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Danesh DO, Peng J, Hammersmith KJ, Gowda C, Maciejewski H, Amini H, Wapner AW, Meyer BD. Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:186-195. [PMID: 36459615 DOI: 10.1097/phh.0000000000001689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice. DESIGN Retrospective claims-based analysis cohort study. SETTING Children with Medicaid insurance through an Ohio pediatric accountable care organization. PARTICIPANTS Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017. INTERVENTION FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider. MAIN OUTCOME MEASURE Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes. RESULTS The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4). CONCLUSIONS Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment.
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Affiliation(s)
- David O Danesh
- Division of Pediatric Dentistry, College of Dentistry (Drs Danesh, Hammersmith, Amini, and Meyer), Department of Pediatrics, College of Medicine (Dr Gowda), and Division of Health Services Management and Policy, College of Public Health (Dr Wapner), The Ohio State University, Columbus, Ohio; Department of Dentistry (Drs Danesh, Peng, Hammersmith, Amini, and Meyer), Partners For Kids (Dr Gowda and Ms Maciejewski), Center for Clinical Excellence (Ms Maciejewski), Division of Emergency Medicine (Dr Wapner), and Information Technology Research and Innovation (Dr Peng), Nationwide Children's Hospital, Columbus, Ohio
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Saikia A, Aarthi J, Muthu MS, Patil SS, Anthonappa RP, Walia T, Shahwan M, Mossey P, Dominguez M. Sustainable development goals and ending ECC as a public health crisis. Front Public Health 2022; 10:931243. [PMID: 36330110 PMCID: PMC9624450 DOI: 10.3389/fpubh.2022.931243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023] Open
Abstract
Early Childhood Caries (ECC) remains a global issue despite numerous advancements in research and interventional approaches. Nearly, 530 million children suffer from untreated dental caries of primary teeth. The consequences of such untreated dental caries not only limit the child's chewing and eating abilities but also, significantly impact the child's overall growth. Research has demonstrated that ECC is associated with nearly 123 risk factors. ECC has also been associated with local pain, infections, abscesses, and sleep pattern. Furthermore, it can affect the child's emotional status and decrease their ability to learn or perform their usual activities. In high-income countries, dental care continues to endorse a "current treatment-based approach" that involves high-technology, interventionist, and specialized approaches. While such approaches provide immediate benefit at an individual level, it fails to intercept the underlying causes of the disease at large. In low-income and middle-income countries (LMICs), the "current treatment approach" often remains limited, unaffordable, and unsuitable for the majority of the population. Rather, dentistry needs to focus on "sustainable goals" and integrate dental care with the mainstream healthcare system and primary care services. Dental care systems should promote "early first dental visits," when the child is 1 year of age or when the first tooth arrives. The serious shortages of appropriately trained oral healthcare personnel in certain regions of the world, lack of appropriate technologies and isolation of oral health services from the health system, and limited adoption of prevention and oral health promotion can pose as critical barriers. The oral health care systems must focus on three major keystones to combat the burden of ECC-1. Essential oral health services are integrated into healthcare in every country ensuring the availability of appropriate healthcare accessible and available globally, 2. Integrating oral and general healthcare to effectively prevent and manage oral disease and improve oral health, 3. Collaborating with a wide range of health workers to deliver sustainable oral health care tailored to cater to the oral health care needs of local communities.
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Affiliation(s)
- Ankita Saikia
- Department of Pediatric Dentistry, Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Jagadeesan Aarthi
- Department of Pediatric and Preventive Dentistry, Madha Dental College and Hospital, Chennai, India
| | - MS Muthu
- Department of Pediatric Dentistry, Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India,*Correspondence: MS Muthu
| | - Sneha S. Patil
- Department of Pediatric Dentistry, Centre for Early Childhood Caries Research (CECCRe), Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Robert Prashanth Anthonappa
- Dental School, Oral Developmental and Behavioural Sciences, University of Western Australia, Perth, WA, Australia
| | - Tarun Walia
- Centre of Medical and Bio allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Moayad Shahwan
- Centre of Medical and Bio allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Peter Mossey
- Dundee Dental School, University of Dundee, Dundee, United Kingdom
| | - Monica Dominguez
- Global Oral Health Programs, Smile Train Head Office, New York, NY, United States
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Kranz AM, Gahlon G, Dick AW, Goff SL, Whaley C, Geissler KH. Variation in prices for an evidence-based pediatric preventive service. Health Serv Res 2022; 57:1175-1181. [PMID: 35467008 PMCID: PMC9441288 DOI: 10.1111/1475-6773.13995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive. DATA SOURCES Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016-2018). STUDY DESIGN We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid. DATA COLLECTION/EXTRACTION METHODS Private claims for fluoride varnish during medical visits for children aged 1-5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics. PRINCIPAL FINDINGS Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers. CONCLUSIONS Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.
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Affiliation(s)
| | | | | | - Sarah L. Goff
- School of Public Health & Health SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | | | - Kimberley H. Geissler
- School of Public Health & Health SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
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Goldstein EV, Dick AW, Ross R, Stein BD, Kranz AM. Impact of state-level training requirements for medical providers on receipt of preventive oral health services for young children enrolled in Medicaid. J Public Health Dent 2022; 82:156-165. [PMID: 33410186 PMCID: PMC9288108 DOI: 10.1111/jphd.12442] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Young children enrolled in Medicaid make few dental visits and have high rates of tooth decay. To improve access to care, state Medicaid programs have enacted policies encouraging nondental providers to deliver preventive oral health services (POHS) in medical offices. Policies vary by state, with some states requiring medical providers to obtain training prior to delivering POHS. Our objective was to test whether these training requirements were associated with higher rates of POHS for Medicaid-enrolled children <6 years. METHODS This study took advantage of a natural experiment in which policy enactment occurred across states at different times. We used Medicaid Analytic eXtract enrollment and claims data, public policy data, and Area Health Resource Files data. We examined an unweighted sample of 8,711,192 (45,107,240 weighted) Medicaid-enrolled children <6 years in 38 states from 2006 to 2014. Multivariable logistic regression models estimated the odds a child received POHS in a calendar year. Results are presented as adjusted probabilities. RESULTS Five or more years after policy enactment, the probability of a child receiving POHS in medical offices was 10.7 percent in states with training requirements compared to 5.0 percent in states without training requirements (P = 0.01). Findings were similar when receipt of any POHS in medical or dental offices was examined 5 or more years post-policy-enactment (requirement = 42.5 percent, no requirement = 33.6 percent, P < 0.001). CONCLUSIONS Medicaid policies increased young children's receipt of POHS and at higher rates in states that required POHS training. These results suggest that oral health training for nondental practitioners is a key component of policy success.
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Affiliation(s)
- Evan V. Goldstein
- RAND Corporation, Arlington, VA,Ohio State University, College of Public Health, Columbus, OH
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Ko A, Banks JT, Hill CM, Chi DL. Fluoride Prescribing Behaviors for Medicaid-Enrolled Children in Oregon. Am J Prev Med 2022; 62:e69-e76. [PMID: 34602339 PMCID: PMC8748272 DOI: 10.1016/j.amepre.2021.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study aims to examine physician and dentist fluoride prescription patterns and identify the factors associated with fluoride prescriptions for Medicaid-enrolled children. The hypothesis is that dentists will be the primary prescribers of fluoride and that caries risk factors will be associated with fluoride prescriptions. METHODS Data were analyzed for Oregon children aged 0-17 years enrolled in Medicaid for ≥300 days in both 2016 and 2017. The outcome variable was receiving a fluoride prescription in 2017. A 2-tailed chi-square test was used to assess fluoride prescribing differences between physicians and dentists. Multivariable logistic regression models were used to examine the likelihood of receiving a fluoride prescription in 2017 and to generate ORs. Model covariates included child's age, sex, race, ethnicity, Medicaid plan type, previous fluoride prescription, previous restorative dental treatment, and water fluoridation status. RESULTS Of 200,169 Medicaid-enrolled children, 6.7% (n=13,337) received fluoride prescriptions. Physicians were >3 times as likely to prescribe fluoride as dentists (73.4% vs 23.0%, p<0.001). Children with a history of fluoride prescriptions (OR=14.30, p<0.001) and any restorative dental treatment (OR=1.58, p<0.001) were significantly more likely to receive a fluoride prescription, whereas children living in areas with water fluoridation were significantly less likely (OR=0.50, p=0.01). CONCLUSIONS Physicians play an important role in prescribing fluoride to Medicaid-enrolled children, especially those at increased dental caries risk. Additional research is needed on strategies to ensure that all high-risk children have an opportunity to benefit from prescription fluoride.
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Affiliation(s)
- Alice Ko
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Jordan T Banks
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Courtney M Hill
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington.
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Retrospective Study of Prenatal and Postnatal Gaps in Oral Health Care Utilization: Medicaid Policy Implications. Matern Child Health J 2022; 26:642-648. [PMID: 34997435 DOI: 10.1007/s10995-021-03343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the frequency and timing of dental treatment completion among pregnant and post-partum women served through the University of North Carolina at Chapel Hill (UNC-CH) Prenatal Oral Health Program (pOHP) dental clinic in the context of North Carolina (NC) dental Medicaid policies. METHODS We completed a retrospective chart review of pregnant women referred to the program between May 2015 and May 2019. Data were collected from the time of referral until up to 2 years after their estimated due date (EDD). We assessed pre- and post-delivery dental appointment timing and dental treatment completion. RESULTS The initial study population included 264 pregnant women. Overall, 213 patients (81%) attended at least one appointment, and 32 patients (12%) completed recommended treatments prior to their EDD. Fifty patients (19%) returned after delivery to resume dental care, with only 25 patients (10%) completing their recommended treatment plan. Women re-entered dental care at a median of 67 days (range 5-613 days) after their EDD and completed treatment at a median of 378 days (range 52-730 days) following delivery. CONCLUSIONS FOR PRACTICE Despite dental clinic referral, most pregnant women do not complete recommended dental treatment before giving birth, and women who resumed dental care after birth demonstrated a lag-time between delivery and care completion. These findings highlight the need for extending post-pregnancy dental care coverage, which is limited under current dental Medicaid policies, posing a major public health issue for new mothers to continue oral health care.
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Ward MC, Carpenter MD, Noll J, Carrizosa D, Moeller BJ, Helgeson ES, Lalla RV, Brennan MT. Oncologists' Perspective on Dental Care Around the Treatment of Head and Neck Cancer: A Pattern of Practice Survey. JCO Oncol Pract 2022; 18:e28-e35. [PMID: 34242067 PMCID: PMC8757964 DOI: 10.1200/op.20.00913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/21/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Patients with head and neck cancer are at risk of long-term dental complications. Proper dental assessment pre- and post-treatment can improve outcomes but is logistically challenging. We surveyed oncologists to better understand their perspectives surrounding dental care in this unique population. METHODS We surveyed oncologists at institutions associated with an ongoing national study of oral health after treatment of head and neck cancer. Seventeen questions were used to assess provider characteristics, patterns of practice, patterns of referral, barriers to referral, and willingness to apply fluoride varnish in the oncology clinic. RESULTS Ninety-seven oncologists were invited from six institutions, of whom 40 (41%) responded. Surgeons represented 45% of the sample, followed by radiation oncologists (40%) and medical oncologists (15%). Both generalists and subspecialists were included. All practiced in a metropolitan area with an academic dental practice, and many felt that this improved access to care. Despite this, most oncologists thought that financial factors were a significant barrier to obtaining timely dental care. Most oncologists performed a dental assessment during visits. Oncologists felt qualified to identify the most significant complications of treatment, such as exposed bone, but felt underqualified to identify early changes in need of intervention. When asked if the oncology clinic could apply fluoride varnish during follow-ups, most stated that this seemed feasible but would require education and financial support. CONCLUSION Oncologists often perform limited dental evaluations during their routine visits. Given the challenges associated with access to proper dental care for this population, these oncology visits may provide a window for preventative intervention.
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Affiliation(s)
| | | | - Jenene Noll
- Department of Oral Medicine, Atrium Health, Charlotte, NC
| | | | | | - Erika S. Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota Minneapolis, MN
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Schroth RJ, Rothney J, Sturym M, Dabiri D, Dabiri D, Dong CC, Grant CG, Kennedy T, Sihra R. A systematic review to inform the development of a Canadian caries risk assessment tool for use by primary healthcare providers. Int J Paediatr Dent 2021; 31:767-791. [PMID: 33497015 DOI: 10.1111/ipd.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Caries risk assessment (CRA) tools may assist in identifying children at risk of early childhood caries. AIM To complete a systematic review of CRA and develop a Canadian CRA tool for preschool children for use in non-dental clinical settings. DESIGN Systematic searches of relevant databases were conducted. Potential variables were based on strength of associations (odd ratios, relative risk, hazard ratios, etc), frequency of occurrence, and existing CRA tools. Quality of the evidence assessments were performed by at least two review teams through consensus following GRADE. RESULTS Overall, 25 publications met the inclusion criteria, all prospective in design. Based on this review, variables to be considered when developing a new CRA tool for use with preschool children are as follows: age, socioeconomic status, family toothbrushing habits, fluoride exposure, infant feeding practices, dietary habits/behaviours, dental home, caries experience, visible plaque, and enamel defects. The environmental scan identified 22 CRA tools suggesting other additional variables to consider including in a CRA tool, including special healthcare needs, enamel defects, and dental attendance. CONCLUSIONS This review informed the development of a Canadian CRA tool for use by primary healthcare professionals, which may improve access to oral health assessments and increase interprofessional collaboration.
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Affiliation(s)
- Robert J Schroth
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Section of Pediatric Dentistry, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Janet Rothney
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Melina Sturym
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Darya Dabiri
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Donya Dabiri
- University of Toledo Medical Center, University of Toledo, Toledo, OH, USA
| | - Cecilia C Dong
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cameron G Grant
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Tara Kennedy
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Rena Sihra
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Olatosi OO, Oyapero A, Boyede GO. A community survey on maternal perception about the initiation of dental home for infants in Lagos, Nigeria. Pan Afr Med J 2021; 40:78. [PMID: 34804345 PMCID: PMC8590252 DOI: 10.11604/pamj.2021.40.78.24441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION because efforts directed toward oral health promotion and disease prevention are fundamentally superior to dental rehabilitation after disease development, early preventive dental visits are widely encouraged by dental professional and academic stakeholders. Aim: this study aimed to determine the perceptions and practices of mothers with regards to the establishment of dental home at four local government areas (LGAs) in Lagos, Nigeria. METHODS was a community-based descriptive household survey conducted amongst mothers in Alimosho, Ikorodu, Surulere and Epe LGAs of Lagos State. Socio-demographic data, information about the importance of primary teeth, knowledge about dental home as well as their child´s age at first dental visit and reasons for attending was obtained with a validated, structured interviewer administered questionnaire. Descriptive statistics, Chi-square and multivariable regression analysis were conducted, and the level of significance was set at P<0.05. RESULTS the highest proportion of the mothers were aged between 26-30 years (27.4%; mean age: 34.58±7.8 years) and had a tertiary level of education (n=206, 59.9%); most respondents (n=80, 51.4%) did not know the age a child should be taken to the dental clinic for the first time and had not taken their child for any dental visit (n=229, 65.4%). Out of those who had previously taken their child for dental visits, the greater proportion (n=115, 95.0%) took the child when he/she was older than one year of age. Overall, only 126 (36.0%) respondents had a good perception about oral health and the need for a dental home while 224 (64.0%) respondents had poor knowledge. Logistic regression analysis of predictor variables that showed mothers with a tertiary level of education (OR=0.108; CI=0.0023-0.495) and those with 2-3 children (OR=0.482; CI=0.253-0.920) had significant lower odds of poor perception about the importance of a dental home. CONCLUSION maternal knowledge and practices with regards to dental home were poor and inadequate. It is necessary to create more awareness among parents/caregivers, especially through antenatal and immunization clinics to establish the concept of dental home.
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Affiliation(s)
- Olubukola Olamide Olatosi
- Department of Child Dental Health, Faculty of Dental Sciences, College of Medicine University of Lagos, Lagos, Nigeria
| | - Afolabi Oyapero
- Department of Preventive Dentistry, Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria
| | - Gbemisola Ojombo Boyede
- Central North West London National Health Service (NHS), Trust Foundation, London, United Kingdom
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Sitthisettapong T, Tasanarong P, Phantumvanit P. Strategic Management of Early Childhood Caries in Thailand: A Critical Overview. Front Public Health 2021; 9:664541. [PMID: 34178924 PMCID: PMC8226079 DOI: 10.3389/fpubh.2021.664541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this report was to advocate early childhood caries (ECC) and share strategic management in Thailand, despite over two decades of free Universal Health Coverage including oral healthcare. The recent Thai national oral health survey in 2017 indicates the very high prevalence of ECC, with an average of three carious teeth affected in 53% of 3-year-old children. This is despite the efforts of the Ministry of Public Health that has launched several interventional programs ranging from an upstream policy that prohibits sugar additions in baby formula milk to downstream remediations such as advocating and encouraging toothbrushing with fluoride toothpastes. Nevertheless, ECC is strongly predicated by other key factors including the family and community commitment and participation, as embodied in the current World Health Organization guidelines. These encompass three different tiers of community-level prevention: primary, secondary, and tertiary. Accordingly, the following strategies for ECC management in Thailand should be based at primary care clusters (PCC) in sub-district health centers, with the assistance of inter-professional health teams. These include community education on the importance of deciduous teeth and effective toothbrushing with fluoride toothpaste (primary prevention), regular examination and detection of ECC lesions and early intervention (secondary prevention), insertion of non-invasive preventive restorations using cost-effective atraumatic restorative treatment (ART) or simplified and modified ART (SMART) (tertiary prevention), and, finally, effective follow-up and monitoring systems. It is anticipated that this triple tier approach to ECC management will improve not only the oral health but also the overall children's health.
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Kranz AM, Opper IM, Estrada-Darley I, Goldstein E, Stein BD, Dick AW. Outcomes Associated With State Policies Enabling Provision of Oral Health Services in Medical Offices Among Medicaid-enrolled Children. Med Care 2021; 59:513-518. [PMID: 33973938 PMCID: PMC8117116 DOI: 10.1097/mlr.0000000000001532] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND To increase receipt of preventive oral health services (POHS), all state Medicaid programs have enacted policies to encourage nondental providers to deliver POHS in medical offices. This study examined if these Medicaid policies improved oral health, as measured by reductions in dental visits with treatment and preventable emergency department (ED) visits for nontraumatic dental conditions (NTDC). METHODS Using data on children aged 6 months to up to 6 years from 38 state Medicaid programs during 2006-2014, we used a generalized difference-in-differences estimation approach to examine the probability of a child having, in a year, any dental visits with caries-related treatment and any ED visits for NTDC, conditional on length of policy enactment. Models included additional child-level and county-level characteristics, state and year fixed effects, probability weights, and clustered standard errors. RESULTS Among a weighted sample of 45,107,240 child/year observations, 11.7% had any dental visits with treatment and 0.2% had any ED visits for NTDC annually. Children in states with and without medical POHS policies had similar odds of having any dental visits with treatment, regardless of length of policy enactment. Children in states with medical POHS policies enacted for one or more years had significantly greater odds of having any ED visits for NTDC (P<0.05). CONCLUSIONS State policies making POHS available in medical offices did not affect rates of dental visits with caries-related treatment, but were associated with increased rates of potentially avoidable ED visits for NTDC. Findings suggest that many young Medicaid-enrollees lack access to dentists.
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Affiliation(s)
| | | | | | - Evan Goldstein
- RAND Corporation, 1200 S. Hayes St. Arlington, VA, 22202
- Ohio State University, College of Public Health, 1841 Neil Ave. Columbus, OH, 43210
| | - Bradley D. Stein
- RAND Corporation, 4570 Fifth Ave. Suite 600, Pittsburgh, PA, 15213
| | - Andrew W. Dick
- RAND Corporation, 20 Park Plaza, 9 Floor, Suite 920, Boston, MA, 02116
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Fluoride Varnish Application in Preschoolers Have a Modest Effectiveness in Reducing the Incidence of Dentinal Caries. J Evid Based Dent Pract 2020; 20:101489. [PMID: 33303097 DOI: 10.1016/j.jebdp.2020.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis. de Sousa FSO, Dos Santos APP, Nadanovsky P, Hujoel P, Cunha-Cruz J, de Oliveira BH. Caries Res. 2019;53(5):502-513. SOURCE OF FUNDING Government. TYPE OF STUDY/DESIGN Systematic review with meta-analysis of data.
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Martin M, Pugach O, Avenetti D, Lee H, Salazar S, Rosales G, Songthangtham N. Oral Health Behaviors in Very Young Children in Low-Income Urban Areas in Chicago, Illinois, 2018-2019. Prev Chronic Dis 2020; 17:E152. [PMID: 33274700 PMCID: PMC7735487 DOI: 10.5888/pcd17.200213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Because most data on oral health do not include infants and toddlers, we aimed to describe the oral health behaviors of low-income children younger than 3 years and determine factors associated with child tooth brushing. Methods We obtained data from the Coordinated Oral Health Promotion Chicago study, which included 420 families with children aged 6 to 36 months and their caregivers in Cook County, Illinois. We assessed child frequency of brushing from caregiver reports and objectively determined child dental plaque scores. Significant factors associated with tooth brushing frequency and dental plaque score were identified using the Least Absolute Shrinkage and Selection Operator variable selection. Results Mean child age was 21.5 (SD, 6.9) months, and only 45% of caregivers brushed their children’s teeth twice per day or more. The mean plaque score was 1.9 (SD, 0.6), indicating high levels of plaque. Child brushing frequency was higher when children were older; used the correct toothpaste amount; brushed for a longer duration; and when caregivers brushed their own teeth more frequently, had more help with the overall care of the child’s teeth, and had family to help. Child brushing frequency was lower for caregivers with more interference from activities of daily life. Children whose caregivers had more adult help with child brushing had better plaque scores; worse plaque scores were seen in children with higher sugary beverage and food consumption and lower household incomes. Conclusion The tooth brushing behaviors of young children are strongly associated with those of their parents and with the level of family support for brushing. Interventions to improve brushing in young children should focus on the entire family.
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Affiliation(s)
- Molly Martin
- College of Medicine, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,University of Illinois at Chicago, 840 South Wood St, M/C 856, Chicago, IL 60612.
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - David Avenetti
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,College of Dentistry, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Helen Lee
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,College of Medicine, Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois
| | - Shojanny Salazar
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Genesis Rosales
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Nattanit Songthangtham
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
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Meyer BD, Wang R, Steiner MJ, Preisser JS. The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia. JDR Clin Trans Res 2019; 5:146-155. [PMID: 31434532 DOI: 10.1177/2380084419870128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. METHODS We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina (N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. RESULTS Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87-0.99; P = 0.029) and expenditures ($114; CI,-$152.61 to -$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. CONCLUSIONS POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome-treatment under general anesthesia. KNOWLEDGE TRANSFER STATEMENT The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.
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Affiliation(s)
- B D Meyer
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Wang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M J Steiner
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Schilling S, Jamison S, Wood C, Perrin E, Austin CJ, Sheridan J, Young A, Burchinal M, Flower KB. Health Status of Children Enrolled in a Family Navigator Program to Eliminate Intergenerational Poverty. Clin Pediatr (Phila) 2019; 58:647-655. [PMID: 30789004 DOI: 10.1177/0009922819832026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2014, Family Success Alliance (FSA) was formed as a place-based initiative to build a pipeline of programs to reduce the impact of poverty on outcomes for children living in Orange County, North Carolina. In this study, FSA parents' perception of child health, parent and child adverse childhood experiences (ACEs), and resilience were obtained by parent interview. Receipt of recommended health services were abstracted from primary care medical records of FSA children. Correlation coefficients investigated relationships among health, ACEs, and resilience. Among 87 parent-child dyads, 65% were Spanish speaking. At least 1 of the 7 ACEs measured was reported in 37% of children and 70% of parents. Parent perceptions of child health were lower than national averages. Routine preventive services included the following: autism screening at 18 months (15%) and 24 months (31%); ≥4 fluoride varnish applications (10%); lead screening (66%); and receipt of immunizations (94%). Parent perception of child health was moderately correlated with resilience.
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Affiliation(s)
| | | | | | | | | | | | - Allison Young
- 3 Orange County Health Department, Hillsborough, NC, USA
| | | | - Kori B Flower
- 1 University of North Carolina, Chapel Hill, NC, USA
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16
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Nguyen TM, Tonmukayakul U, Calache H. A dental workforce strategy to make Australian public dental services more efficient. HUMAN RESOURCES FOR HEALTH 2019; 17:37. [PMID: 31146760 PMCID: PMC6543641 DOI: 10.1186/s12960-019-0370-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/02/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Dental services can be provided by the oral health therapy (OHT) workforce and dentists. This study aims to quantify the potential cost-savings of increased utilisation of the OHT workforce in providing dental services for children under the Child Dental Benefits Schedule (CDBS). The CDBS is an Australian federal government initiative to increase dental care access for children aged 2-17 years. METHODS Dental services billed under the CDBS for the 2013-2014 financial year were used. Two OHT-to-dentist workforce mix ratios were tested: Model A National Workforce (1:4) and Model B Victorian Workforce (2:3). The 30% average salary difference between the two professions in the public sector was used to adjust the CDBS fee schedule for each type of service. The current 29% utilisation rate of the CDBS and the government target of 80% were modelled. RESULTS The estimated cost-savings under the current CDBS utilisation rate was AUD 26.5M and AUD 61.7M, for Models A and B, respectively. For the government target CDBS utilisation rate, AUD 73.2M for Model A and AUD 170.2M for Model B could be saved. CONCLUSION An increased utilisation of the OHT workforce to provide dental services under the CDBS would save costs on public dental service funding. The potential cost-savings can be reinvested in other dental initiatives such as outreach school-based dental check programmes or resource allocation to eliminate adult dental waiting lists in the public sector.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria 3216 Australia
- University of Melbourne, Parkville, Australia
- Peninsula Health, Frankston, Australia
- Coburg Hill Oral Care, Hill, Coburg, Australia
| | | | - Hanny Calache
- Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria 3216 Australia
- University of Melbourne, Parkville, Australia
- La Trobe University, Bendigo, Australia
- North Richmond Community Health, North Richmond, Australia
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17
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Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, Phantumvanit P, Pitts NB, Seow WK, Sharkov N, Songpaisan Y, Twetman S. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. Int J Paediatr Dent 2019; 29:238-248. [PMID: 31099128 DOI: 10.1111/ipd.12484] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018. AIM The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. DESIGN This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. RESULTS Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care. CONCLUSIONS This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.
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Affiliation(s)
- Norman Tinanoff
- Department of Orthodontics and Pediatric Dentistry, University of Maryland, School of Dentistry, Baltimore, Maryland
| | - Ramon J Baez
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Carolina Diaz Guillory
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kevin J Donly
- Department of Developmental Dentistry, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Carlos Alberto Feldens
- Department of Pediatric Dentistry, Lutheran University of Brazil, School of Dentistry, Canoas, Brazil
| | - Colman McGrath
- Dental Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
| | | | - Nigel B Pitts
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Dental Innovation and Impact, Kings College London, London, UK
| | - W Kim Seow
- School of Dentistry, University of Queensland, Herston, Queensland, Australia
| | - Nikolai Sharkov
- Department of Paediatric Dental Medicine, Faculty of Dental Medicine, Medical University, Sofia, Bulgaria
| | - Yupin Songpaisan
- Department of Family and Community Oral Health, Institute of Dentistry, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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18
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Palacio R, Shen J, Vale L, Vernazza CR. Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry. Community Dent Oral Epidemiol 2019; 47:217-224. [DOI: 10.1111/cdoe.12447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Raul Palacio
- School of DentistryPontificia Universidad Católica de Chile Santiago Chile
| | - Jing Shen
- Institute of Health and SocietyNewcastle University Newcastle Upon Tyne UK
| | - Luke Vale
- Institute of Health and SocietyNewcastle University Newcastle Upon Tyne UK
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19
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A Pilot Quality Improvement Collaborative to Improve Safety Net Dental Access for Pregnant Women and Young Children. Matern Child Health J 2019; 22:255-263. [PMID: 29168163 DOI: 10.1007/s10995-017-2397-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives To determine acceptability and feasibility of a quality improvement (QI) collaborative in safety net dental practices, and evaluate its effects on financial stability, access, efficiency, and care for pregnant women and young children. Methods Five safety net dental practices participated in a 15-month learning collaborative utilizing business assessments, QI training, early childhood oral health training, and prenatal oral health training. Practices collected monthly data on: net revenue, no-show rates, total encounters, and number of encounters for young children and pregnant women. We analyzed quantitative data using paired t-tests before and after the collaborative and collected supplemental qualitative feedback from clinic staff through focus groups and directed email. Results All mean measures improved, including: higher monthly revenue ($28,380-$33,102, p = 0.37), decreased no-show rate (17.7-14.3%, p = 0.11), higher monthly dental health encounters (283-328, p = 0.08), and higher monthly encounters for young children (8.8-10.5, p = 0.65), and pregnant women (2.8-9.7, p = 0.29). Results varied by practice, with some demonstrating largest increases in encounters for young children and others pregnant women. Focus group participants reported that the collaborative improved access for pregnant women and young children, and that QI methods were often new and difficult. Conclusion for practice Participation by safety net dental practices in a QI collaborative is feasible and acceptable. Individual sites saw greater improvements in different outcomes areas, based on their own structures and needs. Future efforts should focus on specific needs of each dental practice and should offer additional QI training.
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20
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Geiger CK, Kranz AM, Dick AW, Duffy E, Sorbero M, Stein BD. Delivery of Preventive Oral Health Services by Rurality: A Cross-Sectional Analysis. J Rural Health 2019; 35:3-11. [PMID: 30537073 PMCID: PMC6298795 DOI: 10.1111/jrh.12340] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Integrating oral health care into primary care has been promoted as a strategy to increase delivery of preventive oral health services (POHS) to young children, particularly in rural areas where few dentists practice. Using a multistate sample of Medicaid claims, we examined a child's odds of receiving POHS in a medical office by county rurality. METHODS We used 2012-2014 Medicaid Analytic extract claims data for 6,275,456 children younger than 6 years in 39 states that allowed Medicaid payment for POHS in medical offices. We used county-level characteristics from the Area Health Resources Files, including a 3-level measure of county rurality. We used logistic regression to estimate a child's odds of receiving POHS in a medical office by county rurality, while controlling for other patient and county characteristics. FINDINGS POHS in medical offices were received by 7.8% of children. Rates of POHS in medical offices were higher in metropolitan (metro) counties (8.4%) than nonmetro adjacent to metro (5.8%) and nonmetro not adjacent to metro (4.3%). In adjusted analysis, children living in nonmetro not adjacent to metro (OR = 0.79, 95% CI: 0.64-0.99) and adjacent to metro counties (OR = 0.70, 95% CI: 0.59-0.82) were significantly less likely to receive POHS in medical offices than children living in metro counties. CONCLUSIONS In this study of POHS in medical offices among young Medicaid-enrolled children, we found POHS rates were lowest in nonmetro counties. Given barriers to dental care in rural areas, states should take additional steps beyond allowing Medicaid reimbursement to increase delivery of POHS in medical offices.
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Affiliation(s)
- Caroline K. Geiger
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
- Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts
| | | | | | - Erin Duffy
- Pardee RAND Graduate School, Santa Monica, California
| | - Mark Sorbero
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
| | - Bradley D. Stein
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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21
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Kranz AM, Duffy E, Dick AW, Sorbero M, Rozier RG, Stein BD. Impact of Medicaid Policy on the Oral Health of Publicly Insured Children. Matern Child Health J 2019; 23:100-108. [PMID: 30032444 PMCID: PMC6324972 DOI: 10.1007/s10995-018-2599-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective Fluoride varnish (FV) applications among non-dentist primary care providers has increased due to state Medicaid policies. In this study we examine the impact of FV policies on the oral health of publicly insured children aged 2-6 years old. Methods Using three waves of the National Survey of Children's Health (2003, 2007, 2011/12), we used a logistic regression model with state and year fixed effects, adjusting for relevant child characteristics, to examine the association between years since a state implemented a FV policy and the odds of a publicly insured child having very good or excellent teeth. We compared children with public insurance in states with FV policies to children with public insurance in states without FV policies, controlling for the same difference among children with private insurance who were unlikely to be affected by Medicaid FV policies. Results Among 68,890 children aged 2-6 years, 38% had public insurance. Compared to privately insured children, publicly insured children had significantly lower odds of having very good or excellent teeth [odds ratio (OR) 0.70, 95% CI 0.62-0.81]. Publicly insured children in states with FV policies implemented for four or more years had significantly greater odds of having very good or excellent teeth (OR 1.28, 95% CI 1.03-1.60) compared to publicly insured children in states without FV policies. Conclusions for Practice State policies supporting non-dental primary care providers application of FV were associated with improvements in oral health for young children with public insurance.
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Affiliation(s)
| | - Erin Duffy
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Andrew W Dick
- RAND, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA, 02116, USA
| | - Mark Sorbero
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
| | - Richard Gary Rozier
- University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Bradley D Stein
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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22
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Fontana M, Eckert GJ, Keels MA, Jackson R, Katz B, Levy BT, Levy SM. Fluoride Use in Health Care Settings: Association with Children's Caries Risk. Adv Dent Res 2018; 29:24-34. [PMID: 29355412 DOI: 10.1177/0022034517735297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly ( P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797).
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Affiliation(s)
- M Fontana
- 1 University of Michigan, Ann Arbor, MI, USA
| | - G J Eckert
- 2 Indiana University, Indianapolis, IN, USA
| | | | - R Jackson
- 2 Indiana University, Indianapolis, IN, USA
| | - B Katz
- 2 Indiana University, Indianapolis, IN, USA
| | - B T Levy
- 4 University of Iowa, Iowa City, IA, USA
| | - S M Levy
- 4 University of Iowa, Iowa City, IA, USA
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Lee I, Monahan S, Serban N, Griffin PM, Tomar SL. Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States. Health Serv Res 2018; 53:3592-3616. [PMID: 29194610 PMCID: PMC6153169 DOI: 10.1111/1475-6773.12811] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To quantify the impact of multiyear utilization of preventive dental services on downstream dental care utilization and expenditures for children. DATA SOURCES/STUDY SETTING We followed 0.93 million Medicaid-enrolled children who were 3-6 years old in 2005 from 2005 to 2011. We used Medicaid claims data of Alabama, Georgia, Mississippi, North Carolina, South Carolina, and Texas. STUDY DESIGN We clustered each state's study population into four groups based on utilization of topical fluoride and dental sealants before caries-related treatment using machine learning algorithms. We evaluated utilization rates and expenditures across the four groups and quantified cost savings of preventive care for different levels of penetration. DATA EXTRACTION METHOD We extracted all dental-related claims using CDT codes. PRINCIPAL FINDINGS In all states, Medicaid expenditures were much lower for children who received topical fluoride and dental sealants before caries development than for all other children, with a per-member per-year difference ranging from $88 for Alabama to $156 for Mississippi. CONCLUSIONS The cost savings from topical fluoride and sealants across the six states ranged from $1.1M/year in Mississippi to $12.9M/year in Texas at a 10 percent penetration level. Preventive dental care for children not only improves oral health outcomes but is also cost saving.
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Affiliation(s)
- Ilbin Lee
- School of BusinessUniversity of AlbertaEdmontonABCanada
| | - Sean Monahan
- Fraud Strategy and AnalysisCapital One Financial CorporationArlingtonVA
| | - Nicoleta Serban
- School of Industrial and Systems EngineeringGeorgia Institute of TechnologyAtlantaGA
| | - Paul M. Griffin
- Regenstrief Center for Healthcare EngineeringPurdue UniversityWest LafayetteIN
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Quinonez RB, Rozier RG, Mattison K, Joshi N, Preisser JS. Implementing an early childhood oral health program in a federally qualified health center in North Carolina. J Public Health Dent 2018; 78:329-336. [PMID: 30103268 DOI: 10.1111/jphd.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the Baby Oral Health Program's (bOHP) influence on dental visits for children 0 to 3 years and overall dental visits in four federally qualified health center (FQHC) clinics. METHODS Using an interrupted time series study design, administrative data were obtained for the year prior and following the intervention. The intervention included dental staff training on early childhood oral health, quality improvement, and monthly visits during the follow-up intervention period. Analysis included descriptive and segmented regression using aggregate patient visit data. RESULTS A total of 10,400 patients made 26,416 visits over the study period; 1,187 (11 percent) were children ≤3 years. Visit counts in the youngest age group increased 70 percent following the intervention. When controlling for the naturally increasing trend, the intervention added 8.7 (95 percent CI: 4.7, 12.8) early childhood patient-visits per clinic in the last month of the intervention period. The increase in visit counts in the youngest age group had no significant effect on other ages, except for a decline relative to the natural trend in patient-visits among 35-50 year olds (-32.3 less visits) following the intervention. The proportion of visits for all ages by ≤3 year olds increased from 5 to 8 percent following the intervention. CONCLUSIONS bOHP increased dental visits among children ≤3 years but the finding might be attributable to clinic changes coinciding with bOHP implementation that were not controlled with the study design. Additional studies are needed in populations experiencing challenges accessing dental care.
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Affiliation(s)
- Rocio B Quinonez
- Department of Pediatric Dentistry and Pediatrics, Schools of Dentistry and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Neha Joshi
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Atchison KA, Weintraub JA, Rozier RG. Bridging the dental-medical divide: Case studies integrating oral health care and primary health care. J Am Dent Assoc 2018; 149:850-858. [PMID: 30057150 DOI: 10.1016/j.adaj.2018.05.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/02/2018] [Accepted: 05/17/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND The National Academies of Sciences, Engineering, and Medicine commissioned an environmental scan describing the status of health care integration of oral health and primary care services. METHODS The authors conducted an environmental scan of US integration activities with publications from January 2000 through August 2017. They categorized services as preventive oral health services (POHS) provided by medical care providers, POHS provided by dental providers in nondental settings, preventive health services provided by dental providers, or care coordination using dedicated personnel and technology. The authors chose 4 programs as case studies and interviewed key personnel in each program. One case study illustrates each category of integrated services; additional examples describe category variation. RESULTS The case study involving Into the Mouth of Babes illustrates medical professionals delivering POHS to children. The case study involving Grace Health presents dental hygienists embedded in the obstetrics-gynecology clinic to provide oral screening, prophylaxis, and education to pregnant women. At HealthPartners, medical care providers refer patients with diabetes to dentists and waive copays for periodontal care. The InterCommunity Health Network Coordinated Care Organization uses dedicated patient coordinators, technology, and coordinated payment and referral mechanisms to facilitate care. CONCLUSIONS Integration of dental and medical care increased access to and coordination of patient care by means of offering health care services traditionally provided by the other profession. PRACTICAL IMPLICATIONS Integration models demonstrate the incorporation of POHS by primary care professionals, the embedding of dental professionals into primary care clinics, and the incorporation of care coordination to increase the delivery of oral health care. Similarly, dentists identify and refer patients with medical needs or preventive gaps to medical homes.
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Gnaedinger EA. Fluoride varnish application, a quality improvement project implemented in a rural pediatric practice. Public Health Nurs 2018; 35:534-540. [PMID: 29888506 DOI: 10.1111/phn.12522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The United States has a public health crisis of dental caries in children's primary teeth. Fifty-five percent of children have dental caries by age 8. The majority of these children are nonwhite and poor. Caries could be decreased by 40% if fluoride varnish (FV) application started with tooth eruption. DESIGN AND SAMPLE A four-month FV application QI project was implemented in a rural pediatric practice. The staff was trained by the Vermont Department of Health using the From the First Tooth protocol. Children aged 9, 18, 24, and 30 months. MEASURES Pre- and postproject questionnaires were completed. A caries risk tool assessed a child's risk and access to dental care. Completed FV applications were recorded and staff interviewed weekly. INTERVENTION FV application was offered at well child checks (WCCs). RESULTS Fifty-six percent of sample patients received FV at their WCCs. Qualitative themes included the following: reasons subjects did/did not receive FV, ease of FV application, increased oral hygiene education, visit flow, application time, older children's FV need, and billing issues. CONCLUSION This economical, FV application program can be readily implemented by nurse practitioners and nurses in pediatric practices where children have inadequate dental care.
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Shea CM, Turner K, White BA, Zhu Y, Rozier RG. Providers' preferences for pediatric oral health information in the electronic health record: a cross-sectional survey. BMC Pediatr 2018; 18:5. [PMID: 29325519 PMCID: PMC5765629 DOI: 10.1186/s12887-017-0979-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The majority of primary care physicians support integration of children's oral health promotion and disease prevention into their practices but can experience challenges integrating oral health services into their workflow. Most electronic health records (EHRs) in primary care settings do not include oral health information for pediatric patients. Therefore, it is important to understand providers' preferences for oral health information within the EHR. The objectives of this study are to assess (1) the relative importance of various elements of pediatric oral health information for primary care providers to have in the EHR and (2) the extent to which practice and provider characteristics are associated with these information preferences. METHODS We surveyed a sample of primary care physicians who conducted Medicaid well-child visits in North Carolina from August - December 2013. Using descriptive statistics, we analyzed primary care physicians' oral health information preferences relative to their information preferences for traditional preventive aspects of well-child visits. Furthermore, we analyzed associations between oral health information preferences and provider- and practice-level characteristics using an ordinary least squares regression model. RESULTS Fewer primary care providers reported that pediatric oral health information is "very important," as compared to more traditional elements of primary care information, such as tracking immunizations. However, the majority of respondents reported some elements of oral health information as being very important. Also, we found positive associations between the percentage of well child visits in which oral health screenings and oral health referrals are performed and the reported importance of having pediatric oral health information in the EHR. CONCLUSIONS Incorporating oral health information into the EHR may be desirable for providers, particularly those who perform oral health screenings and dental referrals.
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Affiliation(s)
- Christopher M. Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
| | - Kea Turner
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
| | - B. Alex White
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
- Department of Dental Ecology, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC USA
| | - Ye Zhu
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
| | - R. Gary Rozier
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
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Lamster IB, Myers-Wright N. Oral Health Care in the Future: Expansion of the Scope of Dental Practice to Improve Health. J Dent Educ 2017; 81:eS83-eS90. [PMID: 28864808 DOI: 10.21815/jde.017.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/06/2017] [Indexed: 12/30/2022]
Abstract
The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21st Century."
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Affiliation(s)
- Ira B Lamster
- Dr. Lamster is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University; Dr. Myers-Wright is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University.
| | - Noreen Myers-Wright
- Dr. Lamster is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University; Dr. Myers-Wright is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University
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Braun PA, Widmer-Racich K, Sevick C, Starzyk EJ, Mauritson K, Hambidge SJ. Effectiveness on Early Childhood Caries of an Oral Health Promotion Program for Medical Providers. Am J Public Health 2017; 107:S97-S103. [PMID: 28661802 DOI: 10.2105/ajph.2017.303817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess an oral health promotion (OHP) intervention for medical providers' impact on early childhood caries (ECC). METHODS We implemented a quasiexperimental OHP intervention in 8 federally qualified health centers that trained medical providers on ECC risk assessment, oral examination and instruction, dental referral, and fluoride varnish applications (FVAs). We measured OHP delivery by FVA count at medical visits. We measured the intervention's impact on ECC in 3 unique cohorts of children aged 3 to 4 years in 2009 (preintervention; n = 202), 2011 (midintervention; n = 420), and 2015 (≥ 4 FVAs; n = 153). We compared numbers of decayed, missing, and filled tooth surfaces using adjusted zero-inflated negative binomial models. RESULTS Across 3 unique cohorts, the FVA mean (range) count was 0.0 (0), 1.1 (0-7), and 4.5 (4-7) in 2009, 2011, and 2015, respectively. In adjusted zero-inflated negative binomial models analyses, children in the 2015 cohort had significantly fewer decayed, missing, and filled tooth surfaces than did children in previous cohorts. CONCLUSIONS An OHP intervention targeting medical providers reduced ECC when children received 4 or more FVAs at a medical visit by age 3 years.
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Affiliation(s)
- Patricia A Braun
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Katina Widmer-Racich
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Carter Sevick
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Erin J Starzyk
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Katya Mauritson
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Simon J Hambidge
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
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Mertz E, Spetz J, Moore J. Pediatric Workforce Issues. Dent Clin North Am 2017; 61:577-588. [PMID: 28577638 DOI: 10.1016/j.cden.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Untreated dental disease remains one of the most prevalent health conditions for children, driven in part by disparities in access to care. This article examines evidence-based workforce strategies being used to facilitate better access to pediatric health services and to improve oral health status and outcomes for children. The workforce strategies described in this article include promising new models in the dental field, with new and existing providers as well as emerging workforce models outside of the dental field. Case studies for some of these workforce strategies are also presented. Future directions and health policy implications are considered.
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Affiliation(s)
- Elizabeth Mertz
- Preventive and Restorative Dental Sciences, Healthforce Center, University of California, San Francisco, 3333 California Street, Suite 410, San Francisco, CA 94143, USA.
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, Healthforce Center, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143, USA
| | - Jean Moore
- Center for Health Workforce Studies, School of Public Health, University at Albany, State University of New York, 1 University Place, Suite 220, Rensselaer, NY 12144, USA
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Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J, Twetman S, Tsakos G, Ismail A. Dental caries. Nat Rev Dis Primers 2017; 3:17030. [PMID: 28540937 DOI: 10.1038/nrdp.2017.30] [Citation(s) in RCA: 793] [Impact Index Per Article: 113.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. Caries can occur throughout life, both in primary and permanent dentitions, and can damage the tooth crown and, in later life, exposed root surfaces. The balance between pathological and protective factors influences the initiation and progression of caries. This interplay between factors underpins the classification of individuals and groups into caries risk categories, allowing an increasingly tailored approach to care. Dental caries is an unevenly distributed, preventable disease with considerable economic and quality-of-life burdens. The daily use of fluoride toothpaste is seen as the main reason for the overall decline of caries worldwide over recent decades. This Primer aims to provide a global overview of caries, acknowledging the historical era dominated by restoration of tooth decay by surgical means, but focuses on current, progressive and more holistic long-term, patient-centred, tooth-preserving preventive care.
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Affiliation(s)
- Nigel B Pitts
- Dental Innovation and Translation Centre, King's College London Dental Institute, Floor 17 Tower Wing, Guy's Hospital, Great Maze Pond Road, London SE1 9RT, UK
| | - Domenick T Zero
- Department of Cariology Operative Dentistry and Dental Public Health, Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Phil D Marsh
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - Kim Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Jane A Weintraub
- Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
| | - Francisco Ramos-Gomez
- UCLA Center Children's Oral Health - UCCOH and Section of Pediatric Dentistry, UCLA School of Dentistry, University of California Los Angeles, Los Angeles, California, USA
| | - Junji Tagami
- Cariology and Operative Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Svante Twetman
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, UCL, London, UK
| | - Amid Ismail
- Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
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Blackburn J, Morrisey MA, Sen B. Outcomes Associated With Early Preventive Dental Care Among Medicaid-Enrolled Children in Alabama. JAMA Pediatr 2017; 171:335-341. [PMID: 28241184 PMCID: PMC5470412 DOI: 10.1001/jamapediatrics.2016.4514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/14/2016] [Indexed: 11/14/2022]
Abstract
Importance There is a recommendation for children to have a dental home by 6 months of age, but there is limited evidence supporting the effectiveness of early preventive dental care or whether primary care providers (PCPs) can deliver it. Objective To investigate the effectiveness of preventive dental care in reducing caries-related treatment visits among Medicaid enrollees. Design, Setting, and Participants High-dimensional propensity scores were used to address selection bias for a retrospective cohort study of children continuously enrolled in coverage from the Alabama Medicaid Agency from birth between 2008 and 2012, adjusting for demographics, access to care, and general health service use. Exposures Children receiving preventive dental care prior to age 2 years from PCPs or dentists vs no preventive dental care. Main Outcome and Measures Two-part models estimated caries-related treatment and expenditures. Results Among 19 658 eligible children, 25.8% (n = 3658) received early preventive dental care, of whom 44% were black, 37.6% were white, and 16.3% were Hispanic. Compared with matched children without early preventive dental care, children with dentist-delivered preventive dental care more frequently had a subsequent caries-related treatment (20.6% vs 11.3%, P < .001), higher rate of visits (0.29 vs 0.15 per child-year, P < .001), and greater dental expenditures ($168 vs $87 per year, P < .001). Dentist-delivered preventive dental care was associated with an increase in the expected number of caries-related treatment visits by 0.14 per child per year (95% CI, 0.11-0.16) and caries-related treatment expenditures by $40.77 per child per year (95% CI, $30.48-$51.07). Primary care provider-delivered preventive dental care did not significantly affect caries-related treatment use or expenditures. Conclusions and Relevance Children with early preventive care visits from dentists were more likely to have subsequent dental care, including caries-related treatment, and greater expenditures than children without preventive dental care. There was no association with subsequent caries-related treatment and preventive dental care from PCPs. We observed no evidence of a benefit of early preventive dental care, regardless of the provider. Additional research beyond administrative data may be necessary to elucidate any benefits of early preventive dental care.
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Affiliation(s)
- Justin Blackburn
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham
| | - Michael A. Morrisey
- Department of Health Policy and Management, Texas A&M School of Public Health, College Station
| | - Bisakha Sen
- Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham
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Edelstein BL, Hirsch G, Frosh M, Kumar J. Reducing early childhood caries in a Medicaid population: a systems model analysis. J Am Dent Assoc 2016; 146:224-32. [PMID: 25819653 DOI: 10.1016/j.adaj.2014.12.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite early childhood caries (ECC) being largely preventable, its repair accounts for a disproportionate share of Medicaid expenditures. In this study, the authors model disease reductions and cost savings from ECC management alternatives. METHODS The authors apply system dynamics modeling to the New York State Medicaid population of young children to compare potential outcomes of 9 preventive interventions (water fluoridation, fluoride varnish, fluoride toothpaste, medical screening and fluoride varnish application, bacterial transmission reduction, motivational interviewing, dental prevention visits, secondary prevention, and combinations) and the effect of defluoridating New York City. RESULTS Model simulations help project 10-year disease reductions and net savings from water fluoridation, motivational interviewing, and fluoride toothpaste. Interventions requiring health professionals cost more than they save. Interventions that target children at high risk, begin early, and combine multiple strategies hold greatest potential. Defluoridating New York City would increase disease and costs dramatically. CONCLUSIONS The variety of population-level and individual-level interventions available to control ECC differ substantially in their capacity to improve children's oral health and reduce state Medicaid expenditures. PRACTICAL IMPLICATIONS Using Medicaid and health department dollars to deliver ECC preventive and management interventions holds strong promise to improve children's oral health while reducing state dental expenditures in Medicaid.
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Murshid EZ. Dental knowledge of educators and healthcare providers working with children with autism spectrum disorders. Saudi Med J 2016; 36:1477-85. [PMID: 26620991 PMCID: PMC4707405 DOI: 10.15537/smj.2015.12.12622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate dental knowledge and attitudes toward oral health care among healthcare providers and educators working with children with autism spectrum disorders (ASD) in central Saudi Arabia. METHODS There were 305 questionnaires distributed to 7 special-needs centers between September and November 2014. A total of 217 questionnaires were collected with a response rate of 71.1%. The study took place in the College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. RESULTS Approximately 50.2% of the participants did not offer any toothbrushing advice, and 73.3% never recommended dental checkup visits to parents, and 75.6% never performed dental examinations to children under their care. Ten percent thought that children should have their first dental visit after 6 years of age. Almost all participants agreed that children should practice oral hygiene, and 60.4% think they should brush twice per day. In general, the participants choose toothbrushes and toothpaste as the main tools to perform oral hygiene. There were 35% of participants who believed that parents should be responsible for the children's oral hygiene, and a few participants mentioned teachers and therapists to be responsible. Most of the participants (71.4%) did not receive any dental information from dental professional resources, only 14.3% of participants believed bacteria to be the cause of dental cavities. CONCLUSION There is a clear lack of dental knowledge and attitudes, and its practical application among the participating group of healthcare providers working with children with ASD in Riyadh.
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Affiliation(s)
- Ebtissam Z Murshid
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Kranz AM, Lee J, Divaris K, Baker AD, Vann W. North Carolina physician-based preventive oral health services improve access and use among young Medicaid enrollees. Health Aff (Millwood) 2016; 33:2144-52. [PMID: 25489032 DOI: 10.1377/hlthaff.2014.0927] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To combat disparities in oral health and access to dental care among infants and toddlers, most state Medicaid programs now reimburse physician-based preventive oral health services such as fluoride varnish applications. We used geospatial data to examine the distribution of dental and medical Medicaid providers of pediatric oral health services throughout North Carolina to determine if these services have improved access to care for Medicaid enrollees younger than age three. We then used claims data to examine the association between distance from these practices and use of dental services for a cohort of approximately 1,000 young children. Among one hundred counties, four counties had no physician-based preventive oral health services, and nine counties had no dental practice. While children who lived farther from the nearest dental practice were less likely to make dental visits, distance from physician-based preventive oral health services did not predict utilization. For young Medicaid enrollees, oral health services provided in medical offices can improve access and increase utilization.
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Affiliation(s)
- Ashley M Kranz
- Ashley M. Kranz is an adjunct assistant professor of pediatric dentistry at the University of North Carolina-Chapel Hill School of Dentistry, and a Health Systems Integration Program fellow at the Health and Human Services Agency, County of San Diego, in California
| | - Jessica Lee
- Jessica Lee is a distinguished professor and chair in pediatric dentistry at the University of North Carolina-Chapel Hill School of Dentistry
| | - Kimon Divaris
- Kimon Divaris is an associate professor in pediatric dentistry at the University of North Carolina-Chapel Hill School of Dentistry
| | - A Diane Baker
- A. Diane Baker is a research associate at the University of North Carolina-Chapel Hill School of Dentistry
| | - William Vann
- William Vann Jr. is a research professor in pediatric dentistry at the University of North Carolina-Chapel Hill School of Dentistry
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Dooley D, Moultrie NM, Heckman B, Gansky SA, Potter MB, Walsh MM. Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System. Pediatrics 2016; 137:peds.2014-3532. [PMID: 26647374 PMCID: PMC4702016 DOI: 10.1542/peds.2014-3532] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years. METHODS Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle. RESULTS In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits. CONCLUSIONS With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.
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Affiliation(s)
- Diane Dooley
- Contra Costa Regional Medical Center, Martinez, California;
| | | | - Barbara Heckman
- Departments of Preventive and Restorative Dental Sciences and
| | - Stuart A Gansky
- Departments of Preventive and Restorative Dental Sciences and
| | - Michael B Potter
- Family and Community Medicine, University of California San Francisco, San Francisco, California
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Askelson NM, Chi DL, Momany ET, Kuthy RA, Carter KD, Field K, Damiano PC. The Importance of Efficacy: Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits. HEALTH EDUCATION & BEHAVIOR 2015; 42:805-13. [PMID: 25862302 DOI: 10.1177/1090198115580575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid. The extended parallel process model was used as a theoretical framework for this research. This model suggests that people will act if the perceived threat (severity and susceptibility) is high enough and if efficacy levels (self-efficacy and response efficacy) are likewise high. Following Witte's method of categorizing people's perceptions and emotions into one of four categories based on levels of threat and efficacy, this article describes four groups (high threat/high efficacy, high threat/low efficacy, low threat/high efficacy, and low threat/low efficacy) of parents and how they compare to each other. Using logistic regression to model if a child had a preventive visit, results indicate that parents with low threat/high efficacy and parents with high threat/high efficacy had approximately 2.5 times the odds of having a child with a preventive oral health visit compared to parents with low threat/low efficacy, when controlling for perceived oral health status, health literacy, and child's age. The importance of efficacy needs to be incorporated in interventions aimed at increasing preventive dental visits for young children.
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McManus BM, Chi D, Carle A. State Medicaid Eligibility Criteria and Unmet Preventive Dental Care Need for CSHCN. Matern Child Health J 2015; 20:456-65. [DOI: 10.1007/s10995-015-1843-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Braun PA, Racich KW, Ling SB, Ellison MC, Savoie K, Reiner L, Westfall JM. Impact of an interprofessional oral health education program on health care professional and practice behaviors: a RE-AIM analysis. Pediatric Health Med Ther 2015; 6:101-109. [PMID: 29388574 PMCID: PMC5683258 DOI: 10.2147/phmt.s79826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early childhood caries is the most common chronic childhood condition and largely preventable. Access to oral health preventive services (OHPS) for children at risk for caries is suboptimal and could be expanded if they were provided by non-dental professionals. Many state Medicaid programs in the USA now reimburse non-dental professionals for OHPS but require that they receive oral health education (OHE) to be reimbursed. Few OHE programs have been evaluated. METHODS We evaluated the impact of Colorado's OHE program on professional- and practice-level behaviors regarding the provision of OHPS to children by measuring its reach, effectiveness, adoption, implementation, and maintenance (ie, using the Reach Effectiveness Adoption Implementation Maintenance [RE-AIM] framework) with Medicaid claims data, online surveys, and key informant interviews. RESULTS From 2009 to 2012, the proportion of young, low-income children receiving OHPS from a medical professional increased 16-fold. We surveyed 703 OHE participants; post-OHE response rates were 61% at 12 months, 34% at 24 months (2009 participants), and 39% at 12 months (2011 participants). Respondents reported confidence in providing OHPS; favorable oral health knowledge, attitudes, and beliefs; and were providing OHPS to most eligible children. Approximately half of the practices had initiated practice-level changes to support program implementation and maintenance. Few barriers were reported to care. Eighteen interviewees reported factors facilitating program diffusion, which included quality materials, community need, and reimbursement; barriers included lack of time to provide services, resources to purchase supplies, and referral dentists. CONCLUSION This evaluation of a state interprofessional OHE program shows evidence of program diffusion and identifies facilitating factors and barriers to having medical professionals provide OHPS.
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Affiliation(s)
| | | | - Sarah B Ling
- Department of Family Medicine, Broadlawns Medical Center, Des Moines, IA, USA
| | | | - Karen Savoie
- Area Health Education Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - John M Westfall
- Area Health Education Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Kranz AM, Preisser JS, Rozier RG. Effects of Physician-Based Preventive Oral Health Services on Dental Caries. Pediatrics 2015; 136:107-14. [PMID: 26122805 PMCID: PMC4485004 DOI: 10.1542/peds.2014-2775] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most Medicaid programs reimburse nondental providers for preventive dental services. We estimate the impact of comprehensive preventive oral health services (POHS) on dental caries among kindergarten students, hypothesizing improved oral health among students with medical visits with POHS. METHODS We conducted a retrospective study in 29,173 kindergarten students by linking Medicaid claims (1999-2006) with public health surveillance data (2005-2006). Zero-inflated regression models estimated the association between number of visits with POHS and (1) decayed, missing, and filled primary teeth (dmft) and (2) untreated decayed teeth while adjusting for confounding. RESULTS Kindergarten students with ≥4 POHS visits averaged an adjusted 1.82 dmft (95% confidence interval: 1.55 to 2.09), which was significantly less than students with 0 visits (2.21 dmft; 95% confidence interval: 2.16 to 2.25). The mean number of untreated decayed teeth was not reduced for students with ≥4 POHS visits compared with those with 0 visits. CONCLUSIONS POHS provided by nondental providers in medical settings were associated with a reduction in caries experience in young children but were not associated with improvement in subsequent use of treatment services in dental settings. Efforts to promote oral health in medical settings should continue. Strategies to promote physician-dentist collaborations are needed to improve continuity of care for children receiving dental services in medical settings.
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Affiliation(s)
| | | | - R. Gary Rozier
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Muntean A, Mesaros AS, Festila D, Mesaros M. Modern management of dental decay in children and adolescents - a review. CLUJUL MEDICAL (1957) 2015; 88:137-9. [PMID: 26528061 PMCID: PMC4576786 DOI: 10.15386/cjmed-401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/15/2015] [Accepted: 01/26/2015] [Indexed: 11/24/2022]
Abstract
Health is a right that requires responsible individual actions. Oral health corresponds to an important part of general health, even if for a large majority of people healthy teeth are equal with beautiful teeth. For children and adolescents "having an attractive smile" is synonymous with social acceptance and success. Dental decay has a high incidence in children in our country and progress in decay prevention, diagnosis and treatment is not reflected in children and adolescents' oral health. It is established by studies conducted by dentists and psychologists that dental decay can affect the quality of life by engendering specific eating behaviors, particular ways of speech or smile and unfortunately pain. The aim of this article is to emphasize the modern approach of dental decay in line with principles of non-invasive strategies. An important element to be considered - prophylactic methods - must be included in every treatment plan, in order to control individual caries risk. The time invested in prevention during childhood represents a real benefit for the future adult's oral health. Many a dental problems can be avoided if dental decay management relies on the link between medical science and every day practice.
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Affiliation(s)
- Alexandrina Muntean
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Stefania Mesaros
- Department of Dental Propedeutics and Esthetics, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Festila
- Department of Orthodontics, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michaela Mesaros
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Biordi DL, Heitzer M, Mundy E, DiMarco M, Thacker S, Taylor E, Huff M, Marino D, Fitzgerald K. Improving access and provision of preventive oral health care for very young, poor, and low-income children through a new interdisciplinary partnership. Am J Public Health 2015; 105 Suppl 2:e23-9. [PMID: 25689183 PMCID: PMC4355709 DOI: 10.2105/ajph.2014.302486] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We provided oral health care services at 2 sites using a nurse practitioner-dietitian team to increase dental workforce capacity and improve access to care for low-income preschool children. METHODS Our team provided oral health assessments and education, fluoride varnish application, and dentist referrals. The primary endpoint was participants' access to oral health care. Secondary endpoints included increasing the practice scope of registered dietitians through training programs for oral health assessment and the application of fluoride varnishes for children. The oral health and hygiene and dietary habits of the participants were also determined. RESULTS From 2010 to 2013, 4360 children received fluoride varnishes in 7195 total visits. Although the proportion of children with dental caries at the first visit was greater at the urban site, both sites were similar by visits 2 and 3. The number of caries declined with increased program visits, which coincided with an increase in the proportion of participants visiting a dentist. CONCLUSIONS Progress toward eliminating dental health disparities requires addressing barriers to dental care access. We showed that expanding access to oral health services through nurse practitioner-dietitian cooperation improved access to preventive fluoride varnishing use in low-income children.
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Affiliation(s)
- Diana L Biordi
- Diana L. Biordi, Marjet Heitzer, Eric Mundy, Marguerite DiMarco, Marlene Huff, and Karen Fitzgerald are with the School of Nursing, University of Akron, Akron, OH. Sherrey Thacker is with the College of Health Professions, University of Akron, Akron. Evelyn Taylor and Deborah Marino are with the College of Nutrition and Dietetics, University of Akron, Akron
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Herndon JB, Tomar SL, Catalanotto FA. Effect of training pediatricians and family physicians in early childhood caries prevention. J Pediatr 2015; 166:1055-61.e1. [PMID: 25662286 DOI: 10.1016/j.jpeds.2014.12.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 12/01/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyze the effect of postresidency early childhood caries prevention training on physicians' oral health knowledge, confidence, and practice patterns and to identify variations by type of training. STUDY DESIGN We conducted pre- and post-training surveys of pediatricians and family physicians in Florida. Paired t test and repeated-measures ANOVA analyses were used to compare physicians with no oral health training, those with applied in-office training, and those with another type of training on 5 composite measures: fluoride knowledge, nonfluoride oral health knowledge, confidence in advising parents, confidence in conducting oral health screening and caries risk assessment, and frequency in performing recommended oral health practices. RESULTS The final sample included 229 physicians (162 pediatricians and 67 family physicians). The interaction in the repeated-measures ANOVA between group (training category) and time (pre- and post-training) was significant for the nonfluoride knowledge [F(2, 225) = 4.1, P = .02] and confidence in screening [F(2, 224) = 4.1, P = .02] composite measures, lending support for a positive treatment effect of training on these domains. Greater gains were observed among physicians with in-office training compared with those who received another type of training. A statistically significant treatment effect on oral health practices was not detected. CONCLUSIONS Efforts to engage physicians in oral health training and to incorporate applied components in training curricula may improve physicians' oral health knowledge and increase their confidence in conducting oral health screenings and caries risk assessments. Additional research is needed to evaluate the relative costs and benefits of different training modalities on specific oral health practices.
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Affiliation(s)
- Jill Boylston Herndon
- Department of Health Outcomes and Policy and Institute for Child Health Policy, University of Florida College of Medicine, Gainesville, FL; Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, FL
| | - Scott L Tomar
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, FL
| | - Frank A Catalanotto
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, FL
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Kranz AM, Rozier RG, Preisser JS, Stearns SC, Weinberger M, Lee JY. Examining continuity of care for Medicaid-enrolled children receiving oral health services in medical offices. Matern Child Health J 2015; 19:196-203. [PMID: 24802261 PMCID: PMC4224632 DOI: 10.1007/s10995-014-1510-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Children living in poverty encounter barriers to dentist visits and disproportionally experience dental caries. To improve access, most state Medicaid programs reimburse pediatric primary care providers for delivering preventive oral health services. To understand continuity of oral health services for children utilizing the North Carolina (NC) Into the Mouths of Babes (IMB) preventive oral health program, we examined the time to a dentist visit after a child's third birthday. This retrospective cohort study used NC Medicaid claims from 2000 to 2006 for 95,578 Medicaid-enrolled children who received oral health services before age 3. We compared children having only dentist visits before age 3 to those with: (1) only IMB visits and (2) both IMB and dentist visits. Cox proportional hazards regression was used to estimate the time to a dentist visit following a child's third birthday. Propensity scores with inverse-probability-of-treatment-weights were used to address confounding. Children with only IMB visits compared to only dentist visits before age 3 had lower rates of dentist visits after their third birthday [adjusted hazard ratio (AHR) = 0.41, 95 % confidence interval (CI) 0.39-0.43]. No difference was observed for children having both IMB and dentist visits and only dentist visits (AHR = 0.99, 95 % CI 0.96-1.03). Barriers to dental care remain as children age, hindering continuity of care for children receiving oral health services in medical offices.
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Affiliation(s)
- Ashley M Kranz
- Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, Koury Oral Health Sciences Building, Room 4505, Campus Box 7455, Chapel Hill, NC, 27599-7455, USA,
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Chi DL. Caregivers who refuse preventive care for their children: the relationship between immunization and topical fluoride refusal. Am J Public Health 2014; 104:1327-33. [PMID: 24832428 PMCID: PMC4056200 DOI: 10.2105/ajph.2014.301927] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to examine caregivers' refusal of preventive medical and dental care for children. METHODS Prevalence rates of topical fluoride refusal based on dental records and caregiver self-reports were estimated for children treated in 3 dental clinics in Washington State. A 60-item survey was administered to 1024 caregivers to evaluate the association between immunization and topical fluoride refusal. Modified Poisson regression models were used to estimate prevalence rate ratios (PRRs). RESULTS The prevalence of topical fluoride refusal was 4.9% according to dental records and 12.7% according to caregiver self-reports. The rate of immunization refusal was 27.4%. In the regression models, immunization refusal was significantly associated with topical fluoride refusal (dental record PRR = 1.61; 95% confidence interval [CI] = 1.32, 1.96; P < .001; caregiver self-report PRR = 6.20; 95% CI = 3.21, 11.98; P < .001). Caregivers younger than 35 years were significantly more likely than older caregivers to refuse both immunizations and topical fluoride (P < .05). CONCLUSIONS Caregiver refusal of immunizations is associated with topical fluoride refusal. Future research should identify the behavioral and social factors related to caregiver refusal of preventive care with the goal of developing multidisciplinary strategies to help caregivers make optimal preventive care decisions for children.
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Affiliation(s)
- Donald L Chi
- Donald L. Chi is with the Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle
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Long CM, Quinonez RB, Rozier RG, Kranz AM, Lee JY. Barriers to pediatricians' adherence to American Academy of Pediatrics oral health referral guidelines: North Carolina general dentists' opinions. Pediatr Dent 2014; 36:309-15. [PMID: 25197996 PMCID: PMC4523089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The purposes of this study were to: (1) assess knowledge, attitudes, and behaviors of North Carolina general dentists (GDs) regarding American Academy of Pediatrics (AAP) dental referral guidelines; and (2) determine factors that influence pediatricians' ability to comply with AAP guidelines. METHODS One thousand GDs were surveyed to determine barriers toward acceptance of physician referrals of infants and toddlers. The primary outcome using ordered logistic regression was GDs' acceptance of children described in five case scenarios, with different levels of risk and oral health status. RESULTS GDs believed pediatricians should refer patients at risk for caries to a dentist. While 61 to 75 percent of GDs were willing to accept low caries risk referrals of infants and toddlers, only 35 percent would accept referrals when caries was present. Predictors of referral acceptance were correct knowledge about AAP guidelines (OR=2.0, 95%CI=1.2-3.3), confidence in providing preventive care to infants and toddlers (OR=2.6, 95%CI=1.3-4.9), and agreement that parents see importance in dental referrals (OR=2.1, 95% CI=1.2-3.6). CONCLUSIONS This study identified factors influencing acceptance of pediatrician referrals for the age one dental visit among North Carolina GDs and highlighted challenges pediatricians face in referring young children for dental care.
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Affiliation(s)
| | - Rocio B Quinonez
- University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - R Gary Rozier
- Department of Pediatric Dentistry, School of Dentistry; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Ashley M Kranz
- Department of Health Policy and Management, Gillings School of Global Public Health; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
| | - Jessica Y Lee
- Department of Dental Research; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA
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Kranz AM, Rozier RG, Preisser JS, Stearns SC, Weinberger M, Lee JY. Preventive Services by Medical and Dental Providers and Treatment Outcomes. J Dent Res 2014; 93:633-8. [PMID: 24891593 DOI: 10.1177/0022034514536731] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/29/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is known about how treatment outcomes compare with children visiting dentists. This study compared the association between the provider of preventive services (PCP, dentist, or both) with Medicaid-enrolled children before their third birthday and subsequent dental caries-related treatment (CRT) and CRT payment. METHODS We conducted a retrospective study of young children enrolled in North Carolina Medicaid during 2000 to 2006. The annual number of CRT and CRT payments per child between the ages of 3 and 5 yr were estimated with a zero-inflated negative binomial regression and a hurdle model, respectively. Models were adjusted for relevant child- and county-level characteristics and used propensity score weighting to address observed confounding. RESULTS We examined 41,453 children with > 1 preventive oral health visit from a PCP, dentist, or both before their third birthday. Unadjusted annual mean CRT and payments were lowest among children who had only PCP visits (CRT = 0.87, payment = $172) and higher among children with only dentist visits (CRT = 1.48, payment = $234) and both PCP and dentist visits (CRT = 1.52, payment = $273). Adjusted results indicated that children who had dentist visits (with or without PCP visits) had significantly more CRT and higher CRT payments per year during the ages of 3 and 4 yr than children who had only PCP visits. However, these differences attenuated each year after age 3 yr. CONCLUSIONS Because of children's increased opportunity to receive multiple visits in medical offices during well-child visits, preventive oral health services provided by PCPs may lead to a greater reduction in CRT than dentist visits alone. This study supports guidelines and reimbursement policies that allow preventive dental visits based on individual needs.
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Affiliation(s)
- A M Kranz
- Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R G Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S C Stearns
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Center for Health Services Research in Primary Care, VA Medical Center, Durham, NC, USA
| | - J Y Lee
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Pediatric Density, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kranz AM, Rozier RG, Preisser JS, Stearns SC, Weinberger M, Lee JY. Comparing medical and dental providers of oral health services on early dental caries experience. Am J Public Health 2014; 104:e92-9. [PMID: 24832418 DOI: 10.2105/ajph.2014.301972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Most state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children. We examined the association between who (PCP, dentist, or both) provides these services to Medicaid enrollees before age 3 years and oral health at age 5 years. METHODS We linked North Carolina Medicaid claims (1999-2006) to oral health surveillance data (2005-2006). Regression models estimated oral health status (number of decayed, missing, and filled primary teeth) and untreated disease (proportion of untreated decayed teeth), with adjustment for relevant characteristics and by using inverse-probability-of-treatment weights to address confounding. RESULTS We analyzed data for 5235 children with 2 or more oral health visits from a PCP, dentist, or both. Children with multiple PCP or dentist visits had a similar number of overall mean decayed, missing, and filled primary teeth in kindergarten, whereas children with only PCP visits had a higher proportion of untreated decayed teeth. CONCLUSIONS The setting and provider type did not influence the effectiveness of preventive oral health services on children's overall oral health. However, children having only PCP visits may encounter barriers to obtaining dental treatment.
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Affiliation(s)
- Ashley M Kranz
- Ashley M. Kranz, R. Gary Rozier, and Sally C. Stearns are with the Department of Health Policy and Management, University of North Carolina (UNC) Gillings School of Global Public Health, Chapel Hill. John S. Preisser is with the Department of Biostatistics, UNC Gillings School of Global Public Health. Morris Weinberger is with the Department of Health Policy and Management, UNC Gillings School of Global Public Health, and the Center for Health Services Research in Primary Care, VA Medical Center, Durham, NC. Jessica Y. Lee is with the Department of Pediatric Dentistry, UNC School of Dentistry and the Department of Health Policy and Management, UNC Gillings School of Global Public Health
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Quinonez RB, Kranz AM, Long M, Rozier RG. Care coordination among pediatricians and dentists: a cross-sectional study of opinions of North Carolina dentists. BMC Oral Health 2014; 14:33. [PMID: 24708785 PMCID: PMC3997217 DOI: 10.1186/1472-6831-14-33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care coordination between physicians and dentists remains a challenge. This study of dentists providing pediatric dental care examined their opinions about physicians' role in oral health and identified factors associated with these opinions. METHODS North Carolina general and pediatric dentists were surveyed on their opinions of how physicians should proceed after caries risk assessment and evaluation of an 18-month-old, low risk child. We estimated two multinomial logistic regression models to examine dentists' responses to the scenario under the circumstances of an adequate and a limited dental workforce. RESULTS Among 376 dentists, 52% of dentists indicated physicians should immediately refer this child to a dental home with an adequate dental workforce. With a limited workforce, 34% recommended immediate referral. Regression analysis indicated that with an adequate workforce guideline awareness was associated with a significantly lower relative risk of dentists' recommending the child remain in the medical home than immediate referral. CONCLUSIONS Dentists' opinions and professional guidelines on how physicians should promote early childhood oral health differ and warrant strategies to address such inconsistencies. Without consistent guidelines and their application, there is a missed opportunity to influence provider opinions to improve access to dental care.
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Affiliation(s)
- Rocio B Quinonez
- Department of Pediatric Dentistry and Pediatrics, Schools of Medicine and Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley M Kranz
- Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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