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Khan SY, Schroth RJ, Cruz de Jesus V, Lee VHK, Rothney J, Dong CS, Javed F, Yerex K, Bertone M, El Azrak M, Menon A. A systematic review of caries risk in children <6 years of age. Int J Paediatr Dent 2024; 34:410-431. [PMID: 38071403 DOI: 10.1111/ipd.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 06/14/2024]
Abstract
BACKGROUND For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC). AIM This updated systematic review aimed to identify current evidence on caries risk in young children. DESIGN A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus. RESULTS Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome. CONCLUSION This study provides updated evidence of risk factors for ECC that could be included in CRA tools.
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Affiliation(s)
- Saima Yunus Khan
- Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Robert J Schroth
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Shared Health Inc., Winnipeg, Manitoba, Canada
| | - Vivianne Cruz de Jesus
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Victor H K Lee
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Janet Rothney
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cecilia S Dong
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Faraha Javed
- Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Katherine Yerex
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Bertone
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohamed El Azrak
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anil Menon
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Leung WK. Oral health through primary healthcare in a developed economy dominated by private dental practitioners: A leap forward in Hong Kong? J Dent 2024; 144:104933. [PMID: 38461885 DOI: 10.1016/j.jdent.2024.104933] [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] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
After two and a half decades of preparation, and prompted by advocacy from the World Health Organization in 2014, the Health Bureau of Hong Kong recently implemented the city's primary healthcare blueprint. Integrated within it is an approach to primary oral healthcare. This review provides a brief background and discusses the development of primary oral healthcare in Hong Kong - a developed economy in Asia dominated by private dental services.
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Affiliation(s)
- Wai Keung Leung
- Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China.
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3
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Gracner T, Kranz AM, Li K, Dick AW, Geissler K. The Patient Protection and Affordable Care Act and Pediatric Medical Clinicians' Application of Fluoride Varnish. JAMA Netw Open 2023; 6:e2343087. [PMID: 37962890 PMCID: PMC10646725 DOI: 10.1001/jamanetworkopen.2023.43087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/29/2023] [Indexed: 11/15/2023] Open
Abstract
Importance Fluoride varnish reduces children's tooth decay, yet few clinicians provide it. Most state Medicaid programs have covered this service during medical visits for children aged 1 to 5 years, but private insurers began covering it only in 2015 due to the Patient Protection and Affordable Care Act (ACA) mandate that they cover a set of recommended preventive services without cost-sharing. Evidence on clinicians' behavior change postmandate is limited. Objective To examine monthly changes in fluoride varnish applications among pediatric clinicians following the ACA mandate. Design, Setting, and Participants Using all-payer claims data from Massachusetts, this cohort study applied an interrupted time-series approach with linear regression models comparing changes in monthly clinician-level outcomes before and after the mandate. Participants included clinicians who billed at least 5 well-child visits for patients aged 1 to 5 years and were observed at least once premandate. Adjusted for clinician fixed effects, models were assessed overall and separately for clinicians categorized by their monthly share of well-child visits paid by private insurers before the mandate: mostly private (>66% of visits paid by private insurers), mostly public (<33% of visits paid by private insurers), or mixed (33%-66% of visits paid by private insurers) insurance types. Analysis was performed from June 1, 2022, to July 31, 2023. Exposure Preenactment and postenactment of the ACA mandate for private insurers to cover fluoride varnish applications without cost-sharing. Main Outcomes and Measures Clinician-month measures of whether fluoride varnish was provided during at least 1 well-child visit and the share of such visits, analyzed separately for clinicians who did and did not apply fluoride varnish premandate. Results The sample included 2405 clinicians, with 107 841 clinician-months. Premandate, 10.48% of the visits included fluoride varnish applications. Two years postmandate, the likelihood of ever applying fluoride varnish was 13.64 (95% CI, 10.97-16.32) percentage points higher. For clinicians providing fluoride varnish premandate, the share of visits with fluoride varnish increased by 9.22 (95% CI, 5.41-13.02) percentage points. This increase was observed in clinicians who treated children with insurance that was mostly mixed and mostly private; no substantial change was observed among those treating children with mostly public insurance. Conclusions and Relevance In this cohort study of pediatric primary care clinicians, an association between the ACA mandate and an increase in fluoride varnish application was observed, especially among clinicians primarily treating privately insured patients and those applying it premandate. However, application remains infrequent, suggesting persistent barriers.
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Affiliation(s)
- Tadeja Gracner
- RAND Corporation, Santa Monica, California
- Center for Economic and Social Research at the University of Southern California, Los Angeles
| | | | - Kun Li
- RAND Corporation, Arlington, Virginia
| | | | - Kimberley Geissler
- Department of Healthcare Delivery and Population Sciences, UMass Chan Medical School-Baystate, Springfield, Massachusetts
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Lienhart G, Elsa M, Farge P, Schott AM, Thivichon-Prince B, Chanelière M. Factors perceived by health professionals to be barriers or facilitators to caries prevention in children: a systematic review. BMC Oral Health 2023; 23:767. [PMID: 37853400 PMCID: PMC10585780 DOI: 10.1186/s12903-023-03458-1] [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] [Received: 03/02/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Considered the most prevalent noncommunicable disease in childhood, dental caries is both an individual and a collective burden. While international guidelines highlight prevention as a major strategy for caries management in children, health professionals still struggle to implement prevention into their clinical practice. Further research is needed to understand the gap between the theoretical significance of dental prevention and its lack of implementation in the clinical setting. This systematic review aims to identify and classify factors perceived by health professionals to be barriers or facilitators to caries prevention in children. METHOD A systematic literature search was conducted in three electronic databases (Medline, Web of Science and Cairn). Two researchers independently screened titles, abstracts and texts. To be selected, studies had to focus on barriers or facilitators to caries prevention in children and include health professionals as study participants. Qualitative and quantitative studies were selected. The factors influencing caries prevention in children were sorted into 3 main categories (clinician-related factors, patient-related factors, and organizational-related factors) and then classified according to the 14 domains of the theoretical domains framework (TDF). RESULTS A total of 1771 references were found by combining manual and database searches. Among them, 26 studies met the inclusion criteria, of which half were qualitative and half were quantitative studies. Dentists (n = 12), pediatricians (n = 11), nurses (n = 9), and physicians (n = 5) were the most frequently interviewed health professionals in our analysis. Barriers and facilitators to caries prevention in children were categorized into 12 TDF domains. The most frequently reported domains were Environmental Context and Resources, Knowledge and Professional Role and Identity. CONCLUSION This systematic review found that a wide range of factors influence caries prevention in children. Our analysis showed that barriers to pediatric oral health promotion affect all stages of the health care system. By highlighting the incompatibility between the health care system's organization and the implementation of caries prevention, this study aims to help researchers and policy-makers design new interventions to improve children's access to caries prevention. TRIAL REGISTRATION PROSPERO CRD42022304545.
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Affiliation(s)
- Guillemette Lienhart
- Service d'Odontologie, Hospices Civils de Lyon, 6/8 Place Deperet, 69007, Lyon, France.
| | - Masson Elsa
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Pierre Farge
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
| | - Anne-Marie Schott
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
| | | | - Marc Chanelière
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
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Cohen-Cline H, Ahmed J, Holtorf M, McKeane L, Bartelmann S. Impact of oral health integration training on children's receipt of oral assessment, fluoride varnish and dental services. Community Dent Oral Epidemiol 2023; 51:1017-1023. [PMID: 36345788 DOI: 10.1111/cdoe.12810] [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] [Received: 12/29/2021] [Revised: 09/30/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To evaluate the impact of an oral health integration training program on children's receipt of oral health and dental services in Southern Oregon. METHODS Children under 19 years with at least 6 months of Medicaid enrolment and at least one healthcare visit from 2014 to 2018 were included. The treatment group included children with at least one visit with a trained provider (n = 5541); children with no visits with trained providers (n = 8273) were the control group. The percentage of the treatment group who received oral health assessments was calculated, and regression models were developed to estimate the difference in likelihood of receiving fluoride varnish and dental services between treatment and control groups. RESULTS The percentage of children receiving oral health assessments increased over time. Visiting a trained provider was consistently associated, each year, with a greater likelihood of receipt of fluoride varnish and preventive and diagnostic dental services but was not associated with treatment dental services or dental sealants. CONCLUSIONS This study reports evidence for the overall impact of an oral health integration training on children's receipt of oral and dental services. Health systems implementing these types of training strategies should consider how to reach specific underserved subgroups, increase paediatric dentists, and expand efforts to include older children.
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Affiliation(s)
- Hannah Cohen-Cline
- Center for Outcomes Research and Education (CORE), Providence Health & Services, Portland, Oregon, USA
| | - Jannate Ahmed
- Center for Outcomes Research and Education (CORE), Providence Health & Services, Portland, Oregon, USA
| | - Megan Holtorf
- Center for Outcomes Research and Education (CORE), Providence Health & Services, Portland, Oregon, USA
| | | | - Sarah Bartelmann
- Center for Outcomes Research and Education (CORE), Providence Health & Services, Portland, Oregon, USA
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6
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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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7
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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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8
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Wang Q, Qu X, Houser SH, Zhang Y, Tian M, Zhang Q, Zhang W. Caries Risk Assessment and Dental Referral by Paediatric Primary Care Physicians in Sichuan Province, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2022; 15:1641-1650. [PMID: 36092548 PMCID: PMC9450904 DOI: 10.2147/rmhp.s362004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Qingyu Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People’s Republic of China
- HEOA Group, Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, People’s Republic of China
| | - Xing Qu
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Correspondence: Xing Qu, Institute of Hospital Management, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, People’s Republic of China, +86 13880713452, Email
| | - Shannon H Houser
- Department of Health Services Administration, the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yan Zhang
- Department of Maternity and Child Health Management, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, People’s Republic of China
| | - Meirong Tian
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qiong Zhang
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, People’s Republic of China
- State Key Laboratory of Oral Diseases & National Clinical Research, Sichuan University, Chengdu, People’s Republic of China
| | - Wei Zhang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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9
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Pike NA, Kinsler JJ, Peterson JK, Verzemnieks I, Lauridsen L, Love-Bibbero L, Ramos-Gomez F. Improved oral health knowledge in a primary care pediatric nurse practitioner program. J Am Assoc Nurse Pract 2022; 34:755-762. [PMID: 35102094 DOI: 10.1097/jxx.0000000000000696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pediatric nurse practitioners (PNPs) are a significant workforce in primary care and are uniquely positioned to improve oral health in children through ongoing surveillance in the well-child visit. The purpose of this study was to evaluate PNP student satisfaction and knowledge gained with the integration of the Strategic Partnership for Interprofessional Collaborative Education in Pediatric Dentistry (SPICE-PD) oral health education program into the first-year primary care curriculum. A descriptive, comparative design examined dental test scores across the pre-SPICE-PD (2013-2014; n = 26) and post-SPICE-PD (2015-2020; n = 55) cohorts. An electronic survey was completed (n = 47; 67%), and focus group (n = 12) audio-recordings were analyzed using Atlas.ti 8.0. Chi-square test and independent samples t-test were used to assess differences between groups. The SPICE-PD students reported improved knowledge and skill in clinical practice. Focus group themes were oral health education was beneficial, impact of coronavirus disease 2019, and suggestions for improvement. Mean dental test scores improved pre- and post-SPICE-PD (83 vs. 93; p < .001). The SPICE-PD oral health education improved knowledge and was highly satisfying for students. Pediatric nurse practitioners are ideally positioned to integrate oral health into primary care services, thereby improving access to care and ultimately reducing or mitigating early childhood caries. Evaluation of PNP postgraduation practices in the primary care setting is needed to assess whether improved knowledge results in practice change.
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Affiliation(s)
- Nancy A Pike
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Janni J Kinsler
- School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | | | - Inese Verzemnieks
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Lauren Lauridsen
- School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Laurie Love-Bibbero
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Francisco Ramos-Gomez
- Division of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, California
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10
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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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11
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Burgette JM, Ok SH, Ray KN, Faulds S, Stiles A, Hoberman A, Martin B. Race and payor type for child visits with public health dental hygienist practitioners. J Public Health Dent 2021; 82:53-60. [PMID: 34378198 DOI: 10.1111/jphd.12474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine whether growth in visits to public health dental hygiene practitioners (PHDHPs) providing preventative dental services at a pediatric hospital clinic was predominantly among children receiving public insurance and children of minority background from 2013 to 2017. METHODS Longitudinal descriptive data analysis from electronic health records for 6856 children under age 18 years who visited PHDHPs co-located at a hospital clinic in Pittsburgh, PA, from 2013 to 2017. We compared visits between white versus non-white children and between children with public, private, and no or missing insurance by year. RESULTS Visit volume doubled from 2013 (n = 811) to 2017 (n = 1868). The proportion of PHDHP visits with non-white children increased from 77% (n = 625) in 2013 to 87% (n = 1472) in 2017 (p < 0.001). The proportion of PHDHP visits with children with public insurance increased from 72% (n = 585) in 2013 to 82% (n = 1377) in 2017 (p < 0.001). CONCLUSIONS PHDHPs co-located at a pediatric hospital clinic saw a high proportion of visits from children of non-white race and with public insurance. Visits from children of minority race and with public insurance increased disproportionately as visit volume grew from 2013 to 2017, depicting a vehicle through which historically underserved children increasingly accessed preventive dental services.
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Affiliation(s)
- Jacqueline M Burgette
- Departments of Dental Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sally H Ok
- Department of Pediatric Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,General Academic Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Samantha Faulds
- General Academic Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amy Stiles
- Division of Pediatric Dentistry, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,General Academic Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Martin
- Division of Pediatric Dentistry, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.,Medical Affairs, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Burgette JM, Weyant RJ, Ettinger AK, Miller E, Ray KN. What is the association between income loss during the COVID-19 pandemic and children's dental care? J Am Dent Assoc 2021; 152:369-376. [PMID: 33810832 PMCID: PMC7867385 DOI: 10.1016/j.adaj.2021.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND The degree to which children experience unmet need for dental care during the COVID-19 pandemic and its association with pandemic-related household job or income loss are unknown. METHODS The authors performed a cross-sectional household survey of 348 families in Pittsburgh, Pennsylvania, from June 25 through July 2, 2020. Unmet need for child dental care and pandemic-related household job or income loss were assessed using caregiver self-report. RESULTS Caregivers reported that the greatest unmet child health care need during the COVID-19 pandemic was dental care (16%), followed by medical care for a well visit or vaccination (5%). Approximately 40% of caregivers reported job loss or a decrease in household income due to the COVID-19 pandemic. The authors found a significant association between the probability of unmet child dental care and pandemic-related household job or income loss (P = .022). Losing a job or experiencing a decrease in income due to the COVID-19 pandemic was associated with unmet child dental care (relative risk, 1.77; 95% confidence interval, 1.08 to 2.88). CONCLUSIONS In this sample, 3 times as many households reported unmet dental care for a child compared with unmet medical care. Unmet child dental care was more common in households where pandemic-related job or income loss occurred. PRACTICAL IMPLICATIONS If unmet dental care continues as a result of the COVID-19 pandemic, nontraditional strategies for delivering dental care can be considered to improve access to dental care for children, such as teledentistry and oral health prevention services in primary care settings.
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13
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Burgette JM, Mestre Y, Martin B, Ray KN, Stiles A, Hoberman A. Success rates of pediatric dental referrals made by public health dental hygiene practitioners. J Public Health Dent 2020; 81:169-177. [DOI: 10.1111/jphd.12428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/13/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jacqueline M. Burgette
- Department of Dental Public Health University of Pittsburgh Pittsburgh PA USA
- Department of Pediatric Dentistry University of Pittsburgh Pittsburgh PA USA
| | | | - Brian Martin
- University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh Pittsburgh PA USA
| | - Kristin N. Ray
- Department of Pediatrics University of Pittsburgh School of Medicine, University of Pittsburgh Pittsburgh PA USA
| | - Amy Stiles
- University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh Pittsburgh PA USA
| | - Alejandro Hoberman
- Department of Pediatrics University of Pittsburgh School of Medicine, University of Pittsburgh Pittsburgh PA USA
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Nelson S, Slusar MB, Curtan S, Selvaraj D, Hertz A. Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits. Dent J (Basel) 2020; 8:E101. [PMID: 32882958 PMCID: PMC7559918 DOI: 10.3390/dj8030101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children's Teeth (PACT) trial is investigating multi-level interventions at the practice (incorporation of oral health in electronic medical record [EMR]) and provider levels (theory-based didactic and skills training to communicate oral health facts to parent/caregiver, give a prescription to see a dentist and a list of area dentists) to increase dental utilization among 3 to 6 year old Medicaid-enrolled children attending well-child visits (WCV). The formative and pilot work for the larger main trial are presented. Methods: Formative work-Focus groups with 26 participants (Community leaders, providers, parent/caregivers); and key informant interviews with practice leadership (n = 4). Topics discussed were: core oral health (OH) information to communicate at WCVs and study logistics. Transcripts were coded and analyzed using Atlas.ti; Pilot study was refined using the formative findings and was conducted at two pediatric practices to test the implementation of: the provider didactic and skills training curriculum; EMR incorporation of four OH questions; logistics of incorporating OH activities at a WCV; and parent/caregiver recruitment. Results: Formative work showed that providers and parent/caregivers required knowledge of dental caries, and a list of area Medicaid-accepting dentists. Providers and practice leadership advised on the logistics of incorporating oral health into WCVs. All groups suggested asking parent/caregivers their preferred method of contact and emphasizing importance of OH to motivate participation. Utilizing these findings, the curriculum and protocol was revised. The pilot study in two practices successfully implemented the protocol as follows: all seven providers were trained in two 45 min didactic education and skills session; incorporation of OH questions into practices EMR; recruited 86 child-parent dyads (95% participation) at the WCV; providers delivered the OH intervention to parent/caregivers in <2 min and 90% completed EMR documentation of OH questions. These findings were instrumental in finalizing the main PACT trial in 18 practices. The RE-AIM framework is used in the main trial to collect effectiveness and implementation measures at baseline and follow-up visits. Conclusions: The formative and pilot findings were instrumental in refining the OH intervention and protocol which has resulted in successful implementation of the main trial. Trial Registration: Clinical trials.gov, Registered 9 November 2017, NCT03385629.
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Affiliation(s)
- Suchitra Nelson
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USA; (S.C.); (D.S.)
| | - Mary Beth Slusar
- Department of Sociology, California State University Northridge, Northridge, CA 91330, USA;
| | - Shelley Curtan
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USA; (S.C.); (D.S.)
| | - David Selvaraj
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USA; (S.C.); (D.S.)
| | - Andrew Hertz
- University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
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15
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Kim P, Daly JM, Berkowitz S, Levy BT. Use of the Fluoride Varnish Billing Code in a Tertiary Care Center Setting. J Prim Care Community Health 2020; 11:2150132720913736. [PMID: 32193976 PMCID: PMC7092652 DOI: 10.1177/2150132720913736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Dental caries is the most common chronic disease in children from birth through 5 years of age. Application of fluoride varnish (FV) is recommended for children younger than 6 years every 3 to 6 months by the United States Preventive Services Task Force. The purposes of this study were to (1) assess use and reimbursement of Current Dental Terminology (CDT) D1206 and Current Procedural Terminology (CPT) 99188 codes, which are the billing codes for FV application; (2) determine when and by whom each FV code was used; and (3) summarize the associated clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and its affiliated primary care clinics, the dates of service, departments, provider names, and patient identifiers associated with codes CDT D1206 and CPT 99188 were collected. The content of clinical notes was reviewed and summarized. The study period was from May 1, 2009 through May 17, 2019. Results: During the 10-year time period, CDT D1206 was used 5 times and CPT 99188 was used 35 times. FV was applied exclusively during well-child visits. Only pediatricians, and no family physicians, applied FV in this setting. Discussion: A single pediatrician championing for FV application increased both the completion of procedure and the appropriate billing in 2019. Conclusion: FV application has been likely underutilized in this Midwestern tertiary teaching hospital and its affiliated clinics. For both family medicine and pediatric offices, an advocate for caries prevention is likely needed for successful implementation of FV application at well-child visits.
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Affiliation(s)
- Peter Kim
- Genesis Health System, Davenport, IA, USA.,University of Iowa, Iowa City, IA, USA
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ElSalhy M, Gill M, Isaac DM, Littlechild R, Baydala L, Amin M. Integrating preventive dental care into general Paediatric practice for Indigenous communities: paediatric residents' perceptions. Int J Circumpolar Health 2020; 78:1573162. [PMID: 30696378 PMCID: PMC6352953 DOI: 10.1080/22423982.2019.1573162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This qualitative study aimed to explore paediatric residents' perceptions of the feasibility of incorporating preventive dental care into a general paediatric outreach clinic for a First Nations community. Four focus groups were conducted with paediatric residents and attending paediatricians. Interviews were recorded, transcribed verbatim and analysed using a basic interpretive qualitative approach. Three major themes emerged from the data: advantages of integration, barriers to integration and strategies for integration. Comprehensive care and service delivery were the two identified advantages of integration. Three categories of barriers emerged including patient and caregiver-related, resident-related and setting-related barriers. Training and practice, patient education, support and policy were the suggested strategies for successful integration. Providers were found to be open to integrating preventive dental care into their practice. However, barriers impeded the success of this integration. Multiple strategies including oral health care training for medical providers, office support and policy changes would facilitate successful integration.
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Affiliation(s)
- Mohamed ElSalhy
- a College of Dental Medicine , University of New England , Portland , ME , USA
| | - Mandeep Gill
- b School of Dentistry, Faculty of Medicine and Dentistry , University of Alberta , Edmonton, AB , Canada
| | - Daniela Migliarese Isaac
- c Department of Pediatrics, Faculty of Medicine and Dentistry , University of Alberta , Edmonton, AB , Canada
| | | | - Lola Baydala
- c Department of Pediatrics, Faculty of Medicine and Dentistry , University of Alberta , Edmonton, AB , Canada
| | - Maryam Amin
- b School of Dentistry, Faculty of Medicine and Dentistry , University of Alberta , Edmonton, AB , Canada
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Zhu Y, Close K, Zeldin L, White B, Rozier R. Implementation of Oral Health Screening and Referral Guidelines in Primary Health Care. JDR Clin Trans Res 2018; 4:167-177. [DOI: 10.1177/2380084418810332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the oral health screening and referral practices of pediatric providers, their adherence to American Academy of Pediatrics oral health guidelines, and barriers to adherence. Methods: Providers in 10 pediatric practices participating in the North Carolina Quality Improvement Initiative, funded by the Child Health Insurance Program Reauthorization Act of 2009, were asked to complete a 91-item questionnaire. Questions on risk assessment and referral practices were based on those recommended by the American Academy of Pediatrics. Adherence to oral health guidelines was assessed by practitioners’ evaluation of 4 vignettes presenting screening results for an 18-mo-old child with different levels of risk and caries status. Respondents chose referral recommendations assuming adequate and inadequate dentist workforces. Logit models determined the association between barriers specified in Cabana’s framework and adherence (count of 6 to 8 adherent vignettes vs. 0 to 5). Results: Of 72 eligible providers, 53 (74%) responded. Almost everyone (98.1%) screened for dental problems; 45.2% referred in at least half of well-child visits. Respondents were aware of oral health guidelines, expressed strong agreement with them, and reported confidence in providing preventive oral health services. Yet they underreferred by an average of 42% per vignette for the 7 clinical vignette-workforce scenarios requiring an immediate referral. Frequently cited barriers were providers’ beliefs that 1) parents are poorly motivated to seek dental care, 2) oral health counseling has a small effect on parent behaviors, 3) there is a shortage of dentists in their community who will see infants and toddlers, and 4) information systems to support referrals are insufficient. Conclusion: Pediatric clinicians’ beliefs lead to a conscious decision not to refer many patients, even when children should be referred. Knowledge Transfer Statement: Evidence suggests that the primary care–dental referral process needs improvement. This study identifies barriers to delivering recommended preventive oral health services in pediatrics. The information can be used to improve the screening and referral process and, thus, the quality of preventive oral health services provided in primary care. Results also can guide researchers on the selection of interventions that need testing and might close gaps in the referral process and improve access to dental care.
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Affiliation(s)
- Y. Zhu
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - K. Close
- Oral Health Section, Division of Public Health, NC Department of Health and Human Services, Raleigh, NC, USA
| | - L.P. Zeldin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - B.A. White
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Department of Dental Ecology, School of Dentistry, University of North Carolina at 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, NC, USA
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Sibley JA. Cost-Benefit Analysis of Providing Fluoride Varnish in a Pediatric Primary Care Office. J Pediatr Health Care 2018; 32:620-626. [PMID: 30368308 DOI: 10.1016/j.pedhc.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/11/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The American Academy of Pediatrics and the U.S. Preventive Services Task Force, among others, call for the provision of fluoride varnish in the pediatric primary care setting, but many barriers exist to the implementation of such a service in this setting. Knowledge of costs and benefits is one such barrier. METHODS A cost-benefit analysis of the implementation of a fluoride varnish program in a pediatric primary care office located in Volusia County, Florida was conducted with the assistance of the office manager and a nurse practitioner using data retrieved from the electronic health record program. RESULTS Microsoft Excel was used to calculate estimated mean reimbursement data from the top insurers in this office for this service, and the data show a positive annual net income of $4,498 to $26,775, with an average potential annual net income of $15,637. CONCLUSIONS The data from this cost-benefit analysis show a positive financial benefit as an incentive to implement a fluoride varnish program in this primary care pediatric office and serve as a solid foundation for a future quality improvement project to implement such a program.
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Harnagea H, Lamothe L, Couturier Y, Emami E. How primary health care teams perceive the integration of oral health care into their practice: A qualitative study. PLoS One 2018; 13:e0205465. [PMID: 30312338 PMCID: PMC6185726 DOI: 10.1371/journal.pone.0205465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022] Open
Abstract
Recently, new models for the integration of oral health into primary care have been proposed. However, these models may be adopted by a variety of health care systems, and will reach successful outcomes only if they can be adapted to suit the local context. To this end, the objective of this study was to explore the perceptions of Quebec primary health care teams on the integration of oral health into primary care. A qualitative approach and interpretive description methodology were used to conduct the study within a case-study design. Purposeful sampling with maximum variation and snowball technique were used for recruitment of study participants. Seventy-four in-depth, semi-structured interviews and five focus groups were conducted with primary health care teams including health care providers and managers working in a rural and an urban health care center. The interview guide and study conceptual framework were based on the Rainbow model. Data collection and data analyses were conducted concurrently and continued until saturation was achieved. To analyze the data, four phases of qualitative analysis were followed. The thematic analysis included interview debriefing, transcript coding, data display, and interpretation. Data analysis was conducted both manually and with the use of Atlas-ti software. A total of four themes emerged from the interviews and focus group discussions. These themes covered all domains of the study theoretical model and included: 1) drivers of integration; 2) importance of integration; 3) professionals’ role in integrated care; and 4) barriers and enablers of integration. In general, most of the barriers expressed by study participants were related to the organizational and system domains of integration. Primary health care teams who provide care in rural and urban areas in Quebec expressed their concerns on the absence of integrated oral health services. Implementation of governance policies, the prioritization of educational and management measures as well as inter-professional collaboration toward innovative care models could facilitate this integration.
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Affiliation(s)
- Hermina Harnagea
- School of Public Health, Université de Montréal, Québec, Canada
- Public Health Research Institute, Université de Montréal, Québec, Canada
| | - Lise Lamothe
- School of Public Health, Université de Montréal, Québec, Canada
- Public Health Research Institute, Université de Montréal, Québec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Québec, Canada
| | - Elham Emami
- School of Public Health, Université de Montréal, Québec, Canada
- Public Health Research Institute, Université de Montréal, Québec, Canada
- Faculty of Dentistry, McGill University, Québec, Canada
- * E-mail:
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20
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Dima S, Chang WJ, Chen JW, Teng NC. Early Childhood Caries-Related Knowledge, Attitude, and Practice: Discordance between Pediatricians and Dentists toward Medical Office-Based Prevention in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061067. [PMID: 29795024 PMCID: PMC6024957 DOI: 10.3390/ijerph15061067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess the knowledge, attitude, and practice regarding early childhood caries (ECC) prevention and implementation of medical setting-based caries prevention among pediatricians and dentists in Taiwan. Data were collected from currently practicing pediatricians and general and pediatric dentists using self-administered questionnaires. A total of 301 questionnaires were completed by the pediatricians (n = 105), general dentists (n = 117), and pediatric dentists (n = 79). The pediatric dentists obtained significantly higher knowledge and practice scores than the general dentists and pediatricians (p < 0.0001). The pediatricians’ attitude score related to engaging physicians in medical office-based caries prevention was significantly higher than the attitude scores of the general and pediatric dentists (p < 0.05). A Spearman rank correlation analysis indicated a significant positive correlation between knowledge and practice among the general dentists (rs = 0.271, p < 0.01) and pediatricians (rs = 0.262, p < 0.01). The correlation between knowledge and attitude among the pediatricians was significantly positive (rs = 0.242, p < 0.05). Attitude and practice among the pediatricians were significantly positively correlated (rs = 0.271, p < 0.01). Pediatricians lacked ECC-related knowledge; however, they had a more positive attitude toward medical office-based prevention when they had a higher level of knowledge. Oral health-related education for pediatricians is necessary if such medical office-based caries prevention programs are to be implemented in Taiwan.
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Affiliation(s)
- Shinechimeg Dima
- School of Dentistry, College of Oral Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan.
| | - Wei-Jen Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan.
- Department of Dentistry, Shuang Ho Hospital, New Taipei 235, Taiwan.
| | - Jung-Wei Chen
- School of Dentistry, Department of Pediatric Dentistry, Loma Linda University, Loma Linda, CA 92350, USA.
| | - Nai-Chia Teng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan.
- Department of Dentistry, Taipei Medical University Hospital, 250 Wu-Hsing Street, Taipei 110, Taiwan.
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21
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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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Harnagea H, Couturier Y, Shrivastava R, Girard F, Lamothe L, Bedos CP, Emami E. Barriers and facilitators in the integration of oral health into primary care: a scoping review. BMJ Open 2017; 7:e016078. [PMID: 28951405 PMCID: PMC5623507 DOI: 10.1136/bmjopen-2017-016078] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care. METHODS Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results. RESULTS From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients' oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity. DISCUSSION AND PUBLIC HEALTH IMPLICATIONS This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care.
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Affiliation(s)
- Hermina Harnagea
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Richa Shrivastava
- Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Felix Girard
- Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Lise Lamothe
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Public Health Research Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Elham Emami
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada
- Public Health Research Institute, Université de Montréal, Montréal, Québec, Canada
- Faculty of Dentistry, McGill University, Montréal, Québec, Canada
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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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Bernstein J, Gebel C, Vargas C, Geltman P, Walter A, Garcia R, Tinanoff N. Listening to paediatric primary care nurses: a qualitative study of the potential for interprofessional oral health practice in six federally qualified health centres in Massachusetts and Maryland. BMJ Open 2017; 7:e014124. [PMID: 28360245 PMCID: PMC5372099 DOI: 10.1136/bmjopen-2016-014124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore the opportunities for interprofessional collaboration (IPC) to improve paediatric oral health in federally qualified health centres (FQHCs), to identify challenges to IPC-led integration of oral health prevention into the well-child visit and to suggest strategies to overcome barriers. SAMPLE Nurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format. DESIGN Grounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care. MEASUREMENTS Qualitative data were coded and analysed using NVivo 10 to generate themes iteratively. RESULTS Nurses in diverse roles recognised the importance of oral health prevention but were unaware of professional guidelines for incorporating oral health into paediatric encounters. They valued collaborative care, specifically internal communication, joint initiatives and training and partnering with dental schools or community dental practices. Barriers to IPC included inadequate training, few opportunities for cross-communication and absence of charting templates in electronic health records. CONCLUSIONS NMs, NPs and paediatric nursing staff all value IPC to improve patients' oral health, yet are constrained by lack of oral health training and supportive charting and referral systems. With supports, they are willing to take on responsibility for introducing oral health preventive measures into the well-child visit, but will require IPC approaches to training and systems changes. IPC teams in the health centre setting can work together, if policy and administrative supports are in place, to provide oral health assessments, education, fluoride varnish application and dental referrals, decrease the prevalence of early childhood caries and increase access to a dental home for low-income children.
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Affiliation(s)
- Judith Bernstein
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Christina Gebel
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Clemencia Vargas
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
- Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Paul Geltman
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Ashley Walter
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Raul Garcia
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Norman Tinanoff
- Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
- Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
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Braun PA, Cusick A. Collaboration Between Medical Providers and Dental Hygienists in Pediatric Health Care. J Evid Based Dent Pract 2016; 16 Suppl:59-67. [DOI: 10.1016/j.jebdp.2016.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bernstein J, Gebel C, Vargas C, Geltman P, Walter A, Garcia RI, Tinanoff N. Integration of Oral Health Into the Well-Child Visit at Federally Qualified Health Centers: Study of 6 Clinics, August 2014-March 2015. Prev Chronic Dis 2016; 13:E58. [PMID: 27126556 PMCID: PMC4856482 DOI: 10.5888/pcd13.160066] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Early childhood caries, the most common chronic childhood disease, affects primary dentition and can impair eating, sleeping, and school performance. The disease is most prevalent among vulnerable populations with limited access to pediatric dental services. These same children generally receive well-child care at federally qualified health centers. The objective of this study was to identify facilitators and barriers to the integration of oral health into pediatric primary care at health centers to improve problem recognition, delivery of preventive measures, and referral to a dentist. METHODS We collected and analyzed background data and data from structured observations and 39 interviews with administrators and staff at 6 clinics in 2 states, Maryland and Massachusetts. RESULTS Participants valued oral health across professional roles but cited limited time, lack of training and expertise, low caregiver literacy, and lack of shared medical and dental electronic records as barriers to cooperation. Facilitators included an upper-level administration with the vision to see the value of integration, designated team leaders, and champions. An administration's vision, not structural determinants, patient characteristics, or geographic location, predicted the level of integration. Interviewees generated multilevel recommendations to promote delivery of oral health preventive measures and services during a well-child visit. CONCLUSION Poor oral health contributes to health care disparities. Barriers to integrating dental care into pediatric medical practice at health centers must be overcome to improve oral health for children living in poverty, with a disability, at a rural address, or any combination of these. Implementation will require adapting delivery systems to support multidisciplinary collaboration. Strategies suggested here may point the way to enhancing children's oral health.
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Affiliation(s)
- Judith Bernstein
- Dept of Community Health Sciences, Boston University, 801 Massachusetts Ave 431B, Boston, MA 02118.
| | | | - Clemencia Vargas
- Boston University and University of Maryland School of Dentistry, Baltimore, Maryland
| | | | | | | | - Norman Tinanoff
- Boston University and University of Maryland School of Dentistry, Baltimore, Maryland
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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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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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Arheiam A, Masoud I, Bernabé E. Perceived barriers to preventive dental care among Libyan dentists. Libyan J Med 2014; 9:24340. [PMID: 24767673 PMCID: PMC4000429 DOI: 10.3402/ljm.v9.24340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 03/23/2014] [Accepted: 03/28/2014] [Indexed: 11/18/2022] Open
Abstract
AIM To explore the barriers to providing preventive dental care to patients, as perceived by Libyan dentists working in Benghazi. SETTINGS AND DESIGN A cross-sectional, questionnaire-based survey was conducted among dentists working in Benghazi, Libya. MATERIALS AND METHODS All dentists registered with the Dental Association of Benghazi and with 2 or more years of practice were invited to participate. The questionnaire collected information on participants' demographic and professional characteristics as well as the patient-, practice- and dentist-related barriers to providing preventive dental care. STATISTICAL ANALYSIS Scores for each type of barrier were compared by demographic and professional characteristics in bivariate and multivariate analyses. RESULTS One hundred and seventy five dentists returned the questionnaires (response rate: 79%) and 166 had complete information on all the variables selected for analysis (75%). The majority were females (70%), aged between 23 and 34 years (85%), was working in the public health sector (43%), and had up to 5 years of service (46%). Patient-related barriers were scored the highest, followed by practice- and dentist-related barriers. Dentists with mixed practice reported lower scores on patient- and practice-related barriers than those in public or private practice. CONCLUSION Respondents were generally aware of the barriers to preventive dentistry and perceived the barriers as being more related to their patients than to their practices or themselves. However, these perceptions varied by practice sector.
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Affiliation(s)
- Arheiam Arheiam
- Department of Health Service Research, University of Liverpool, Liverpool, United Kingdom; Faculty of Dentistry, Department of Community and Preventive Dentistry, Benghazi University, Benghazi, Libya;
| | - Ibtisam Masoud
- Faculty of Dentistry, Department of Community and Preventive Dentistry, Benghazi University, Benghazi, Libya
| | - Eduardo Bernabé
- Unit of Dental Public Health, King's College London Dental Institute, London, United Kingdom
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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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Pesaressi E, Villena RS, van der Sanden WJM, Mulder J, Frencken JE. Barriers to adopting and implementing an oral health programme for managing early childhood caries through primary health care providers in Lima, Peru. BMC Oral Health 2014; 14:17. [PMID: 24597792 PMCID: PMC4016564 DOI: 10.1186/1472-6831-14-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify barriers to participation in a primary oral health care programme aimed at preventing early childhood caries, as perceived by nurses. METHODS Of a total of 140 randomly selected nurses employed in 40 government health centres in Lima, 123 completed a pre-tested questionnaire. Background variables were districts' 'socio-economic status' (SES) and 'years of experience'. Factor analysis was performed. ANOVA was applied for testing the influence of the background variables on the barrier factors. Chi-square test was applied to test for differences between single item barriers and the background variables. The Likert-scale (1-4) was used. RESULTS There was no statistical significant effect of 'SES' or of 'years of experience' of nurses on any of the 7 barrier factors, nor on the 11 single item barrier factors. The highest mean score (3.81) was obtained for the barrier factor 'importance of oral health', followed by 'perceived responsibility' (3.44). The lowest mean score was (1.70) for 'knowledge on caries prevention'. CONCLUSIONS Nurses consider oral health very important and are willing to participate actively in programmes aimed at reducing Early Childhood Caries, provided that they will be trained well and that the director and dentists of the health centre give their consent.
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Affiliation(s)
- Eraldo Pesaressi
- Department of Paediatric Dentistry, Universidad de San Martin de Porres; Dental School, Lima, Peru
| | - Rita S Villena
- Department of Paediatric Dentistry, Universidad de San Martin de Porres; Dental School, Lima, Peru
| | - Wil JM van der Sanden
- Department of Global Oral Health, Radboud University Medical Center, College of Oral Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Jan Mulder
- Department of Global Oral Health, Radboud University Medical Center, College of Oral Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Jo E Frencken
- Department of Global Oral Health, Radboud University Medical Center, College of Oral Sciences, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
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Sams LD, Rozier RG, Wilder RS, Quinonez RB. Adoption and implementation of policies to support preventive dentistry initiatives for physicians: a national survey of Medicaid programs. Am J Public Health 2013; 103:e83-90. [PMID: 23763420 PMCID: PMC4007883 DOI: 10.2105/ajph.2012.301138] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the number of state Medicaid programs adopting initiatives to support preventive dental services provision by nondental health care professionals, their perceived attributes, and implementation barriers. METHODS We used Qualtrics to conduct a cross-sectional survey in 2008 of Medicaid dental program managers to determine organizational stage of adoption classified according to the Transtheoretical Model of Behavior Change with 3-year follow-up. We assessed perceptions of the influence of 18 initiative attributes on the decision to adopt, drawn from Roger's diffusion of innovations theory. Stage and date of adoption are presented descriptively. Attributes and barriers were analyzed by stage of adoption by using analyses of variance or χ(2) statistics. RESULTS By 2011, 42 states had adopted a policy. Only 9 states included a comprehensive set of preventive services, the most common being fluoride varnish. Adoption was affected by perceived initiative simplicity and its compatibility with other Medicaid programs. Administrative barriers were the most common among the 15 studied. CONCLUSIONS State Medicaid policies to reimburse nondental providers for preventive dental services are becoming widespread. Interventions are needed to ensure oral health services delivery at the practice level.
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Affiliation(s)
- Lattice D Sams
- Department of Dental Ecology, University of North Carolina at Chapel Hill School of Dentistry, 3240 Old Dental Building, Chapel Hill, NC 27599-7450, USA.
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Nammalwar RB, Rangeeth P. Knowledge and attitude of pediatricians and Family Physicians in Chennai on Pediatric Dentistry: A survey. Dent Res J (Isfahan) 2013; 9:561-6. [PMID: 23559920 PMCID: PMC3612192 DOI: 10.4103/1735-3327.104874] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: The aim of this study was to study the knowledge and attitude of the pediatricians and family physicians on the dental counterpart, i.e. pediatric dentistry and the objective of this study were to determine what can improve the knowledge and attitude on pediatric dentistry and suggest certain methodologies to more participation of physicians in improving oral health. Materials and Methods: A systematic random survey of 400 pediatricians and 400 family physicians received a questionnaire pertaining to individual details, approach towards pediatric dentistry, knowledge level and the training on oral health received. Results: Most of pediatricians and family physicians acknowledged the importance of pediatric dentistry. Less of pediatricians and more of family physicians predicted the parents may pose a barrier for referral. More number of pediatricians were aware of the oral benefits of breast feeding when compared to the family physician. Most of the practitioners in both groups were less aware of the first dental visit including ECC. Acknowledgement of the role in cleft lip and palate was more or less same in both groups of practitioners were as the effect of systemic disease on oral health was recognized by more number of pediatricians. Only a small percentage in both the groups acknowledged the cariogenicity of medicated syrups, which was substantiated by the fact that only a small number of physicians underwent dental training and most of them were accepting to undergo training. Conclusion: When basic medical training is provided in dental school, medical schools can also provide dental training. Dental lectures can also be incorporated into CME programs and recognition of pediatric dentistry by providing referral to needy patients have been suggested.
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Affiliation(s)
- Rangeeth Bollam Nammalwar
- Department of Pedodontics and Preventive Dentistry, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute, Deemed University, Chennai, India
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Braun PA, Kahl S, Ellison MC, Ling S, Widmer-Racich K, Daley MF. Feasibility of colocating dental hygienists into medical practices. J Public Health Dent 2013; 73:187-94. [DOI: 10.1111/jphd.12010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/01/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Patricia A. Braun
- Children's Outcomes Research Program; University of Colorado Anschutz Medical Campus; Aurora CO USA
| | - Shelby Kahl
- Independent Registered Dental Hygienist; Fort Collins CO USA
| | - Misoo C. Ellison
- Colorado School of Public Health; University of Colorado Anschutz Medical Campus; Aurora CO USA
| | - Sarah Ling
- College of Osteopathic Medicine; Des Moines University; Des Moines IA USA
| | - Katina Widmer-Racich
- Children's Outcomes Research Program; University of Colorado Anschutz Medical Campus; Aurora CO USA
| | - Matthew F. Daley
- Institute for Health Research; Kaiser Permanente Colorado; Aurora CO USA
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Block SL. Put some 'teeth' into your pediatric preventive counseling. Pediatr Ann 2012; 41:356-9. [PMID: 22953980 DOI: 10.3928/00904481-20120827-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chi DL, Leroux B. County-level determinants of dental utilization for Medicaid-enrolled children with chronic conditions: how does place affect use? Health Place 2012; 18:1422-9. [PMID: 22981229 DOI: 10.1016/j.healthplace.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/11/2012] [Accepted: 07/26/2012] [Indexed: 10/28/2022]
Abstract
Little is known about how place affects childrens' access to dental care. We analyzed data for 25,908 Iowa Medicaid-enrolled children with chronic conditions to identify the county-level determinants of dental utilization. Our analyses suggest that higher levels of poverty and designation as a dental health professional shortage area at the county-level are associated with lower probability of child-level dental use. There are significant interactions between child-level race/ethnicity and county-level poverty as well as between child-level disability and county-level unemployment. We present a new descriptive model on dental utilization that emphasizes county-level factors as well as interactions between county-level and child-level factors.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195, USA.
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Kagihara LE, Huebner CE, Mouradian WE, Milgrom P, Anderson BA. Parents' perspectives on a dental home for children with special health care needs. SPECIAL CARE IN DENTISTRY 2012; 31:170-7. [PMID: 21950531 DOI: 10.1111/j.1754-4505.2011.00204.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors surveyed parent-leaders about aspects of a dental home for children with special health care needs (CSHCN). State leaders in two advocacy groups completed the survey; the response rate was 70.6% of all states. Two of the most highly rated aspects of a dental home, endorsed as "essential" by 89% of respondents, pertained to dentist-parent interactions: the dentist listens carefully to the family, and the dentist helps the family feel like a partner in treatment decisions. Likewise, 89% said it was essential that insurance coverage allows the child to see needed providers. Dentists' lack of knowledge or willingness to treat CSHCN and refusal of Medicaid insurance coverage were identified as major barriers to care. More than 84% of respondents reported that parents were unaware of the recommendation to establish dental care by 1 year of age. Establishing policy and educational strategies should help parents meet this dental health goal.
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Affiliation(s)
- Lynette E Kagihara
- Department of Dental Practice, University of Pacific Arthur A. Dugoni School of Dentistry, Union City Dental Care Center, Union City, California, USA.
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Isong IA, Silk H, Rao SR, Perrin JM, Savageau JA, Donelan K. Provision of fluoride varnish to Medicaid-enrolled children by physicians: the Massachusetts experience. Health Serv Res 2011; 46:1843-62. [PMID: 21762142 DOI: 10.1111/j.1475-6773.2011.01289.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a 2008 Medicaid policy in Massachusetts (MA), regarding reimbursing physicians for providing fluoride varnish (FV) to eligible children in medical settings. DATA SOURCE Survey of a sample of primary care physicians in MA. STUDY DESIGN Cross-sectional survey of a sample of physicians who provide care to MassHealth (MA Medicaid) enrolled-children. DEPENDENT VARIABLES history of completed preventive dental skills training, and FV provision. INDEPENDENT VARIABLES oral health knowledge, FV-attitudes, and physician and practice characteristics. PRINCIPAL FINDINGS Overall, 19 percent of respondents had completed the training required to be eligible to bill for FV provision. Only 5 percent of physicians were providing FV. Most respondents (63 percent) were not familiar with the new policy, and only 25 percent felt that FV should be provided during well-child visits. Most physicians (60 percent) did not feel that the reimbursement rate of U.S.$26/application was sufficient; 17 percent said that they would not provide FV, regardless of payment. Most common barriers to FV provision were a lack of time and logistical challenges. CONCLUSIONS Our findings suggest that simply reimbursing physicians for FV provision is insufficient to ensure provider participation. Success of this policy will likely require addressing several barriers identified.
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Affiliation(s)
- Inyang A Isong
- Harvard Medical School, Center for Child and Adolescent Health Policy, Massachusetts General Hospitalfor Children, Boston, MA 02114, USA.
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Pahel BT, Rozier RG, Stearns SC, Quiñonez RB. Effectiveness of preventive dental treatments by physicians for young Medicaid enrollees. Pediatrics 2011; 127:e682-9. [PMID: 21357343 PMCID: PMC3065140 DOI: 10.1542/peds.2010-1457] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To estimate the effectiveness of a medical office-based preventive dental program (Into the Mouths of Babes [IMB]), which included fluoride varnish application, in reducing treatments related to dental caries. METHODS We used longitudinal claims and enrollment data for all children aged 72 months or younger enrolled in North Carolina Medicaid from 2000 through 2006. Regression analyses compared subgroups of children who received up to 6 IMB visits at ages 6 to 35 months with children who received no IMB visits. Analyses were adjusted for child and area characteristics. RESULTS Children enrolled in North Carolina Medicaid with ≥ 4 IMB visits experienced, on average, a 17% reduction in dental-caries-related treatments up to 6 years of age compared with children with no IMB visits. When we simulated data for initial IMB visits at 12 and 15 months of age, there was a cumulative 49% reduction in caries-related treatments at 17 months of age. The cumulative effectiveness declined because of an increase in treatments from 24 to 36 months, an increase in referrals for dental caries occurred with increasing time since fluoride application, and emergence of teeth not initially treated with fluoride. CONCLUSIONS North Carolina's IMB program was effective in reducing caries-related treatments for children with ≥ 4 IMB visits. Multiple applications of fluoride at the time of primary tooth emergence seem to be most beneficial. Referrals to dentists for treatment of existing disease detected by physicians during IMB implementation limited the cumulative reductions in caries-related treatments, but also contributed to improved oral health.
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Affiliation(s)
| | | | | | - Rocio B. Quiñonez
- Pediatric Dentistry and Pediatrics, University of North Carolina, Chapel Hill, North Carolina
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Rozier RG, Stearns SC, Pahel BT, Quinonez RB, Park J. How a North Carolina program boosted preventive oral health services for low-income children. Health Aff (Millwood) 2010; 29:2278-85. [PMID: 21134930 PMCID: PMC5702492 DOI: 10.1377/hlthaff.2009.0768] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dental caries (tooth decay), the most common chronic disease affecting young children, is exacerbated by limited access to preventive dental services for low-income children. To address this problem, North Carolina implemented a program to reimburse physicians for up to six preventive oral health visits for Medicaid-enrolled children younger than age three. Analysis of physician and dentist Medicaid claims from the period 2000-2006 shows that the program greatly increased preventive oral health services. By 2006 approximately 30 percent of well-child visits for children ages six months up to three years included these services. However, additional strategies are needed to ensure preventive oral health care for more low-income children.
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Affiliation(s)
- 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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Abstract
PURPOSE OF REVIEW Oral health is an integral part of the overall health of children. Pediatricians must be competent in issues of oral health and disease if they are to fulfill their role as professionals dedicated to the health of children. This review will update pediatricians on the epidemiology of child oral disease, highlight the importance of good oral health in special populations of children, and examine the role pediatricians can play in maintaining children's oral health. RECENT FINDINGS Dental caries continues to be a common chronic disease of childhood and has increased in the youngest age groups. Oral disease has implications beyond the mouth and can cause significant problems for children with other chronic diseases. Pediatricians receive very little education on oral health during their medical training and numerous barriers exist to incorporating oral health into practice. Despite these facts, opportunities exist to both increase knowledge and overcome the barriers to incorporating oral health into daily practice. Collaboration with other child health professionals to improve children's oral health will make the job of the pediatrician easier. SUMMARY Pediatricians have an opportunity to increase their knowledge of children's oral health, incorporate it into their daily clinical routine, and improve the overall health of children.
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Bibliography. Genetics. Current world literature. Curr Opin Pediatr 2010; 22:833-5. [PMID: 21610333 DOI: 10.1097/mop.0b013e32834179f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Janet Serwint
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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