Caries Risk Assessment and Dental Referral by Paediatric Primary Care Physicians in Sichuan Province, China: A Cross-Sectional Study

Background

Limited information is known about dental implementation by pediatric primary care physicians (PCPs) at the primary care level in China. This study aimed to explore the current status of primary oral care implementation and related influencing factors.

Methods

A cross-sectional survey was conducted among PCPs in Sichuan Province, China. Multivariable logistic regression was used to analyse factors associated with CRA and dental referral for high caries-risk children.

Results

A total of 504 out of 524 questionnaires remained for analysis. In all, 93.8% of PCPs reported that they usually or sometimes performed dental screening for children, 31.3% performed CRA, and 49.0% referred high caries-risk children to dentists. More CRA activities were associated with PCPs who encountered a greater number of children with caries during systematic care (adjusted OR: 2.37, 95% CI:[1.08,5.18], had dental knowledge training by pediatric dentists (aOR: 2.26, 95% CI:[1.36, 3.75], and learned pediatric dental knowledge on their own (aOR: 2.87, 95% CI: [1.51, 5.45]). In addition to the above associators, a higher rate of dental referrals for high caries-risk children was associated with having a dental department in the same work institute (aOR: 1.72, 95% CI: [1.09, 2.70] and having more confidence in their dental knowledge (aOR: 1.29, 95% CI: [1.04, 1.61]).

Conclusion

Paediatric PCPs commonly implement dental screening but perform fewer CRAs and dental referrals for high caries-risk children during systematic health management in western China. To increase CRA activities and dental referral by paediatric PCPs, health policymakers could encourage interdisciplinary cooperation between dental professionals and paediatric PCPs.

Screening for type 2 diabetes and periodontitis patients (CODAPT-My©): a multidisciplinary care approach

BACKGROUND

The practice of referring diabetic patients for dental intervention has been poor despite awareness and knowledge of the oral health effects of diabetes. Likewise, dentists treating patients receiving diabetes treatment are rarely updated on the glycaemic status and as a result, the opportunity for shared management of these patients is missed. This study aimed to provide a standardised care pathway which will initiate screening for diabetes from dental clinics and link patients with primary care for them to receive optimised care for glycaemic control.

METHOD

A Modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices to screen for diabetes among patients attending dental clinics for periodontitis. Expert panel members were recruited using snowball technique where the experts comprised Family Medicine Specialists (5), Periodontists (6), Endocrinologists (3) and Clinical Pharmacists (4) who are involved in management of patients with diabetes at public and private healthcare facilities. Care algorithms were designed based on existing public healthcare services.

RESULTS

The CODAPT^© panel recommends referral to primary care for further evaluation of glycaemic status if patients diagnosed with periodontitis record fasting capillary blood glucose levels ≥ 5.6 mmol/L. Intervention treatment options for prediabetes are listed, and emphasis on feedback to the dental healthcare team is outlined specifically.

CONCLUSION

The CODAPT^© care pathway has the potential to link dental clinics with primary care for diagnosis and/or optimised treatment of prediabetes/diabetes among patients receiving periodontitis treatment.

Impact of state-level training requirements for medical providers on receipt of preventive oral health services for young children enrolled in Medicaid

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.

The oral health status of America's rural children: An opportunity for policy change

OBJECTIVES

The purpose of our study was to examine the association between rurality and select oral health care metrics: teeth condition, decay, and access measures such as preventive dental care among children in the United States.

METHODS

We conducted a cross-sectional study with a sample of 20,842 respondents from the 2017 to 2018 National Survey of Children's Health (NSCH), a nationally representative sample of U.S. children. Socio-demographic information, residence, and oral health and healthcare utilization information were used to create study variables. Descriptive statistics, bivariate analyses, and a multivariable regression model were performed.

RESULTS

Rural children were less likely to have a preventive dental visit than urban children (84.9 percent versus 87.5 percent, P = 0.03). Children residing in rural areas were more likely to have their teeth condition reported as fair or poor than children residing in urban areas (7.3 percent versus 6.6 percent, P = 0.02). Compared to their urban counterparts, rural children were also less likely to have received fluoride treatment (46.6 percent versus 52.5 percent, P = 0.0022) and less likely to have received a dental sealant (19.5 percent versus 22.5 percent, P = 0.0147). In adjusted analysis, there was no significant difference in receiving a preventive dental visit for rural children, compared to their urban counterparts.

CONCLUSIONS

As preparations are made for the 2020 Surgeon General's report on oral health, the current study provides important evidence to inform future advocacy and legislative priorities. To reduce urban-rural disparities among children, there must be enhanced dental care access, dental workforce expansion, and increased awareness about preventive oral health services.

Do Oral Health Services in Medical Offices Replace Pediatric Dental Visits?

In the United States, state Medicaid programs pay for medical and dental care for children from low-income families and support nondental primary care providers delivering preventive oral health services (POHS) to young children in medical offices ("medical POHS"). Despite the potential of these policies to expand access to care, there is concern that they may replace dental visits with medical POHS. Using Medicaid claims from 38 states from 2006 to 2014, we conducted a repeated cross-sectional study and used linear probability regression to estimate the association between the annual proportion of children in a county receiving medical POHS and the probability that a child received 1) dental POHS and 2) a dental visit in a given year. Models included county and year fixed effects and controlled for child- and county-level factors, and standard errors were clustered at the state level. In a weighted population of 45.1 million child-years (age, 6 mo to <6 y), we found no significant nor substantively important association between the proportion of children in a county receiving medical POHS and the probability that a child received dental POHS or a dental visit. Additionally, we found an almost zero probability (<0.001) that the reduction in dental POHS was at least as large as the expansion in medical POHS (full substitution) and a 0.50 probability that increased medical POHS was associated with an increase in dental POHS of at least 6.6% of the expansion of medical POHS. Results were similar when receipt of dental visits was examined. This study failed to find evidence that medical POHS replaced dental visits for young children enrolled in Medicaid and, in fact, offers evidence that increased medical POHS was associated with increased utilization of dental care. Given lower-than-desired rates of dental visits for this population, delivery of medical POHS should be expanded.

Trends of children being given advice for dental checkups and having a dental visit in the United States: 2001-2016

INTRODUCTION

The objectives of this study were to describe trends of children being given dental checkup advice by primary care providers (PCPs) and having dental visits and to assess factors associated with being given dental checkup advice and having a dental visit.

METHODS

Data were from the annual, cross-sectional Medical Expenditure Panel Survey (MEPS) from 2001 to 2016. The sample included 126,773 children ages 2-17 years. We used predictive margins to estimate the probability of being given dental checkup advice and having a dental visit. We examined time trends of the proportion of children being given dental checkup advice from PCPs, as well as trends in the proportion of children having a dental visit from 2001 to 2016. Multiple logistic regression was used to assess the association between being given dental checkup advice and having a dental visit.

RESULTS

Overall, the proportion of children being given dental checkup advice increased from 31.4% in 2001 to 51.8% in 2016 (Trend P < 0.001). No significant increasing trend was found for having a dental visit among those being given dental checkup advice (Trend P > 0.05). Children being given dental checkup advice were more likely to have a dental visit (AOR = 1.54, P < 0.001).

CONCLUSIONS

Although there was an increase in the proportion of children being given advice to have dental checkups by PCPs from 2001 to 2016, there was no significant increase in having a dental visit among children being given the advice. More research is needed to better understand how dental care advice from a PCP can effectively motivate and facilitate dental care for children.