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Ballantine JL, Carlson JC, Ferreira Zandoná AG, Agler C, Zeldin LP, Rozier RG, Roberts MW, Basta PV, Luo J, Antonio‐Obese ME, McNeil DW, Weyant RJ, Crout RJ, Slayton RL, Levy SM, Shaffer JR, Marazita ML, North KE, Divaris K. Exploring the genomic basis of early childhood caries: a pilot study. Int J Paediatr Dent 2018; 28:217-225. [PMID: 29057527 PMCID: PMC5811369 DOI: 10.1111/ipd.12344] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE A genetic component in early childhood caries (ECC) is theorized, but no genome-wide investigations of ECC have been conducted. This pilot study is part of a long-term research program aimed to: (1) determine the proportion of ECC variance attributable to the human genome and (2) identify ECC-associated genetic loci. METHODS The study's community-based sample comprised 212 children (mean age=39 months; range = 30-52 months; males = 55%; Hispanic/Latino = 35%, African-American = 32%; American Academy of Pediatric Dentistry definition of ECC prevalence = 38%). Approximately 2.4 million single nucleotide polymorphisms (SNPs) were genotyped using DNA purified from saliva. A P < 5 × 10-8 criterion was used for genome-wide significance. SNPs with P < 5 × 10-5 were followed-up in three independent cohorts of 921 preschool-age children with similar ECC prevalence. RESULTS SNPs with minor allele frequency ≥5% explained 52% (standard error = 54%) of ECC variance (one-sided P = 0.03). Unsurprisingly, given the pilot's small sample size, no genome-wide significant associations were found. An intergenic locus on 4q32 (rs4690994) displayed the strongest association with ECC [P = 2.3 × 10-6 ; odds ratio (OR) = 3.5; 95% confidence interval (CI) = 2.1-5.9]. Thirteen loci with suggestive associations were followed-up - none showed evidence of association in the replication samples. CONCLUSION This study's findings support a heritable component of ECC and demonstrate the feasibility of conducting genomics studies among preschool-age children.
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Affiliation(s)
- Jami L. Ballantine
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Jenna C. Carlson
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA
| | - Andrea G. Ferreira Zandoná
- Department of Operative DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Cary Agler
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Leslie P. Zeldin
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Richard Gary Rozier
- Department of Health Policy and ManagementGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Michael W. Roberts
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Patricia V. Basta
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA,Biospecimen Processing Facility coreUniversity of North CarolinaChapel HillNCUSA
| | - Jason Luo
- Lineberger Comprehensive Cancer CenterSchool of MedicineUniversity of North CarolinaChapel HillNCUSA,Mammalian Genotyping coreUniversity of North CarolinaChapel HillNCUSA
| | - Mikafui E. Antonio‐Obese
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Daniel W. McNeil
- Departments of Dental Practice & Rural Health and PsychologyWest Virginia UniversityMorgantownWVUSA
| | - Robert J. Weyant
- Department of Dental Public Health and Information ManagementSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA
| | - Richard J. Crout
- Department of PeriodonticsSchool of DentistryWest Virginia UniversityMorgantownWVUSA
| | - Rebecca L. Slayton
- Department of Pediatric DentistrySchool of DentistryUniversity of WashingtonSeattleWAUSA
| | - Steven M. Levy
- Department of Preventive and Community DentistryUniversity of Iowa College of DentistryIowa CityIAUSA,Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIAUSA
| | - John R. Shaffer
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA,Department of Oral BiologySchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA
| | - Mary L. Marazita
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA,Department of Oral BiologySchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of PsychiatrySchool of MedicineUniversity of PittsburghPittsburghPAUSA,Clinical and Translational Science InstituteSchool of MedicineUniversity of PittsburghPittsburghPAUSA
| | - Kari E. North
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Kimon Divaris
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA,Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
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Collins CC, Villa-Torres L, Sams LD, Zeldin LP, Divaris K. Framing Young Childrens Oral Health: A Participatory Action Research Project. PLoS One 2016; 11:e0161728. [PMID: 27548714 PMCID: PMC4993516 DOI: 10.1371/journal.pone.0161728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children's oral health, within the contexts of the family and the community. METHODS This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: "What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?" Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software. FINDINGS Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children's oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children's oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources. CONCLUSIONS Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children's oral health must take into consideration the role of families and the communities in which they live.
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Affiliation(s)
- Chimere C. Collins
- Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Laura Villa-Torres
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Lattice D. Sams
- Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Leslie P. Zeldin
- Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
| | - Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
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Born CD, Divaris K, Zeldin LP, Rozier RG. Influences on preschool children's oral health-related quality of life as reported by English and Spanish-speaking parents and caregivers. J Public Health Dent 2016; 76:276-286. [PMID: 26990804 DOI: 10.1111/jphd.12152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/20/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study examined young, preschool children's oral health-related quality of life (OHRQoL) among a community-based cohort of English and Spanish-speaking parent-child dyads in North Carolina, and sought to quantify the association of parent/caregiver characteristics, including spoken language, with OHRQoL impacts. METHODS Data from structured interviews with 1,111 parents of children aged 6-23 months enrolled in the Zero-Out Early Childhood Caries study in 2010-2012 were used. OHRQoL was measured using the overall score (range: 0-52) of the Early Childhood Oral Health Impact Scale (ECOHIS). We examined associations with parents' sociodemographic characteristics, spoken language, self-reported oral and general health, oral health knowledge, children's dental attendance, and dental care needs. Analyses included descriptive, bivariate, and multivariate methods based upon zero-inflated negative binomial regression. To determine differences between English and Spanish speakers, language-stratified model estimates were contrasted using homogeneity χ2 tests. RESULTS The mean overall ECOHIS score was 3.9 [95% confidence interval (CI) = 3.6-4.2]; 4.7 among English-speakers and 1.5 among Spanish speakers. In multivariate analyses, caregivers' education showed a positive association with OHRQoL impacts among Spanish speakers [prevalence ratio (PR) = 1.12 (95% CI = 1.03-1.22), for every added year of schooling], whereas caregivers' fair/poor oral health showed a positive association among English speakers (PR = 1.20; 95% CI = 1.02-1.41). CONCLUSIONS The overall severity of ECOHIS impacts was low among this population-based sample of young, preschool children, and substantially lower among Spanish versus English speakers. Further studies are warranted to identify sources of these differences in - actual or reported - OHRQoL impacts.
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Affiliation(s)
- Catherine D Born
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Leslie P Zeldin
- Department of Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Lee J, Stucky B, Rozier G, Lee SY, Zeldin LP. Oral Health Literacy Assessment: development of an oral health literacy instrument for Spanish speakers. J Public Health Dent 2012; 73:1-8. [PMID: 23215757 PMCID: PMC4082329 DOI: 10.1111/jphd.12000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 10/05/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop an oral health literacy instrument for Spanish-speaking adults, evaluate its psychometric properties, and determine its comparability to an English version. METHODS The Oral Health Literacy Assessment in Spanish (OHLA-S) and English (OHLA-E) are designed with a word recognition section and a comprehension section using the multiple-choice format developed by an expert panel. Validation of OHLA-S and OHLA-E involved comparing the instrument with other health literacy instruments in a sample of 201 Spanish-speaking and 204 English-speaking subjects. Comparability between Spanish and English versions was assessed by testing for differential item functioning (DIF) using item response theory. RESULTS We considered three OHLA-S scoring systems. Based on validity and reliability comparisons, 24 items were retained in the OHLA-S instrument. OHLA-S was correlated with another health literacy instrument, Spanish Test of Functional Health Literacy in Adults (P < 0.05). Significant correlations were also found between OHLA-S and years of schooling, oral health knowledge, overall health, and an understanding of written health-care materials (P < 0.05). OHLA-S displayed satisfactory reliability with a Cronbach Alpha of 0.70-0.80. DIF results suggested that OHLA-S and OHLA-E scores were not comparable at a given level of oral health literacy. CONCLUSIONS OHLA-S has acceptable reliability and validity. OHLA-S and OHLA-E are two different measurement tools and should not be used to compare oral health literacy between English- and Spanish-speaking populations.
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Affiliation(s)
- Jessica Lee
- Pediatric Dentistry, UNC, Chapel Hill, NC 27599, USA
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Kranz AM, Rozier RG, Zeldin LP, Preisser JS. Oral health activities of Early Head Start and Migrant and Seasonal Head Start programs. J Health Care Poor Underserved 2012; 23:1205-21. [PMID: 24212169 PMCID: PMC4238909 DOI: 10.1353/hpu.2012.0090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Guidelines recommend that Migrant and Seasonal Head Start programs (MSHS) address the dental needs of children of migrant and seasonal farmworkers. This study describes parent- and child-oriented oral health activities of North Carolina's MSHS programs and compares them with non-migrant Early Head Start (EHS) programs using data collected from a questionnaire completed by teachers and family services staff. Migrant and Seasonal Head Start staff reported engaging in more oral health activities than EHS staff, which was confirmed by results of logit and ordered logit regression models. Despite promising findings about the engagement of MSHS staff, participation in oral health activities is lower than recommended. Differences between EHS and MSHS programs might be due to differing needs of enrolled children and families or to different approaches to meeting the needs of families.
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Abstract
OBJECTIVES This cross-sectional study examined Early Head Start (EHS) teachers' oral health program activities and their association with teacher and program characteristics. METHODS Self-completed questionnaires were distributed to the staff in all EHS programs in North Carolina. Variables for dental health activities for parents (four items) and children (four items) were constructed as the sum of responses to a 0-4 Likert-type scale (never to very frequently). Ordinary least squares regression models examined the association between teachers' oral health program activities and modifiable teacher (oral health knowledge, values, self-efficacy, dental health training, perceived barriers to dental activities) and program (director and health coordinator knowledge and perceived barriers to dental activities) characteristics. RESULTS Teachers in the parent (n=260) and child (n=231) analyses were a subset of the 485 staff respondents (98 percent response rate). Teachers engaged in child oral health activities (range = 0-16; mean = 9.0) more frequently than parent activities (range = 0-16; mean = 6.9). Teachers' oral health values, perceived oral health self-efficacy, dental training, and director and health coordinator knowledge were positively associated with oral health activities (P < 0.05). Perceived barriers were negatively associated with child activities (P < 0.05). CONCLUSION The level of oral health activity in EHS programs is less than optimal. Several characteristics of EHS staff were identified that can be targeted with education interventions. Evidence for effectiveness of EHS interventions needs to be strengthened, but results of this survey provide encouraging findings about the potential effects of teacher training on their oral health practices.
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Affiliation(s)
- Ashley M Kranz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
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Abstract
OBJECTIVE To determine the barriers to adopting preventive oral health procedures in medical primary care. METHODS Medical providers who participated in a Medicaid demonstration in North Carolina completed questionnaires reporting their experiences with providing preventive dental services for children from birth to 3 years of age. Eleven factors were established as possible obstacles to the adoption of an oral health program. After 12 months of participation in the Into the Mouths of Babes training program, providers (N = 231) from 49 pediatric practices and 28 family physician practices reported if any of the 11 factors had been an obstacle to adoption and, if so, whether these obstacles were overcome. Program adoption and implementation, defined as providing all of the services on a regular basis, were predicted by using logistic regression to analyze the responses from providers who reported 1 or more barriers, the number of barriers identified (knowledge, attitudes, and external factors), and the number that were overcome. RESULTS Program-adoption rates were high, with 70.3% of the participants providing dental services on a routine basis. Attitude and external factors were positively associated with adoption, particularly with difficulty in applying the varnish, integration of the dental procedures into practice, resistance among staff and colleagues, and dentist referral difficulties. From 40.4% to 61.5% of providers overcame these 4 most common barriers. Those who reported external barriers and were unable to overcome them were less likely to provide the services, compared with those providers who reported no barriers (odds ratio: 0.08 [95% confidence interval: 0.01-0.44]). CONCLUSIONS The number of barriers to adopting preventive dental procedures in primary care medical practices is associated with implementation. A large proportion of these barriers can be overcome, leading to high adoption rates in a short amount of time. The barriers to adoption are similar to those identified in the literature on changing patient care, with the unique aspects of fluoride application to teeth. Interventions to promote preventive dental care in medical settings should rely heavily on empirical literature. Training physicians in preventive dentistry should identify and target potential barriers with information and options for introducing office-based systems to improve the chances of adoption.
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Affiliation(s)
- Kelly Close
- MSUP, University of North Carolina, Gillings School of Global Public Health, Department of Health Policy and Management, 1105-F McGavran-Greenberg Hall, 135 Dauer Dr, CB 7411, Chapel Hill, NC 27499, USA
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Mofidi M, Zeldin LP, Rozier RG. Oral health of early head start children: a qualitative study of staff, parents, and pregnant women. Am J Public Health 2008; 99:245-51. [PMID: 19059853 DOI: 10.2105/ajph.2008.133827] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored the oral health knowledge, attitudes, and activities of Early Head Start (EHS) staff members, parents, and pregnant women, along with their suggestions related to future oral health educational interventions targeting EHS children. METHODS Nine focus groups were conducted with EHS staff, parents, and pregnant women. Audiotapes of sessions were transcribed and entered into ATLAS.ti 5.0 for coding and analysis. RESULTS Attitudes about the importance of children's oral health among parents and pregnant women were mixed. Staff members voiced responsibility for children's oral health but frustration in their inability to communicate effectively with parents. Parents in turn perceived staff criticism regarding how they cared for their children's oral health. Gaps were noted in the oral health activities of EHS programs. Participants expressed confusion regarding the application of Head Start oral health performance standards to EHS. The need for culturally sensitive, hands-on oral health education was highlighted. CONCLUSIONS Tailored, theory-based interventions are needed to improve communication between EHS staff and families. Clear policies on the application of Head Start oral health performance standards to EHS are warranted. Educational activities should address the needs and suggestions of EHS participants.
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Affiliation(s)
- Mahyar Mofidi
- Schools of Dentistry and Public Health, University of North Carolina, Chapel Hill, NC, USA.
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Mathu-Muju KR, Lee JY, Zeldin LP, Rozier RG. Opinions of Early Head Start staff about the provision of preventive dental services by primary medical care providers. J Public Health Dent 2008; 68:154-62. [PMID: 18843804 DOI: 10.1111/j.1752-7325.2007.00052.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study investigates the opinions of the Early Head Start (EHS) staff about physicians and nurses providing preventive dental services for children in EHS. METHODS A cross-sectional survey was undertaken of the EHS staff having contact with families in EHS programs in North Carolina (NC). A self-completed questionnaire solicited their opinions (agree, disagree, don't know) about whether physicians and nurses can "provide preventive dental care" and "identify dental problems" in infants and toddlers. Staff knowledge (four items) and attitudes (five items) were tested for their association with whether staff had an opinion (agree/disagree versus don't know) and if so, what that opinion was (agree versus disagree) using the generalized estimating equation method. RESULTS Questionnaires were completed by 476 staff (98 percent response) in 18 programs (100 percent response). The majority of staff believed that physicians and nurses can provide preventive dental services (66 percent) and identify dental problems (52 percent). Staff placing importance on ensuring access to dental care and who were knowledgeable about fluoride uses were more likely to have an opinion. Among staff with an opinion, those familiar with the NC program where these services are provided in medical offices were more likely to agree that physicians and nurses can provide preventive services and identify problems. CONCLUSIONS Although the opinions of the majority of the EHS staff are not a barrier to using primary medical care providers to deliver preventive dental care, education is needed for staff who are unfamiliar with this approach.
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Affiliation(s)
- Kavita R Mathu-Muju
- College of Dentistry, University of Kentucky, 333 Waller Avenue, Suite 101, Lexington, KY 40504-2915, USA.
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Slade GD, Rozier RG, Zeldin LP, Margolis PA. Training pediatric health care providers in prevention of dental decay: results from a randomized controlled trial. BMC Health Serv Res 2007; 7:176. [PMID: 17980021 PMCID: PMC2190767 DOI: 10.1186/1472-6963-7-176] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Accepted: 11/02/2007] [Indexed: 11/10/2022] Open
Abstract
Background Physicians report willingness to provide preventive dental care, but optimal methods for their training and support in such procedures are not known. This study aimed to evaluate the effect of three forms of continuing medical education (CME) on provision of preventive dental services to Medicaid-enrolled children by medical personnel in primary care physician offices. Methods Practice-based, randomized controlled trial. Setting: 1,400 pediatric and family physician practices in North Carolina providing care to an estimated 240,000 Medicaid-eligible children aged 0–3 years. Interventions: Group A practices (n = 39) received didactic training and course materials in oral health screening, referral, counseling and application of fluoride varnish. Group B practices (n = 41) received the same as Group A and were offered weekly conference calls providing advice and support. Group C practices (n = 41) received the same as Group B and were offered in-office visit providing hands-on advice and support. In all groups, physicians were reimbursed $38–$43 per preventive dental visit. Outcome measures were computed from reimbursement claims submitted to NC Division of Medical Assistance. Primary outcome measure: rate of preventive dental services provision per 100 well-child visits. Secondary outcome measure: % of practices providing 20 or more preventive dental visits. Results 121 practices were randomized, and 107 provided data for analysis. Only one half of Group B and C practices took part in conference calls or in-office visits. Using intention-to-treat analysis, rates of preventive dental visits did not differ significantly among CME groups: GroupA = 9.4, GroupB = 12.9 and GroupC = 8.5 (P = 0.32). Twenty or more preventive dental visits were provided by 38–49% of practices in the three study groups (P = 0.64). Conclusion A relatively high proportion of medical practices appear capable of adopting these preventive dental services within a one year period regardless of the methods used to train primary health care providers. Trial Registration ClinicalTrials.gov NCT00464009
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Affiliation(s)
- Gary D Slade
- Australian Research Centre for Population Oral Health, Dental School, University of Adelaide, Adelaide, SA, Australia.
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Rozier RG, Slade GD, Zeldin LP, Wang H. Parents' satisfaction with preventive dental care for young children provided by nondental primary care providers. Pediatr Dent 2005; 27:313-22. [PMID: 16317972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE The purpose of this study was to assess parents' satisfaction with the preventive dental care their children received in medical offices. METHODS Caregivers accompanying Medicaid children for their medical visits at 30 practices, with at least 1 physician providing dental services, completed questionnaires just before and 12 months after initial dental care visits. Information at follow-up was obtained on the type of dental services received and parents' satisfaction with this care using questions adapted from the Consumer Assessment of Health Plans Survey. Child, parent, and practice characteristics were used in logistic regression to predict categories representing the least satisfaction. RESULTS About 92% of 342 parents who recalled at least 1 medical visit with dental care reported that the provider usually or always explained things in a way they could understand, and 84% reported that the provider spent enough time with their child. Seventy-seven percent rated overall dental care greater than 7 on an 11-point scale with 10 indicating the best care. Parents reporting race other than Caucasian or African American, mostly Hispanic or Asian, were the least satisfied with interpersonal aspects of care. Poor child oral health and lack of follow-up preventive dental care were associated with low ratings for communication, time, and overall care. CONCLUSIONS Most parents rated highly their children's preventive dental care. Because it usually is attached to medical visits for other reasons, improvements in dental care quality may require process and systems initiatives that address the delivery of all pediatric care in a patient centered and culturally appropriate manner.
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Affiliation(s)
- R Gary Rozier
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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