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Choi SE, Mo E, Sima C, Wu H, Thakkar-Samtani M, Tranby EP, Frantsve-Hawley J, Barrow JR. Impact of COVID-19 on Dental Care Utilization and Oral Health Conditions in the United States. JDR Clin Trans Res 2023:23800844231165016. [PMID: 37082861 PMCID: PMC10125887 DOI: 10.1177/23800844231165016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
PURPOSE We aim to understand the impact of the COVID-19 on health care utilization and oral health conditions of patients at federally qualified health centers (FQHCs), where patients are disproportionately low income, publicly insured, or uninsured. METHODS Using deidentified electronic health records of patients at FQHCs in the United States from January 2019 through December 2020 (n = 431,509), variations in health care utilization since the COVID-19 outbreak were observed by procedure types and patient characteristics. Changes in dental utilization and oral health conditions were characterized using mixed-effect negative binomial and logistic regression models. RESULTS Dental utilization decreased more drastically than medical utilization during shelter-in-place periods in 2020 and rebounded more slowly after the reopening. Greater demands for oral surgery and teledentistry and less demands for preventive services were observed in 2020. As compared to 2019, patients experienced more psychological stress-related dental conditions with odds ratios of 1.52 (95% confidence interval [CI], 1.31-1.76) for uninsured, 1.48 (95% CI, 1.07-2.02) for Medicaid enrollees, and 2.38 (95% CI, 1.68-3.40) for private insurance beneficiaries. CONCLUSION As a result of COVID-19, patients received more invasive dental procedures due to delayed treatment and experienced a higher risk of psychological stress-related dental conditions. Continued support for statewide policies to expand access to oral health care and oral health promotion strategies for the vulnerable populations would be encouraged. KNOWLEDGE TRANSFER STATEMENT Our study describes the impact of COVID-19 on dental care use and oral health conditions at Federally Qualified Health Centers, targeted to provide care for some of the most vulnerable populations in the United States. The results of this retrospective cohort study can be used by clinicians and policymakers on understanding the clinical needs of the vulnerable populations after the pandemic. It highlights the need for continued support to expand access to oral health care and oral health promotion to these populations.
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Affiliation(s)
- S E Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - E Mo
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
| | - C Sima
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - H Wu
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
| | - M Thakkar-Samtani
- Analytics and Evaluation, CareQuest Institute for Oral Health, Boston, MA, USA
| | - E P Tranby
- Analytics and Evaluation, CareQuest Institute for Oral Health, Boston, MA, USA
| | - J Frantsve-Hawley
- Analytics and Evaluation, CareQuest Institute for Oral Health, Boston, MA, USA
| | - J R Barrow
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
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2
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Simon L, Song Z, Barnett ML. Dental Services Use: Medicare Beneficiaries Experience Immediate And Long-Term Reductions After Enrollment. Health Aff (Millwood) 2023; 42:286-295. [PMID: 36745837 PMCID: PMC10022587 DOI: 10.1377/hlthaff.2021.01899] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Traditional Medicare does not cover routine dental care, but little is known about transitions in dental outcomes upon reaching Medicare eligibility at age sixty-five. Using data from the 2010-19 Medical Expenditure Panel Surveys, we examined dental insurance, utilization, and outcomes among US adults before and after age sixty-five, using a regression discontinuity design and segmented regression analysis. Among 97,108 US adults representing a weighted population of 104,787,300 people, complete edentulism, or the loss of all teeth, increased by 4.8 percentage points at age sixty-five, and the percentage of people receiving restorative dental care decreased by 8.7 percentage points. Enrollment in Medicare Advantage, which may offer a dental benefit, was not associated with greater use of dental services relative to traditional Medicare, and Medicare Advantage enrollees had a significantly larger drop in dental spending from private insurance at age sixty-five than traditional Medicare enrollees. Expanding Medicare to cover dental services may help counteract these effects among all enrollees.
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Affiliation(s)
- Lisa Simon
- Lisa Simon , Harvard University and Brigham and Women's Hospital, Boston, Massachusetts
| | - Zirui Song
- Zirui Song, Harvard University and Massachusetts General Hospital, Boston, Massachusetts
| | - Michael L Barnett
- Michael L. Barnett, Harvard University and Brigham and Women's Hospital
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3
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Frichembruder K, Prass TS, Hugo FN. [Times series of dental emergency attendance in Brazil between 2008 and 2015]. CIENCIA & SAUDE COLETIVA 2022; 27:3215-3226. [PMID: 35894332 DOI: 10.1590/1413-81232022278.22302021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/06/2022] [Indexed: 11/22/2022] Open
Abstract
The option to use emergency dental services is dependent upon the social, epidemiological and organizational conditions of the health services. In order to evaluate the specific emergency indicators in the care network for understanding access and performance, a time series study of emergency dental care according to the codes of care by health facilities in Brazil from 2008 to 2015 was carried out. Health services were grouped into primary and secondary care points and total services. Secondary services were subdivided into specialized and hospital services. The primary care group accounted for 72.75% of the emergency care and the mean of the standardized rate of total emergencies was 0.04 visits per inhabitant. The trend for total services was stable, though there was growth in primary health care services (5.58%/year). The results highlight the participation of primary health care services in the care of dental emergencies, followed by specialized and hospital services, which is in line with the assumption of the inverse relationship between the capacity of emergency dental care service and its technological density.
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Affiliation(s)
- Karla Frichembruder
- Centro de Pesquisas em Odontologia social, Universidade Federal do Rio Grande do Sul (UFRGS). R. Ramiro Barcelos 2492, sala 402, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
| | - Taiane Schaedler Prass
- Programa de Pós-Graduação em Estatística, Instituto de Matemática e Estatística, UFRGS. Porto Alegre RS Brasil
| | - Fernando Neves Hugo
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, UFRGS. Porto Alegre RS Brasil
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4
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Cothron A, Diep VK, Shah S, Brow A, Thakkar-Samtani M, Okunseri C, Tranby EP, Frantsve-Hawley J. A systematic review of dental-related emergency department among Medicaid beneficiaries. J Public Health Dent 2021; 81:280-289. [PMID: 34075587 DOI: 10.1111/jphd.12458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/11/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dental-related emergency department (ED) visits are a growing public health concern. Dental insurance coverage is a strong predictor of dental service access. The objective of this study was to conduct a systematic review to assess the incidence of dental-related ED visits for Medicaid dental enrollees compared to those with other insurances. METHODS PubMed, EMBASE, and Google Scholar were searched for surveillance and observational data published in English from January 1999 to April 2020 to address the following PECOT question: Do patients with nontraumatic dental conditions (NTDC) (P1), or patients with any dental condition (P2) who have Medicaid (E) compared to other insurance status (private insurance, Medicare, no insurance) (C) have a differential incidence of single dental-related ED visits (O) in the literature search results from 1999 to April 2020 (T)? A critical appraisal was performed using a combination of the AXIS tool (for cross-sectional studies with observational data and MetaQAT (for public health evidence). RESULTS This systematic review included 32 studies. Overall, risk of bias was low. Due to significant statistical heterogeneity, a synthesis without meta-analysis was conducted. NTDC ED visits ranged from 16.0 percent to 79.8 percent for Medicaid patients and 0.9 percent to 57.2 percent for uninsured patients. The range for any dental visit to the ED was 2.2-63.8 percent for Medicaid patients and 2.9-40.8 percent for uninsured patients. CONCLUSIONS The results of this study support expanding insurance coverage in Medicaid programs to reduce ED use for NTDC visits in the United States.
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Affiliation(s)
| | - Vuong K Diep
- CareQuest Institute for Oral Health, Boston, MA, USA
| | | | - Avery Brow
- Chase Brexton Health Care, Baltimore, MD, USA
| | | | | | - Eric P Tranby
- CareQuest Institute for Oral Health, Boston, MA, USA
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5
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Akinlotan MA, Ferdinand AO. Emergency department visits for nontraumatic dental conditions: a systematic literature review. J Public Health Dent 2020; 80:313-326. [DOI: 10.1111/jphd.12386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/24/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Marvellous A. Akinlotan
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
| | - Alva O. Ferdinand
- Department of Health Policy and Management Texas A&M School of Public Health College Station TX USA
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6
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Simon L. How Will Dentistry Respond to the Coronavirus Disease 2019 (COVID-19) Pandemic? JAMA HEALTH FORUM 2020; 1:e200625. [DOI: 10.1001/jamahealthforum.2020.0625] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lisa Simon
- Harvard School of Dental Medicine, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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7
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Elani HW, Kawachi I, Sommers BD. Changes in emergency department dental visits after Medicaid expansion. Health Serv Res 2020; 55:367-374. [PMID: 31943200 PMCID: PMC7240762 DOI: 10.1111/1475-6773.13261] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To estimate the effect of Medicaid expansion under the Affordable Care Act (ACA) on the frequency and payment source for Emergency Department (ED) visits for dental care. STUDY DESIGN Retrospective, quasi-experimental study. DATA SOURCES/STUDY SETTING We used the State Emergency Department Database to compare changes in ED visit rates and payment source for dental conditions among patients from 33 states. These states represent four distinct policy environments, based on whether they expanded Medicaid and whether their Medicaid programs provide dental benefits. We first assessed the number of ED dental visits before (2012) and after (2014) the ACA. Then, we used differences-in-differences regression to estimate changes in insurance for dental visits by nonelderly adults. PRINCIPAL FINDINGS Our sample contained 375 944 dental ED visits. In states that expanded Medicaid and offered dental coverage, dental ED visits decreased by 14.1 percent (from 19 443 to 16 709, for a net difference of 2734). By contrast, in the remaining three state groups, dental ED visits rose. Meanwhile, the expansion significantly increased Medicaid coverage and decreased the rate of self-pay for ED dental visits. CONCLUSIONS Medicaid expansion, combined with adult dental coverage in Medicaid, was associated with a reduction in ED utilization for dental visits.
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Affiliation(s)
- Hawazin W Elani
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Benjamin D Sommers
- Department of Health Policy and Mangament, Harvard School of Public Health, Boston, Massachusetts
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Kim PC, Zhou W, McCoy SJ, McDonough IK, Burston B, Ditmyer M, Shen JJ. Factors Associated with Preventable Emergency Department Visits for Nontraumatic Dental Conditions in the U.S. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193671. [PMID: 31574897 PMCID: PMC6801501 DOI: 10.3390/ijerph16193671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022]
Abstract
This study was designed to examine national trends and evaluate social determinants of health that were associated with the provision of dental services in emergency rooms in the United States between 2007 and 2014. A pooled cross-sectional database of emergency department (ED) visits combined the 2007-2014 waves of the Nationwide Emergency Department Sample. A total of 3,761,958 ED visits with dental conditions were extracted and the principal diagnosis was identified. A series of modified Poisson regression models were used to assess the relationship between patient sociodemographic factors and hospital characteristics, and the likelihood of visiting the ED for a nontraumatic dental reason. Unadjusted descriptive results indicated that there was no apparent increase in the percentage of patients who visited an ED with nontraumatic dental conditions (NTDCs) between 2007 and 2014. The greatest users of EDs for NTDCs were among those who were uninsured and Medicaid beneficiaries relative to persons privately insured. ED visitors were more likely to reside in lower socioeconomic areas (when compared with visitors in the top quartile of the income distribution). Patients in all other age groups were more likely to seek care in an ED for NTDCs relative to those 65 years of age or older. Multiple strategies are required to reduce the use of EDs for routine dental care. This approach will require an interprofessional dialogue and solutions that reduce barriers to receiving dental care.
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Affiliation(s)
- Pearl C Kim
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA.
| | - Wenlian Zhou
- Department of Dental Medicine, School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA.
| | - Shawn J McCoy
- Department of Economics, Lee Business School, University of Nevada, Las Vegas, NV 89154, USA.
| | - Ian K McDonough
- Department of Economics, Lee Business School, University of Nevada, Las Vegas, NV 89154, USA.
| | - Betty Burston
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA.
| | - Marcia Ditmyer
- Department of Dental Medicine, School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA.
| | - Jay J Shen
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA.
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9
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Ranade A, Young GJ, Garcia R, Griffith J, Singhal A, McGuire J. Emergency department revisits for nontraumatic dental conditions in Massachusetts. J Am Dent Assoc 2019; 150:656-663. [PMID: 31235066 DOI: 10.1016/j.adaj.2019.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/15/2019] [Accepted: 03/17/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Inadequate access to oral health care and palliative care provided in the emergency department (ED) creates a pattern of repeat nontraumatic dental condition (NTDC) ED visits. The authors examined NTDC ED revisits and assessed the determinants associated with these visits in Massachusetts. METHODS The authors examined NTDC ED revisits in Massachusetts during 2013 using the Massachusetts All-Payer Claims Database. The authors report patient characteristics of those who made a single NTDC ED visit and of those who made NTDC ED revisits within 30 days of the index NTDC ED visit. The authors used a multilevel logistic regression model to examine the determinants associated with NTDC ED repeat visits. RESULTS In 2013, 21.5% of NTDC ED visits were revisits. Men from 26 through 35 years of age who were enrolled in Medicaid and who did not make an outpatient dental office visit within 30 days of the index NTDC ED visit had increased odds of repeat visits. CONCLUSIONS The sizable proportion of NTDC ED repeat visits indicates that certain patients in Massachusetts experience consistent and systematic barriers in accessing appropriate and timely oral health care. PRACTICAL IMPLICATIONS Prioritizing young adults and Medicaid enrollees for ED diversion programs and setting up a formal referral process via connecting patients to dental offices and community health centers after an NTDC ED visit may reduce NTDC ED revisits and provide appropriate oral health care to these patients.
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10
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Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness. Am J Prev Med 2018; 55:470-479. [PMID: 30126670 DOI: 10.1016/j.amepre.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/31/2018] [Accepted: 05/02/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable. Individuals with mental illness experience multiple risk factors for poor oral health and need targeted intervention. This study investigated experiences of Kansas Medicaid enrollees with serious mental illness in accessing dental services, examined their oral health risk factors, and identified oral health needs and outcomes. METHODS Survey data were collected from October 2016 through February 2017 from 186 individuals in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively (descriptive and bivariate statistics) and qualitatively (for major themes). RESULTS Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived need, uncertainty about coverage, difficulty accessing providers, fear of the dentist, and transportation issues. High rates of comorbid physical health conditions, including diabetes and cardiovascular disease, and current or former tobacco use were also observed. CONCLUSIONS Medicaid dental benefits that cover only dental cleanings and low levels of oral health knowledge create barriers to utilizing needed preventive dental care. Lack of perceived need for preventive dental services and lack of contact with dentists necessitates the development of targeted oral health promotion efforts that speak to the specific needs of this group and are disseminated in locations of frequent contact. The Medicaid population with serious mental illness would be an ideal group to target for the integration of chronic oral, physical, and mental health prevention services and control.
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11
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Strane D, Griffis HM. Inaccuracies in the 2020 Census Enumeration Could Create a Misalignment Between States' Needs. Am J Public Health 2018; 108:1330-1333. [PMID: 30138064 DOI: 10.2105/ajph.2018.304569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
As the most accurate reflection of the United States population, the US decennial census is vital to health policymakers and others at all levels of government. Competing priorities related to cost containment and the introduction of new reforms raise concerns about the resources available to the US Census Bureau to conduct an accurate population enumeration in 2020. We examined the state of the Census Bureau's preparations for the 2020 Census and how inaccuracies in the coming census enumeration could influence public health and health equity in the coming decade. The results of the 2020 Census will be used to allocate trillions of dollars in federal funding to states, including support for programs vital to public health such as Medicaid and the Special Supplemental Nutrition Program for Women, Infants, and Children. Inaccuracies in the census enumeration could create a misalignment between states' needs and allocation of federal resources. Also, a census miscount of the population could create challenges for public health surveillance and research activities that inform public health policies and interventions.
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Affiliation(s)
- Douglas Strane
- Douglas Strane is with PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA. Heather M. Griffis is with PolicyLab and the Healthcare Analytics Unit, Children's Hospital of Philadelphia
| | - Heather M Griffis
- Douglas Strane is with PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA. Heather M. Griffis is with PolicyLab and the Healthcare Analytics Unit, Children's Hospital of Philadelphia
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12
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Okunseri C. Limiting Dental Benefits May Lead to Hospital Emergency Department Visits for Nontraumatic Dental Conditions. J Evid Based Dent Pract 2018; 18:185-186. [DOI: 10.1016/j.jebdp.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Alhajji D, Amaral Mendes R. Global health challenges in treating an elderly institutionalised patient: an oral medicine perspective. BMJ Case Rep 2017; 2017:bcr-2017-221539. [PMID: 29103008 DOI: 10.1136/bcr-2017-221539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 64-year-old institutionalised woman presented to our clinic for the management of black hairy tongue. Despite the predictable outcome in treating this disease, this case presents multiple challenges such as the patients' cognitive impairment, her family dynamics, social factors and the health system as a whole, that makes it difficult to treat.
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Affiliation(s)
- Dalal Alhajji
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, USA
| | - Rui Amaral Mendes
- Adjunct Professor, Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, USA.,Centre for Research in Higher Education Policies, University of Porto, Porto, Portugal
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14
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Baicker K, Allen HL, Wright BJ, Taubman SL, Finkelstein AN. The Effect of Medicaid on Dental Care of Poor Adults: Evidence from the Oregon Health Insurance Experiment. Health Serv Res 2017; 53:2147-2164. [PMID: 28884818 DOI: 10.1111/1475-6773.12757] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations. DATA SOURCES Primary and secondary data on health care use and outcomes for participants in Oregon's 2008 Medicaid lottery. STUDY DESIGN We used the lottery's random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care. DATA COLLECTION Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229). Emergency department (ED) records were matched to lottery participants in Portland (N = 24,646). PRINCIPAL FINDINGS Medicaid coverage significantly reduced the share of respondents who reported needing dental care (-9.8 percentage points, p < .001) or having unmet dental care needs (-13.5 percentage points, p < 0.001). Medicaid doubled the share visiting the ED for dental care (+2.6 percentage points, p = .003) and the use of anti-infective medications often prescribed for dental care, but it had no detectable effect on uncovered dental care or out-of-pocket spending. CONCLUSIONS Expansion of Medicaid covering emergency dental care substantially reduced unmet need for dental care, increasing ED dental visits and medication use, while not changing patient use of uncovered dental services.
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Affiliation(s)
- Katherine Baicker
- Harris School of Public Policy, University of Chicago, Chicago, IL.,National Bureau of Economic Research, Cambridge, MA.,Jameel Poverty Action Lab, Cambridge, MA.,Harvard T. H. Chan School of Public Health, Boston, MA
| | - Heidi L Allen
- School of Social Work, Columbia University, New York, NY
| | - Bill J Wright
- Center for Outcomes Research and Education, Providence Health and Services, Portland, OR
| | | | - Amy N Finkelstein
- National Bureau of Economic Research, Cambridge, MA.,Jameel Poverty Action Lab, Cambridge, MA.,Massachusetts Institute of Technology, Cambridge, MA
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15
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Mohamed A, Alhanti B, McCullough M, Goodin K, Roling K, Glickman L. Temporal association of implementation of the Arizona Health Care Cost Containment System (AHCCCS) with changes in dental-related emergency department visits in Maricopa County from 2006 to 2012. J Public Health Dent 2017; 78:49-55. [DOI: 10.1111/jphd.12238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 06/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Kate Goodin
- Public Health, Maricopa County; Phoenix AZ USA
| | - Kirsten Roling
- California Oral Health Coalition for the Aging & Developmentally Disabled; San Diego CA USA
| | - Larry Glickman
- Comparative Pathobiology; Purdue University College of Veterinary Medicine; West Lafayette IN USA
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16
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Northridge ME, Estrada I, Schrimshaw EW, Greenblatt AP, Metcalf SS, Kunzel C. Racial/Ethnic Minority Older Adults' Perspectives on Proposed Medicaid Reforms' Effects on Dental Care Access. Am J Public Health 2017. [PMID: 28640674 DOI: 10.2105/ajph.2016.303640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
To examine how proposed Medicaid reform plans are experienced by racial/ethnic minority older adults and what the implications are for their ability to access dental care through Medicaid, from 2013 to 2015 we conducted focus groups in northern Manhattan, New York, New York, among African American, Dominican, and Puerto Rican adults aged 50 years and older. Participants reported problems with affording copayments for care, complicated health and social issues, the need for vision and dental care close to home, and confusion about and stigmatization with Medicaid coverage. Federal, state, and local public health agencies can help by clarifying and simplifying Medicaid plans and sustaining benefits that older adults need to live healthy and dignified lives.
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Affiliation(s)
- Mary E Northridge
- Mary E. Northridge and Ariel P. Greenblatt are with the Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York. Ivette Estrada and Carol Kunzel are with the Section of Population Oral Health, Columbia University College of Dental Medicine, New York. Eric W. Schrimshaw is with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York. Sara S. Metcalf is with the Department of Geography, State University of New York, Buffalo
| | - Ivette Estrada
- Mary E. Northridge and Ariel P. Greenblatt are with the Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York. Ivette Estrada and Carol Kunzel are with the Section of Population Oral Health, Columbia University College of Dental Medicine, New York. Eric W. Schrimshaw is with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York. Sara S. Metcalf is with the Department of Geography, State University of New York, Buffalo
| | - Eric W Schrimshaw
- Mary E. Northridge and Ariel P. Greenblatt are with the Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York. Ivette Estrada and Carol Kunzel are with the Section of Population Oral Health, Columbia University College of Dental Medicine, New York. Eric W. Schrimshaw is with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York. Sara S. Metcalf is with the Department of Geography, State University of New York, Buffalo
| | - Ariel P Greenblatt
- Mary E. Northridge and Ariel P. Greenblatt are with the Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York. Ivette Estrada and Carol Kunzel are with the Section of Population Oral Health, Columbia University College of Dental Medicine, New York. Eric W. Schrimshaw is with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York. Sara S. Metcalf is with the Department of Geography, State University of New York, Buffalo
| | - Sara S Metcalf
- Mary E. Northridge and Ariel P. Greenblatt are with the Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York. Ivette Estrada and Carol Kunzel are with the Section of Population Oral Health, Columbia University College of Dental Medicine, New York. Eric W. Schrimshaw is with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York. Sara S. Metcalf is with the Department of Geography, State University of New York, Buffalo
| | - Carol Kunzel
- Mary E. Northridge and Ariel P. Greenblatt are with the Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York. Ivette Estrada and Carol Kunzel are with the Section of Population Oral Health, Columbia University College of Dental Medicine, New York. Eric W. Schrimshaw is with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York. Sara S. Metcalf is with the Department of Geography, State University of New York, Buffalo
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17
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Laniado N, Badner VM, Silver EJ. Expanded Medicaid dental coverage under the Affordable Care Act: an analysis of Minnesota emergency department visits. J Public Health Dent 2017; 77:344-349. [DOI: 10.1111/jphd.12214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 02/04/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nadia Laniado
- Department of Dentistry, Jacobi Medical Center; Albert Einstein College of Medicine, Bronx; NY USA
| | - Victor M. Badner
- Department of Dentistry, Jacobi Medical Center; Albert Einstein College of Medicine, Bronx; NY USA
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Visits to US emergency departments by 20- to 29-year-olds with toothache during 2001-2010. J Am Dent Assoc 2016; 146:295-302.e2. [PMID: 25925521 DOI: 10.1016/j.adaj.2015.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/02/2015] [Accepted: 01/11/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Visits to emergency departments (EDs) for dental symptoms are on the rise, yet reliance on EDs for dental care is far from ideal. ED toothache visits represent opportunities to improve access to professional dental care. METHODS This research focuses on 20- to 29-year-olds, who account for more ED toothache visits than do other age groups. The authors analyzed publicly available ED visit data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 through 2010. They assessed trends in ED toothache visit rates compared with back pain and all cause ED visits during the past decade. The authors used NHAMCS data for years 2009 and 2010 to characterize the more recent magnitude, relative frequency, and independent risk factors for ED toothache visits. Statistical analyses accounted for the complex sampling design. RESULTS The average annual increase in ED visit rates among 20- to 29-year-olds during 2001-2010 was 6.1% for toothache, 0.3% for back pain, and 0.8% for all causes of ED visits. In 2009 and 2010, 20- to 29-year-olds made an estimated 1.27 million ED visits for toothaches and accounted for 42% of all ED toothache visits. Toothache was the fifth most common reason for any ED visit and third most common for uninsured ED visits by 20- to 29-year-olds. Independent risk factors for ED toothache visits were being uninsured or Medicaid-insured. CONCLUSIONS Younger adults increasingly rely on EDs for toothaches-likely because of barriers to accessing professional dental care. Expanding dental coverage and access to affordable dental care could increase options for timely dental care and decrease ED use for dental symptoms. PRACTICAL IMPLICATIONS Though additional research is needed to better understand why younger adults disproportionately use the ED for toothaches, findings from this study suggest the importance of maintaining access to a dental home from childhood through adolescence and subsequently into early adulthood.
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Salomon D, Heidel RE, Kolokythas A, Miloro M, Schlieve T. Does Restriction of Public Health Care Dental Benefits Affect the Volume, Severity, or Cost of Dental-Related Hospital Visits? J Oral Maxillofac Surg 2016; 75:467-474. [PMID: 27875708 DOI: 10.1016/j.joms.2016.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital. MATERIALS AND METHODS A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed. Data were collected using related International Classification of Diseases, Ninth Revision codes from January 1, 2011 through December 31, 2013 and divided into 2 cohorts over consecutive 18-month periods. Outcome variables included age, gender, insurance status, oral and maxillofacial surgery (OMS) consultation, imaging, treatment, treatment location, number of hospital admission days, and inpatient care level. Severity was determined by the presence of OMS consultation, incision and drainage, hospital admission, and cost per encounter. Hospital charges were used to compare the cost of care between cohorts. Between-patients statistics were used to compare risk factors and outcomes between cohorts. RESULTS Of 5,192 encounters identified, 1,405 met the inclusion criteria. There were no significant differences between cohorts for age (P = .28) or gender (P = .43). After passage of the SMART Act, emergency department visits increased 48%, surgical intervention increased 100%, and hospital admission days increased 128%. Patients were more likely to have an OMS consult (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.11-1.81), an incision and drainage (OR = 1.48; 95% CI, 1.13-1.94), and a longer hospital admission (P = .04). The average cost per encounter increased by 20% and the total cost of care increased by $1.6 million. CONCLUSION After limitation of dental benefits, there was an increase in the volume and severity of odontogenic infections. In addition, there was an escalated health care cost. The negative public health effects and increased economic impact of eliminating basic dental care show the importance of affordable and accessible preventative oral health care.
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Affiliation(s)
- David Salomon
- Resident, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL
| | - R Eric Heidel
- Assistant Professor of Biostatistics, Department of Surgery, Office of Medical Education, Research, and Development, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Antonia Kolokythas
- Department Chair, Department of Oral and Maxillofacial Surgery, University of Rochester Medical Center, Rochester, NY
| | - Michael Miloro
- Department Head and Professor, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL
| | - Thomas Schlieve
- Assistant Professor, Department of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, TX.
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Northridge ME. Dental Benefits: "Because Medicaid Has, How Do You Call It? A Limit". Am J Public Health 2016; 106:1726-8. [PMID: 27626333 DOI: 10.2105/ajph.2016.303295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mary E Northridge
- Mary E. Northridge is AJPH editor emerita and Associate Professor, Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY
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Zhang Y. Racial/Ethnic Disparity in Utilization of General Dental Care Services Among US Adults: Medical Expenditure Panel Survey 2012. J Racial Ethn Health Disparities 2015; 3:565-572. [PMID: 27294750 DOI: 10.1007/s40615-015-0175-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of this study was to examine racial/ethnic disparity and associated factors in general dental care utilization among US adults. METHODS Data were adults 18-85 years old (N = 27,394) from the 2012 Medical Expenditure Panel Survey (MEPS). The outcome was the receipt of general dental care, measured by (1) whether the individual has ever had a general dental visit and (2) the number of general dental visits the individual has had during the past year. Race/ethnicity was the primary interest. Logistic regressions and negative binomial regressions were conducted using STATA version 12 to assess the effect of race/ethnicity on the receipt of general dental care both independently and adjusted for other demographic and socioeconomic factors. RESULTS Non-Hispanic blacks (odds ratio (OR) 0.39, 95 % confidence intervals (CI) 0.37-0.43), Hispanics (0.34, 0.43-0.37), and other minorities (0.61, 0.56-0.68) were less likely to report general dental visits both independently and adjusted for other demographic and socioeconomic factors, compared with non-Hispanic whites. General dental visits were more likely to be observed among individuals who were female, married, native speakers, living in a metropolitan statistical area, and with dental insurance, and the number of visits was increasing with age, educational level, and family income. CONCLUSION The race/ethnicity disparity in the utilization of general dental care still existed. Policy makers and dental care providers should promote dental insurance coverage and language support programs, and increase the diversity of dental professionals among minorities to encourage their visits to dentists.
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Affiliation(s)
- Yefei Zhang
- University of Texas Health Science Center at Houston, Houston, TX, USA.
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