated into their practice. This study provides evidence of the incorporation of the DHC into the MOH primary oral healthcare services and suggests an effort to increase the awareness of the workforce regarding the concept and its implementation.

A feasibility and acceptability study of screening the parents/guardians of pediatric dental patients for the social determinants of health

BACKGROUND

The social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. Lack of SDOH training of dental providers on SDOH may result in suboptimal care provided to pediatric dental patients and their families. The purpose of this pilot study is to report the feasibility and acceptability of SDOH screening and referral by pediatric dentistry residents and faculty in the dental clinics of Family Health Centers at NYU Langone (FHC), a Federally Qualified Health Center (FQHC) network in Brooklyn, NY, USA.

METHODS

Guided by the Implementation Outcomes Framework, 15 pediatric dentists and 40 pediatric dental patient-parent/guardian dyads who visited FHC in 2020-2021 for recall or treatment appointments participated in this study. The a priori feasibility and acceptability criteria for these outcomes were that after completing the Parent Adversity Scale (a validated SDOH screening tool), ≥ 80% of the participating parents/guardians would feel comfortable completing SDOH screening and referral at the dental clinic (acceptable), and ≥ 80% of the participating parents/guardians who endorsed SDOH needs would be successfully referred to an assigned counselor at the Family Support Center (feasible).

RESULTS

The most prevalent SDOH needs endorsed were worried within the past year that food would run out before had money to buy more (45.0%) and would like classes to learn English, read better, or obtain a high school degree (45.0%). Post-intervention, 83.9% of the participating parents/guardians who expressed an SDOH need were successfully referred to an assigned counselor at the Family Support Center for follow-up, and 95.0% of the participating parents/guardians felt comfortable completing the questionnaire at the dental clinic, surpassing the a priori feasibility and acceptability criteria, respectively. Furthermore, while most (80.0%) of the participating dental providers reported being trained in SDOH, only one-third (33.3%) usually or always assess SDOH for their pediatric dental patients, and most (53.8%) felt minimally comfortable discussing challenges faced by pediatric dental patient families and referring patients to resources in the community.

CONCLUSIONS

This study provides novel evidence of the feasibility and acceptability of SDOH screening and referral by dentists in the pediatric dental clinics of an FQHC network.

Dental innovations which will influence the oral health care of baby boomers

From the widespread use of smartphones and tablets to the multitude of applications available, older adults are showing an interest in utilizing technology to maintain their independence and to improve their quality of life. As technology continues to advance and be incorporated into many day-to-day activities, the baby boom generation will see these changes affecting the way they access and utilize dental services. Innovative toothbrushes and chemotherapeutics are continuing to be developed and utilized by many older adults. Within the dental office, older adults are seeing greater application of technology in every day dental procedures. These include the use of teledentistry, artificial intelligence (AI), innovative restorative materials, digitization of fixed and removable prosthodontics, cone beam computed tomography (CBCT) scans to guide dental implant placement and endodontic procedures. There is also new technology to aid in cancer detection and shielding during cancer treatment. Improved communication between the medical and dental fields has become increasingly necessary to facilitate effective patient care and a few innovative healthcare systems have begun to consolidate these services. Overall, the baby boom generation will continue to see dental innovations that will change the way they experience everyday life and dental services.

The Oral Health Status and Treatment Needs of Pediatric Patients Living with Autism Spectrum Disorder: A Retrospective Study

BACKGROUND

The objective of this retrospective study was to assess the oral health status and treatment needs of children with ASD and to explore the differences in risk factors and oral health care status and the risk factors for treatment under GA.

METHODS

Dental charts of children between 6 and 14 years of age who were examined at a dental facility associated with the College of Dentistry, University of Saskatchewan between 2016 to 2019 were assessed. Children who were identified as having ASD, as well as an age- and gender-matched control group consisting of otherwise healthy children were included in the study.

RESULTS

The sample included 346 dental records, with 173 children having a diagnosis of ASD. Children diagnosed with ASD had significantly higher experience with caries (91.3% vs. 65.9%, p = 0.003) and severity (mean DMFT/dmft = 8.18 ± 1.62 vs. 4.93 ± 0.58 p = 0.007). Children with ASD were also older when visiting the dentist for the first time (age of 5.97 ± 1.18 vs. 2.79 ± 1.09, p = 0.02)). Children with ASD were less likely to brush once a day (66.5% vs. 88.4%, p = 0.02), were more likely to have bruxism (35.8% vs. 10.4%, p = 0.003) and were less likely to have class I occlusion (64.7% vs. 80.9%, p = 0.03). Findings from the logistic regression analysis revealed that children with ASD were also 2.13 times more likely to receive a referral for general anesthesia when all other variables were held constant (p = 0.03).

CONCLUSIONS

This research demonstrates that children diagnosed with ASD may face more barriers with access to oral health care, leading to poorer outcomes and greater treatment dental needs.

Expert consensus on early childhood caries management

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.

Assessment of Knowledge, Attitude, and Practices about Dental Home among Healthcare Professionals of Belagavi City: A Cross-sectional Study

Aim and objective

The aim and objective of the study was to assess the knowledge, attitude, and practices about dental home among healthcare professionals of Belagavi city.

Materials and methods

A sample of 400 participants was divided into four groups (Ayurveda, Homeopathy, Nursing, and Medical) based on their healthcare specialty. A 20 item validated questionnaire containing four domains was distributed among the participants. The data was statistically analyzed.

Results

Descriptive analysis was used followed by Chi-square for association and one-way ANOVA for comparison followed by Karl Pearson correlation coefficient for determining the correlation between knowledge, attitude, and practices of healthcare professionals. The results of the study showed that the knowledge and practices were statistically not significant among all healthcare professionals (p > 0.05). However, the results were found to be statistically highly significant when correlation was done between knowledge, attitude, and practices (p < 0.0001).

Conclusion

The study concludes that there is a need to increase the level of knowledge, attitude, and practices among healthcare professionals about the concept of dental home.

Clinical Significance

The clinical significance of our study is the implementation of the dental home concept in India, which can prove to be a source of coordinated care that emphasizes overall patient health and aids in rendering quality treatment. Through this initiative oral health can be incorporated as a primary healthcare entity. This can also provide an opportunity for dental professionals to take the lead in applying successful strategies to improve the provision of dental care. Moreover, treatment needs if taken care at the preliminary stages itself, can reduce a major oral healthcare burden from extensive debilitating oral pathologies in the pediatric population.

How to cite this article

Saxena N, Hugar SM, Patil V, et al. Assessment of Knowledge, Attitude, and Practices about Dental Home among Healthcare Professionals of Belagavi City: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(2):164-167.

Risk Indicators and Treatment Needs of Children 2-5 Years of Age Receiving Dental Treatment under General Anesthesia in Saskatchewan

BACKGROUND

When compared to national averages in Canada, Saskatchewan has one of the highest rates of dental treatment under general anesthesia (GA) and average costs per child. Thus, the purpose of this cross-sectional study is to explore the risk indicators and treatment needs of children receiving dental treatment under GA in Saskatchewan.

METHODS

In this cross-sectional study, we recruited caregivers of children between 24 and 71 months of age in Saskatoon, Canada. Caregivers completed a 40-item questionnaire, which was supplemented with clinical data and then subject to statistical analysis (independent t-tests and one-way ANOVA).

RESULTS

A total of 90 caregiver/child dyads were enrolled with the mean age for children being 49.5 ± 12.3 months. The mean age of a child's first dental visit was 34.7 ± 15.3 months with only 37.9% of children having a dental home. The mean deft index was 11.7 ± 3.4, with an average of 10.9 ± 3.5 teeth receiving treatment. Additionally, location of primary residence (p = 0.03), family income (p = 0.04), family size (p = 0.01), parental education (p = 0.03), dental home (p = 0.04), and body mass index (p = 0.04) had a statistically significant association with a higher mean deft.

CONCLUSIONS

Our cross-sectional study confirms that children who require dental treatment under GA have a high burden of disease. While individual risk indicators such as diet and oral hygiene play a role in the progression of early childhood caries (ECC), we also demonstrate that children who do not have access to early preventive visits or a dental home are at a higher risk. In addition to improving motivation for oral hygiene at home and nutritional education, improving access to oral health care should be addressed in strategies to reduce ECC.

Patient centered dental home: Building a framework for dental quality measurement and improvement

INTRODUCTION

This article presents results of the second phase of a project to develop a patient-centered dental home (PCDH) model. Aims of PCDH model development include broadening the scope of prior dental home definitions to include populations across the lifespan, developing a quality measurement framework to facilitate quality assessment and improvement, and promoting opportunities for medical-dental integration through alignment with existing PCMH models. This phase determined the components, or conceptual subdivisions, associated with a previously developed PCDH definition and characteristics.

METHODS

We used a modified Delphi process to obtain structured feedback and gain consensus among the project national advisory committee (NAC). The process included a web-based survey that asked NAC members to rank the importance of each potential component on a scale of 1-9. Criteria for consensus on component inclusion/exclusion combined a median rating and measure of disagreement. Respondents were also encouraged to provide open-ended feedback regarding rationale for component ratings and additional suggested components.

RESULTS

A total of 47 out of 51 members completed the survey. All 34 components met the quantitative criteria for inclusion in the PCDH model. Changes were made to components based on open-ended feedback.

CONCLUSIONS

This project phase further developed a PCDH measurement framework that aims to guide practice transformation, quality measurement and improvement in dental care delivery, as well as integration between medicine and dentistry. Using a Delphi approach with a broad group of stakeholders ensured that components had face validity and were conceptually aligned with the PCDH definition and characteristics.

Infant Oral Healthcare and Anticipatory Guidance Practices among Dentists in a Pediatric Care Shortage Area

Objectives

To assess dentists' practices and barriers towards infant oral healthcare (IOH) and anticipatory guidance (AG) in eastern Saudi Arabia.

Methods

A regional, cross-sectional survey was distributed to 340 (323 general dentists (GPs) and 17 pediatric dentists (PDs)) working in a governmental setting in eastern Saudi Arabia. A 23 close-ended, pilot-tested questionnaire was developed. The questionnaire asked about dentists' IOH and AG practices. A five-point Likert scale question assessed barriers interfering with AG practices. Descriptive and multivariate logistic regressions were used.

Results

Participation rate was 98.5% (335/340). Only 18% of GPs indicated performing IOH exams, while 100% of PDs do. About 90% of GPs would see children on a first visit when they are ≥3 years old, whereas 60% of PDs reported seeing one-year-old children. Older practitioners and those performing AG were more likely to perform IOH (OR = 1.8, CI = 1.06-3.1, and OR = 3.84, CI = 1.93-7.65, resp.). The majority of respondents (94%) felt their training did not prepare them to practice AG. "Parents bringing their children for the first time for emergency or existing conditions" was cited by 99% of respondents as a barrier to performing AG.

Conclusion

Increasing the awareness of GPs and parents about the importance of IOH and AG is crucial in improving children's oral health. Collaboration with pediatricians for early referral of children is equally important in increasing the awareness on prevention principles.

Role of Communication, Professionalism, and Clinical Care Skills of Postgraduate Students on Patients Recall Visits in Dental School-An Observational Study

Preservation of periodontal health after periodontal therapy is paramount for the complete elimination of periodontal diseases. In most of the Dental Schools, recall appointments are considerably low, and in particular, to the Department of Periodontics, the compliance to recall visits by the patients diagnosed with periodontal disease is still inadequate. Faculty from the Department of Periodontics framed new criteria to follow in the comprehensive clinics by the postgraduate students. The criteria include communication, intraoral examination skills, and professionalism toward dental patients. Faculty in each comprehensive dental clinic observed the clinical encounters of postgraduate students with patients and provided the feedback. The study conducted from May 2018 to April 2019, and the patients attended were 1164 of 1544. Unattended patients were 380 of 1544. Effective evaluation of the feedback provided by faculty and communication with both the postgraduate students and unattended patients resulted in further improvement in recall, that is, 151 of 380 patients. Reframed criteria, direct observation of the postgraduate students by faculty during patients interaction, assessment of feedback forms, and immediately modifying the student’s way of communication allowed maximum recall visits to the Department of Periodontics.

Inpatient dental consultations at a pediatric hospital: A single center 1-year review

AIMS

Inpatient dental consultations done at a pediatric hospital in 2017 were analyzed to determine consult reasons, requesting departments, and patient characteristics. Findings were compared to a 2007 study from the hospital.

METHODS AND RESULTS

Data were collected from medical records. Descriptive statistics and logistic regressions were calculated. In 2017, 300 consults were performed for 211 patients (1.8% of inpatients). hematology-oncology requested the most consults (63%). Evaluation prior to cancer treatment, cardiac surgery, or organ transplantation was the most common reason for consult requests (52%). Fifty-eight percent patients had a dental home; older patients were more likely to have a dental home (P < .001). Patients with a dental home were less likely to have caries (P = .047). Many patients with a dental home had caries (33% in 2007 and 29% in 2017); more patients without a dental home had caries (46% in 2007 and 38% in 2017).

CONCLUSIONS

This study both supports the dental home concept and reveals that many children with a dental home have treatment needs. This indicates that medical providers should not equate having a dental home with having dental health and emphasizes the value of an in-hospital dental service to support the management of critically ill children.

Facilitating Access to Dental Care for People Experiencing Homelessness

INTRODUCTION

Fear, lack of information, and lower health literacy are prominent barriers preventing people experiencing homelessness from accessing dental services. Most of this population are eligible for free dental treatment in Australia, yet few access care. This study evaluated 3 models for facilitating access to dental services for people experiencing homelessness.

METHODS

Three facilitated access models were developed and implemented at 4 community organizations. In model 1, dental appointments were booked on the spot after a screening by dental practitioners. Model 2 also involved dental screenings followed by appointments made via phone call from the service. In model 3, the community organizations referred clients directly to the service where appointments were made via a phone call to the client. The models were trialed with community organizations between 2017 and 2019. For each model, participant demographic information, attendance at subsequent dental appointments, and program operation resource use were collected. Cost-effectiveness was assessed as an incremental cost per additional person attending a dental appointment.

RESULTS

A total of 76 people participated in model 1, 66 in model 2, and 43 in model 3. Model 1 was the most effective, leading to 84.2 (confidence interval, 75.8-92.7) of every 100 participants attending a dental appointment. Model 2 had a lower effectiveness of 56.1 (44.6-67.6), and model 3 was the least effective, with a mean of 29.3 (15.0-43.6) per 100 participants attending. Incremental cost-effectiveness ratios were $51 per additional person attending a dental appointment for model 3 (compared to no strategy) and $173 per additional person attending for model 1 (compared to model 3).

CONCLUSIONS

Model 3 was the most cost-effective strategy of increasing access to dental care for people experiencing homelessness. Decision makers who find the effectiveness of model 3 insufficient should look instead to employ model 1 or a combination of these 2 models. The importance of face-to-face engagement to foster trust between the individual and health care practitioner was evident.

KNOWLEDGE TRANSFER STATEMENT

This study provides a range of models for dental and community services to facilitate access to dental care for people experiencing homelessness. Decision makers should consider the needs of vulnerable populations, alternative model designs, and their cost-effectiveness when implementing models of facilitated access to dental care. Face-to-face engagement between clients and dental practitioners by inclusion of a screening stage appears to be instrumental in overcoming barriers to access clinical care.

Medical, Dental, and Nursing Students' Knowledge about Early Childhood Oral Health Care

Gaps in knowledge of physicians and nurses about early childhood oral health care were reported and are likely due to the poorly focused education on oral health issues; therefore, the purpose of this study was to assess the knowledge level of Qassim University medical, dental and nursing students about early childhood oral health care and its relation to demographic variables, students’ perceived knowledge, satisfaction with their knowledge and interest in further education about the topic. A total of 571 medical, dental, and nursing students received a questionnaire that included demographic questions, questions to assess knowledge level of the students about early childhood oral health care, and questions to assess their perceived knowledge level, satisfaction with their knowledge and interest in further education about the topic. Results of the study revealed that knowledge of dental students was highest (score 7.72 out of 10) followed by nursing students (4.79), and medical students (4.43). Additionally, students with a higher level of perceived knowledge were more likely to score higher. In view of the inadequate knowledge level of medical and nursing students about early childhood oral health care when compared to dental students, improvements in medical and nursing education programs are necessary at Qassim University.

A Practice Report From the Northern Dental Access Center: Offering Wraparound Services at a Community Dental Access Clinic to Improve Treatment Outcomes Among Rural Populations in Poverty

CONTEXT

Rural populations suffer significant adverse health outcomes without reliable access to dental care, including increased emergency department use for oral health. The Northern Dental Access Program (Northern Dental) serves more than 20 counties in Greater Minnesota and bordering states. Its population is generally poor and less healthy than the rest of the state, with high rates of Medicaid.

APPROACH

Evaluation of Northern Dental focused primarily on utilization of dental and nondental wraparound/support services. First, descriptive analyses were conducted, including assessing the patient population, visit, and client counts over time. Measures include procedures performed, visits, unique clients, active client base (based on previous visits in 12, 18, or 24 months), treatment plan completion, and use of wraparound services.

RESULTS

Between 2009 and 2016, Northern Dental saw 20 367 unique clients. The staff performed more than 307 000 prevention and screening procedures, more than 55 000 fillings and restorations, and 20 000 oral surgery/endodontic procedures. Overall, 32% of patients (n = 6 626) completed their treatment plans. Bivariate comparisons suggested that those who were provided transportation assistance (5% of all patients) were more likely to complete their treatment than the overall patient population. Overall, in 2016, a total of 1 748 unduplicated clients worked with the staff more than 3 800 times to receive referrals and wraparound services. This represented about 27% of all clients seen in 2016 who had at least 1 clinical visit.

DISCUSSION

Evaluation of Northern Dental's practice and approach shows sustained growth over time in service provision to the Medicaid population in Greater Minnesota, high need for transportation assistance, and significant interest in wraparound services. Transportation assistance involved substantial outlays from Northern Dental but resulted in substantially higher reimbursement, billing, and treatment completion for patients.

IMPLICATIONS FOR PRACTICE

Wraparound services are typically supported through grants and charitable giving. Evidence like this can inform policy makers and insurance companies, making the case for reimbursing nonprofits that provide them.

The patient-centered dental home: A standardized definition for quality assessment, improvement, and integration

OBJECTIVE

To develop the first standardized definition of the patient-centered dental home (PCDH).

DATA SOURCES/STUDY SETTING

Primary data from a 55-member national expert panel and public comments.

STUDY DESIGN

We used a modified Delphi process with three rounds of surveys to collect panelists' ratings of PCDH characteristics and open-ended comments. The process was supplemented with a 1-month public comment period.

DATA COLLECTION/EXTRACTION METHODS

We calculated median ratings, analyzed consensus using the interpercentile range adjusted for symmetry, and qualitatively evaluated comments.

PRINCIPAL FINDINGS

Forty-nine experts (89%) completed three rounds and identified eight essential PCDH characteristics, resulting in the following definition: "The patient-centered dental home is a model of care that is accessible, comprehensive, continuous, coordinated, patient- and family-centered, and focused on quality and safety as an integrated part of a health home for people throughout the life span."

CONCLUSIONS

This PCDH definition provides the foundation for developing measures for research, care improvement, and accreditation and is aligned with the patient-centered medical home. Consensus among a broad national expert panel-including provider, payer, and accreditation stakeholder organizations and experts in medicine, dentistry, and quality measurement-supports the definition's usability and its potential to facilitate medical-dental primary care integration.

Characteristics of Patients Discontinuing Care

Objectives: Due to lower fees, dental school clinics (DSCs) may provide dental care for vulnerable populations. This study evaluates factors associated with patients deciding to discontinue care at a DSC. Methods: This is a retrospective analysis of a patient transfer form that was implemented to smooth transition of a patient when their student provider graduated. Forms provided deidentified information about characteristics and unmet dental needs. Descriptive and bivariate statistics were used to identify associations between patient characteristics and deciding to continue treatment in the student practice. Results: Of 1894 patients, 73.4% continued care. Financial limitations were most commonly reported as the reason for discontinuing care (30.1%). Patients speaking a language other than English or who had reported financial barriers were significantly less likely to continue care. Conclusions: Dental school patients from vulnerable groups are more likely to discontinue care. Dental schools should implement programs that will assist patients in maintaining a dental home.

Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self-assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre-booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.

Person-centered care model in dentistry

BACKGROUND

To achieve optimal health and oral health, the system of care must place a person and their social well-being at the center of decision making and understand factors spent outside the clinical settings, including individual behavior, context and lifestyle.

MAIN TEXT

Person-centered care offers a unique and compelling opportunity for dentistry, and its practitioners, to improve quality of care and overall health outcomes. For decades, the dominant treatment modalities within dentistry primarily focused on a surgical, treatment-oriented approach as opposed to health promotion and improvement. However, new business and care models are disrupting the dental care system, and transforming it into one that is focused on disease management and prevention-oriented primary care that considers overall health and well-being. We proposed a person-centered care model to improve oral health as an integral part of overall health. The model identified three key players who act as change agents with their respective roles and responsibilities: Person, provider, and health care system designer.

CONCLUSIONS

While previous person-centered models in dentistry focused on the role of providers within the clinical setting, this work emphasizes the role of the care designer in creating an environment where both person and provider are able to communicate effectively and achieve improved health outcomes.

Parental attitudes about acquiring a dental home for preschool children: a new concept in the Arab state of Qatar

OBJECTIVE

The purpose of the study was to assess parental perceptions and acceptability of a dental home for their preschool children, a new concept in the state of Qatar.

METHODS

A cross-sectional prospective study was conducted at Hamad Medical Corporation, in the state of Qatar. Parents of infants and children <5 years of age were offered an interview survey.

RESULTS

A total of 309 questionnaires were completed (response rate =98%). More than 90% of the participants believed that oral health and dentition affected total-body well-being. Only 18% of parents stated that their children had excellent oral health. Interestingly, more than two-thirds of children had not had a routine dentist visit in the 12 months preceding the interview. Reasons for not having such visits included long appointment times (17.4%), the perception that dental care was expensive (15.5%), the notion that deciduous teeth did not need care (9%), the impression that insurance did not cover dental procedures (8%), unawareness of location of dental centers (4%), the child did not want to go (4%), the notion that children are difficult to handle during a dental procedure (3%), a combination of these factors (33.5%), and other factors (5%). When asked what factors would encourage them to enrol a dental home for their children, almost 20% mentioned speedy appointments followed by dentists specialized in pediatrics (14.3%), child-friendly atmosphere (12%), low cost (12%), close to home (5.7%), none (2.7%), others (2%), and all of the above (32.3%).

CONCLUSION

Counseling by primary-care physicians can increase dental home acceptability in the state of Qatar, especially that access to health care is easy in our community.

A Developmental Approach to Pediatric Oral Health

Orofacial growth and development is a complex process spanning the life course. This article provides an oral health overview in the context of overall growth, physical and social development from infancy through adolescence. It reviews oral health-specific developmental milestones during childhood (0-12 years) and adolescence (≥13 years). It examines issues particular to each age category or spanning multiple ages (eg, pediatric overweight and obesity, tobacco use, and dental trauma) in relation to oral health and development. In addition, the oral microbiome and its potential role in informing personalized oral health care across the life course is discussed.

Assessment of Knowledge and Attitude of Medical Practitioners Towards Pediatric Dental Care in Raichur District, Karnataka, India-A Survey

AIM

To determine the knowledge and attitude of medical practitioners towards dental care of children in Raichur district.

MATERIALS AND METHODS

The present study is a cross-sectional survey conducted among the medical practitioners of Raichur district. The study was conducted on 300 practitioners, randomly selected. The data pertaining to their knowledge and attitude about oral health was gathered using a self-administered questionnaire. Data were analyzed using descriptive studies.

RESULTS

Among the study subjects, 32.7% of the respondents could recognize the precancerous and cancerous lesions in the oral cavity. A total of 65.3% considered that dental caries is not infectious. About 52.7% of the physicians thought that scaling causes tooth sensitivity and only 22.7% knew that tooth brushing should be initiated after the eruption of the first milk tooth.

CONCLUSION

Medical practitioners had a moderate knowledge and attitude towards pediatric dental care.How to cite this article: Rao DG, Sheereen S, Havale R, Prakasha SS, Zulfikar MM. Assessment of Knowledge and Attitude of Medical Practitioners Towards Pediatric Dental Care in Raichur District, Karnataka, India-A Survey. Int J Clin Pediatr Dent, 2018;11(5):375-381.

Infant Oral Health: An Emerging Dental Public Health Measure

Infant oral health (IOH) is a preventive service advocated by major medical and dental organizations. IOH aims to prevent early childhood caries (ECC) and impart health strategies to families for continued oral health and prevention of future caries. IOH reaches across disciplines, is low cost, and is covered by Medicaid and many private dental payers. Increasing evidence points to immediate and long-term positive oral health outcomes of reduced disease, reduction in costly care, and reduction in ECC-associated morbidities.

Interprofessional oral health initiative in a nondental, American Indian setting

BACKGROUND AND PURPOSE

Tooth decay is the most common chronic childhood disease and American Indian (AI) children are at increased risk. Pediatric primary care providers are in an opportune position to reduce tooth decay. The purpose of this study was to integrate and evaluate a pediatric oral health project in an AI, pediatric primary care setting.

METHODS

The intervention set included caregiver education, caries risk assessment, and a same-day dental home referral. All caregiver/child dyads age birth to 5 years presenting to the pediatric clinic were eligible (n = 47).

CONCLUSIONS

Most children (n = 35, 91.1%) were scored as high risk for caries development. Of those with first tooth eruption (n = 36), ten had healthy teeth (27.8%) and seven had seen a dentist in the past 3 months (19.4%). All others were referred to a dentist (n = 29) and 21 families (72.4%) completed the referral.

IMPLICATIONS FOR PRACTICE

In fewer than 5 min per appointment (x = 4.73 min), the primary care provider integrated oral health screening, education, and referral into the well-child visit. Oral health is part of total health, and thus should be incorporated into routine well-child visits.

Comparison of the Effectiveness of a Mobile Phone-based Education Program in Educating Mothers as Oral Health Providers in Two Regions of Saudi Arabia

Aims and Objectives:

The penetration of mobile phone devices is widespread across the Kingdom of Saudi Arabia. Recently, there has been evidence of the success of phone-based applications in the provision of preventive oral health care to children and their parents. The aim of this study was to compare the effectiveness of a mobile phone-based application in educating mothers of children aged below 6 years of age in preventive dental care.

Materials and Methods:

A mobile phone-based application (iTeethey™) was developed for iPhone and Android and made freely available on Google Play and App Store. The application was then distributed to 3879 mothers of children below 6 years of age (1989 in Riyadh Region and 1890 in Najran region). The mothers were subjected to a standardized knowledge attitude and practice of oral hygiene questionnaire before being asked to download the application. A total of 1055 mothers who downloaded the application completed 3-month recall process.

Results:

Significant improvement in the knowledge of the mothers was reported after the use of the application from both regions. The mothers from Najran showed significantly greater improvement in knowledge when compared to the mothers from Riyadh region. The application was also more effective in mothers with more than one child when compared to first-time mothers.

Conclusion:

Within the limitations of this study, we can state that the mobile phone application used in this study significantly improves the knowledge of mothers toward their child's oral health.

Early Head Start, Pediatric Dental Use, and Oral Health-Related Quality of Life

The objective of the study was to examine the mediating effect of child dental use on the effectiveness of North Carolina Early Head Start (EHS) in improving oral health-related quality of life (OHRQoL). In total, 479 parents of children enrolled in EHS and 699 parents of Medicaid-matched children were interviewed at baseline when children were approximately 10 mo old and 24 mo later. In this quasi-experimental study, mediation analysis was performed using the counterfactual framework analysis, which employed 2 logit models with random effects: 1) for the mediator as a function of the treatment and covariates and 2) for the outcome as a function of the treatment, mediator, and covariates. The covariates were baseline dental OHRQoL, dental need, survey language, and a propensity score. We used in-person computer-assisted, structured interviews to collect information on demographic characteristics and dental use and to administer the Early Childhood Oral Health Impact Scale, a measure of OHRQoL. Dental use had a mediation effect in the undesired direction with a 2-percentage point increase in the probability of any negative impact to OHRQoL (95% confidence interval [CI], 0.3%-3.9%). Even with higher dental use by EHS participants, the probability of any negative impact to OHRQoL was approximately 8 percentage points lower if an individual were moved from the non-EHS group to the EHS group (95% CI, -13.9% to -1.2%). EHS increases child dental use, which worsens family OHRQoL. However, EHS is associated with improved OHRQoL overall. Knowledge Transfer Statement: Study results can inform policy makers that comprehensive early childhood education programs improve oral health-related quality of life (OHRQoL) for disadvantaged families with young children in pathways outside of clinical dental care. This awareness and its promotion can lead to greater resource investments in early childhood education programs. Information about the negative impacts of dental use on OHRQoL should lead to the development and testing of strategies in dentistry and Early Head Start to improve dental care experiences.

Primary Oral Health Care in India: Vision or Dream?

The contemporary approach to dental caries management in children focuses on prevention than treatment. Pediatricians, general dentists and pediatric dentists must be involved in a detailed preventive program, which includes prenatal counselling, treatment of expectant mothers at risk for dental caries, infant oral health care and the establishment of the dental home, so that dental disease can be prevented in infants, starting at a young age. Various health care system and organizations in India must join together to promote oral health care for all the children and specially focused toward children from disadvantaged background and children with special health care needs.

HOW TO CITE THIS ARTICLE

Suresh KS, Kumar P, Javanaiah N, Shantappa S, Srivastava P. Primary Oral Health Care in India: Vision or Dream? Int J Clin Pediatr Dent 2016;9(3):228-232.

Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program

INTRODUCTION

Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities.

METHODS

Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015.

RESULTS

In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively).

CONCLUSIONS

Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.

Preventive strategies in oral health for special needs patients

As regards to the most common oral disease in pediatric patients, intellectual disability is not a risk factor for caries disease itself, but it rather reduces the individual capability to self-care and therefore to his own oral care. Children suffering of systemic pathologies and/or with different stages of disability are to be considered at high risk for dental caries development. According to recent guidelines for oral health prevention in childhood, individual additional strategies for a preventive care should be applied for these patients. All the health providers, family and caregivers should be involved with the aim of being aware, motivated and informed on oral health issues, and a better access system to the dental care structure, both logistic, professional and economical should be assured.

Non-traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders

We analyzed 2010 US National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million NTDC-related ED visits in 2010. Less than 1.0% (children) and 2.1% (adults) of all ED visits were for NTDC. There was no significant difference in NTDC-related ED visits or costs for children by ASD status. Adults with ASD had significantly lower odds of NTDC-related ED visits (OR 0.39; 95% CI 0.29, 0.52; p < 0.001) but incurred significantly greater mean costs for NTDC-related ED visits (p < 0.006) than did adults without ASD.

Economic models for prevention: making a system work for patients

The purpose of this article is to describe alternative means of providing patient centered, preventive based, services using an alternative non-profit, economic model. Hard to reach, vulnerable groups, including children, adults and elders, often have difficulties accessing traditional dental services for a number of reasons, including economic barriers. By partnering with community organizations that serve these groups, collaborative services and new opportunities for access are provided. The concept of a dental home is well accepted as a means of providing care, and, for these groups, provision of such services within community settings provides a sustainable means of delivery. Dental homes provided through community partnerships can deliver evidence based dental care, focused on a preventive model to achieve and maintain oral health. By using a non-profit model, the entire dental team is provided with incentives to deliver measurable quality improvements in care, rather than a more traditional focus on volume of activity alone. Examples are provided that demonstrate how integrated oral health services can deliver improved health outcomes with the potential to reduce total costs while improving quality.

Receipt of preventive oral health care by U.S. children: a population-based study of the 2005-2008 medical expenditure panel surveys

This study provides estimates of the annual use of preventive oral health care by U.S. children ages 6 months-17 years. We estimated the annual use of preventive oral health care with data from the Medical Expenditure Panel Survey for the years 2005 through 2008 (n = 18,218). Additionally, we tested associations between use of preventive oral health care and predisposing factors, enabling factors and health need within three age groups: young children, school-age children and youth. Overall, 21 % of the sample was reported to have received preventive oral health care in the prior year. More school-age children received preventive care than did young children or youth regardless of gender, race/ethnicity, health status, residence, or family size. Among the youngest children, low parental education and lack of health insurance were associated with lower odds of receiving preventive care. School-age children of racial and ethnic minority groups had a higher odds of receiving preventive care than did non-Hispanic Whites. Youth with special health care needs were less likely to receive care than their peers. Within each age group, use of preventive care increased significantly from 2005 to 2008. In the U.S. there has been an increase in use of pediatric preventive dental care. Continued effort is needed to achieve primary prevention. Outreach and education should include all parents and especially parents with low levels of education, parents of children with special health care needs and those without health insurance.

Insurer views on reimbursement of preventive services in the dental setting: results from a qualitative study

OBJECTIVES

We explored insurers' perceptions regarding barriers to reimbursement for oral rapid HIV testing and other preventive screenings during dental care.

METHODS

We conducted semistructured interviews between April and October 2010 with a targeted sample of 13 dental insurance company executives and consultants, whose firms' cumulative market share exceeded 50% of US employer-based dental insurance markets. Participants represented viewpoints from a significant share of the dental insurance industry.

RESULTS

Some preventive screenings, such as for oral cancer, received widespread insurer support and reimbursement. Others, such as population-based HIV screening, appeared to face many barriers to insurance reimbursement. The principal barriers were minimal employer demand, limited evidence of effectiveness and return on investment specific to dental settings, implementation and organizational constraints, lack of provider training, and perceived lack of patient acceptance.

CONCLUSIONS

The dental setting is a promising venue for preventive screenings, and addressing barriers to insurance reimbursement for such services is a key challenge for public health policy.

Time until first dental caries for young children first seen in Federally Qualified Health Centers: a retrospective cohort study

OBJECTIVES

The study assessed the time until first dental caries for young children seen at five Federally Qualified Health Centers (FQHC) in Iowa and the relationship with the frequency and gaps (in months) of dental episodes, the number of topical fluoride treatments, and the number of dentists caring for the subject.

METHODS

Forty children were randomly selected at each FQHC (n = 200). All children were continuously enrolled in the Medicaid program and had their first dental visit prior to age 6. Dental chart findings, claims data for the child and family, and birth certificate information were merged into one dataset. Dental visits were followed for a minimum of 36 months, including dental visits external to the FQHCs. Using time until first caries as the dependent variable, the data were subject to left, interval, and right censoring and were analyzed via Weibull regression.

RESULTS

Slightly more than half of the 200 children experienced caries. Regression analysis indicated that the hazard of first dental caries increased by approximately 2% with each additional month that transpired between preventive recall examinations. In addition, children with older siblings who had a dental visit at the same center during the previous year prior to the subject's first visit were more likely to have a longer time until first dental caries.

CONCLUSIONS

Timing of dental care episodes was associated with caries experience in young children from low income families. Dental professionals should focus on regularity of dental care to prevent or delay caries experience in young children.

Periodicity of dental recall visits for young children first seen in community health centers

OBJECTIVES

To study the factors associated with young children who had their first dental visit (FDV) at a Federally Qualified Health Center (FQHC) and returned within 12 months for a second dental episode.

METHODS

Two hundred Medicaid-enrolled children who were less than 6 years old were randomly selected from five Iowa FQHCs. Dental utilization was followed for 36 months using dental charts and Medicaid medical and dental claims data, regardless of provider. Child's birth certificate data were also used as covariates. Multivariable logistic regression, using backward elimination, was used to identify variables that were associated with whether a child returned for a dental recall visit within 1 year of the initial dental episode.

RESULTS

About 56% of the children returned for dental care within 1 year of their initial episode. The number of children in the household had a positive impact on children returning for a second dental episode. However, an increase in the frequency of medical well-child visits at the FQHC prior to the FDV had a negative influence. Unadjusted analysis demonstrated that children with dental caries at the FDV were less likely to return within 12 months; however, this variable failed to make the final regression model. Moreover, age at FDV did not make a difference in regard to returning for a second episode within 12 months.

CONCLUSIONS

The experience gained from having other Medicaid-enrolled children in the household appears to be important for younger children entering into continuous and comprehensive dental care.

Variations in children's dental service use based on four national health surveys

OBJECTIVE

To compare estimates of dental service use and delayed dental care across 4 national surveys of children's health.

METHODS

Among children 2 to 17 years of age, prevalence estimates of the use of any dental services, preventive dental services, and delayed dental care in the past year were obtained from the 2003 and 2007 National Survey of Children's Health, the 2003-2004 National Health and Nutrition Examination Survey (NHANES), the 2003 and 2007 National Health Interview Survey, and the 2003 and 2007 Medical Expenditure Panel Survey. Trends in parent-reported dental use, including delayed care, by sociodemographic characteristics were assessed by using logistic regression and odds ratios.

RESULTS

Data collection methodologies varied across the 4 surveys, and estimates of dental service use varied accordingly. Surveys differed in the survey items used, recall time frames, and protocols for eliciting visit history. As a result, estimates of any dental use ranged from 52% to 81%, whereas estimates of preventive dental use ranged from 67% to 78%. Rates of delayed dental care were low, ranging from 3% to 8%; however, surveys showed consistent sociodemographic disparities in use of dental services and delayed dental care.

CONCLUSIONS

Each survey has a unique approach to defining and eliciting parents' reports of children's dental service use, which could result in under- or overestimation of the number and nature of children's dental services. Each survey's methodology must be considered when accepting population-based estimates of dental service use to monitor progress in achieving national oral health goals.

Knowledge of paediatricians regarding child oral health

BACKGROUND

In dentistry, clinical practice is directed towards attitudes that promote oral health and the paediatricians occupy a privileged position in this process.

AIM

To assess the knowledge and attitudes of paediatricians in relation to the oral health of their patients.

DESIGN

A cross-sectional study was carried out at the Institute of Integrative Medicine Professor Fernando Figueira, Recife, Brazil. A total of 182 paediatricians participated by filling out a questionnaire.

RESULTS

A total of 63.9% believed the first visit to the dentist should occur before the child completes 1 year of life. Moreover, 67.8% considered their knowledge on oral health to be insufficient. Approximately 78% of the paediatricians diagnosed caries through an analysis of cavities. Only 29.9% always recommended fluoride dentifrice. The term 'fluorosis' was unknown by 48.3% of the respondents. Concerning pacifiers, 32.6% did not allow it and 66.9% did not either recommend it or restrict it. A total of 83.4% classified the oral health content in their medical education as either nonexistent or deficient; this figure remained high (72.4%) in relation to residency.

CONCLUSIONS

It is important to develop oral health information programmes to paediatricians. Information on oral health should be included in medical curricula and residency.

Retention of people living with HIV/AIDS in oral health care

OBJECTIVE

We identified factors associated with retention in oral health care for people living with HIV/AIDS (PLWHA) and the impact of care retention on oral health-related outcomes.

METHODS

We collected interview, laboratory value, clinic visit, and service utilization data from 1,237 HIV-positive patients entering dental care from May 2007 to August 2009, with at least an 18-month observation period. Retention in care was defined as two or more dental visits at least 12 months apart. We conducted multivariate regression using generalized estimating equations to explore factors associated with retention in care.

RESULTS

In multivariate analysis, patients who received oral health education were 5.91 times as likely (95% confidence interval 3.73, 9.39) as those who did not receive this education to be retained in oral health care. Other factors associated with care retention included older age, taking antiretroviral medications, better physical health status, and having had a dental visit in the past two years. Patients retained in care were more likely to complete their treatment plans and attend a recall visit. Those retained in care experienced fewer oral health symptoms and less pain, and better overall health of teeth and gums.

CONCLUSIONS

Retention in oral health care was associated with positive oral health outcomes for this sample of PLWHA. The strongest predictor of retention was the receipt of oral health education, suggesting that training in oral health education is an important factor when considering competencies for new dental professionals, and that patient education is central to the development of dental homes, which are designed to engage and retain people in oral health care over the long term.

Parents' perspectives on a dental home for children with special health care needs

The authors surveyed parent-leaders about aspects of a dental home for children with special health care needs (CSHCN). State leaders in two advocacy groups completed the survey; the response rate was 70.6% of all states. Two of the most highly rated aspects of a dental home, endorsed as "essential" by 89% of respondents, pertained to dentist-parent interactions: the dentist listens carefully to the family, and the dentist helps the family feel like a partner in treatment decisions. Likewise, 89% said it was essential that insurance coverage allows the child to see needed providers. Dentists' lack of knowledge or willingness to treat CSHCN and refusal of Medicaid insurance coverage were identified as major barriers to care. More than 84% of respondents reported that parents were unaware of the recommendation to establish dental care by 1 year of age. Establishing policy and educational strategies should help parents meet this dental health goal.

Welcome back? Frequent attenders to a pediatric primary care center

This study examines frequent attenders of a pediatric primary care clinic at a large urban children's hospital--who they are and their reasons for frequent attendance to the clinic. The literature suggests that some visits by frequent attenders may not be medically necessary, and these additional appointments may impair others' access to medical care within the same system. The key to eliminating excessive primary care visits is to determine if it is a problem in the primary care practice (quantify the problem), explore the reasons for the visits (from the patients' perspective), and then provide educational interventions that address the various causes for the extra visits and encourage the use of available resources, either ancillary services in the practice itself or resources and agencies available in the community (e.g. social service, legal aid).